Table 3.

Some of the challenges and potential solutions to implementing WHO interventional targets to achieve cervical cancer elimination. Bold type highlights areas in need of additional research.

HPV Vaccination		Challenge	Potential Solution (s)
	Financial	Cost of vaccines.	One-dose HPV vaccination. Expand GAVI eligibility and include Gardasil-9. Use lower cost biosimilars.
	Technical/Logistical	Lack of adolescent health platform.	Develop adolescent health platform. Include HPV vaccination of infants WHO EPI vaccine schedule.
	Human Capacity	Expand the providers who can provide HPV vaccination.	Training and certification of community health workers to vaccinate.
	Infrastructure	Cold chain for vaccine delivery.	Develop cold-chain infrastructure. Develop temperature-resistant VLP vaccine.
HPV Testing-Based Screening		Challenge	Potential Solution(s)
	Financial	Test cost.	Development of low-cost testing technology. Establish a global procurement strategy for laboratory tests and testing.
		Cost of disposables (pipet tips, PPE, etc.).	Tests that require minimal specimen handling and processing. Global procurement strategy for laboratory tests and testing.
	Technical/logistical	Getting the specimen to the HPV test.	Development and validation point-of-care or near point-of-care HPV tests. Use pre-existing or develop specimen courier networks to transport specimens to central testing laboratory.
		Management of HPV-positive women.	Develop and validate deep learning algorithms for image analysis to distinguish those with and without cervical pre-cancer. Develop a robust methylation assay that works from a self-collected specimen.
	Human capacity	Number of trained technicians,	Expand training and retention of laboratory technicians; develop assays that require minimal training.
	Infrastructure	Lack of qualified labs with “clean rooms” for PCR-based testing.	Develop assays that do not require PCR safe testing environments.
	Other
Management/Treatment of Precursors		Challenge	Potential Solution (s)
	Human capacity	Limited capacity for gynecologic services including colposcopy and treatment of precursors.	Increase gynecology training. Develop pan-HPV Therapeutics
		Limited capacity for pathology.	Screen and treat; screen, triage (non-pathology methods), and treat. Develop an AI-based digital pathology platform. Increase human capacity in histotechnology and pathology.
	Infrastructure	Lack of clinics to provide services.	Mobile clinics.
Cancer Treatment, Management, and Care
	Financial	Cost of treatment.	Subsidized care based on ability to pay.
	Technical/logistical	Long distances to reach health care facilities with cancer care capacities.	Dedicated transportation for cancer care.
	Human capacity	Lack of gynecologic oncologists. Lack of radiation oncologists and technologists. Lack of pathologists.	Training and mentoring programs for staffing of gynecologic oncology, radiation oncology, and pathology services.
	Infrastructure	Lack of LINACs. Lack of brachytherapy.	Place more LINACs. Increase availability of brachytherapy. Validate the use of neoadjuvant therapy and surgery.
	Policy	Access to and acceptance of morphine/opioids for pain management [218].	Policy changes and de-regulation of morphine/opioids. Education and training on their use and abuse.