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Research Article: COVID-19 vaccination rates as a proxy for health system resilience: implications of development disparities for cervical cancer control during the pandemic

Date Published: 2026-07-24

Abstract:
To assess COVID-19’s impact on global cervical cancer burden and examine how COVID-19 vaccination rates and Human Development Index (HDI) interact to shape disease trends, with exploratory projections to 2050. Using Global Burden of Disease 2023 data (1990–2023), we analyzed age-standardized incidence (ASIR) and disability-adjusted life-year (DALY) rate of cervical cancer. Joinpoint regression estimated annual percentage changes (EAPC) for pre-pandemic (1990–2019) and pandemic (2020–2023) periods. Linear and interaction models assessed associations between HDI, COVID-19 vaccination rates, and EAPC, with bidirectional stratified analyses. Projections to 2050 were generated under three exploratory scenarios. The pandemic coincided with a reversal of the pre-pandemic declining trend in cervical cancer burden indicators. Global ASIR increased 6.0% ( p =?0.031), with EAPC shifting from ?0.41%/year ( p <?0.001) to 3.93%/year ( p =?0.008). Low-SDI regions experienced the sharpest rise (ASIR 18.6%). EAPC showed a significant negative association with HDI ( ? =??15.4, p <?0.001). The interaction term was positive ( ? =?36.1, p <?0.001, ? R 2 =?6.4%). Bidirectional stratification revealed divergent patterns. In low-HDI countries, higher vaccination coincided with lower EAPC ( ? =??7.15, p =?0.005). In high-HDI countries, a positive association emerged ( ? =?6.53, p <?0.001). HDI effects attenuated across vaccination quartiles: strong negative associations in low-vaccination contexts (Q1: ? =??29.06, R 2 =?39.7%) to non-significance in high-vaccination settings (Q4: ? =??4.97, p =?0.244). Under current trends, low-SDI regions would achieve WHO 90–70-90 targets ~10–12?years behind high-SDI regions. COVID-19 vaccination rate shows context-dependent associations with cervical cancer burden: stronger negative associations in low-HDI settings and positive associations in high-HDI settings. These findings support dual-purpose investments in emergency infrastructure for pandemic preparedness and cancer control.

Introduction:
Cervical cancer ranks fourth among cancers in women worldwide ( 1 ). In 2022, there were approximately 660,000 new cases and 350,000 deaths, with 90% occurring in low-and middle-income countries ( 2 ). The disease is largely preventable through HPV vaccination, screening, and early treatment ( 3 ). In 2020, the World Health Organization (WHO) launched the “Global Strategy to Accelerate the Elimination of Cervical Cancer” ( 4 ). The strategy sets 90–70-90 targets to be achieved by 2030: 90% HPV vaccination, 70%…

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