Cervical Cancer elimination strategy: action plan

Introduction

In 2025, the Scottish Government published its Population Health Framework^[11]. It set out a new vision for health (and healthcare) in Scotland. The plan has two guiding principles. First, that prevention must be at the heart of all aspects of healthcare. Second, that healthcare services alone cannot determine health outcomes, or tackle the inequalities that, for many, are still reflected in access to and effectiveness of healthcare services.

This strategic action plan has been developed in the spirit of that framework. It recognises that our screening programme, vaccination programme and treatment services cannot achieve elimination alone. It will take a concerted, joined-up approach across the whole NHS for a sustained number of years. More than that, it will require us to make space for the voices of third sector organisations, educators, local communities and the groups we most want to reach. We must acknowledge that our efforts so far have not arrested declining uptake, and that new ideas and perspectives are needed to reinvigorate our approach.

Modelling in the final report of the Cervical cancer Elimination in Scotland Expert Group Final Report^[12] indicates that, if we continue as we are, we could potentially eliminate cervical cancer before 2040 for those in the least deprived areas. However, for those in our most deprived areas, elimination might – and probably will – never happen.

That cannot be tolerated. Poverty should not be the defining factor in someone’s health outcomes. We must achieve population-wide elimination by 2040 – for women in all population groups, irrespective of income, ethnicity or disability.

To do this, we must focus relentlessly on vaccines and screening. In Scotland, treatment is already meeting the WHO target of 90% of women treated once cervical disease is identified. This is not to discount treatment challenges, and we continue to take action to improve waiting times. However, we are confident that these can and will be addressed through other work, particularly commitments made in phase two of the Women’s Health Plan^[13]. For this reason, the actions in this plan focus almost entirely on screening and vaccination.

In these areas, we will need to go further than the WHO targets. Screening uptake must instead improve to 90%^[14] both for women living in the areas with highest deprivation, as well as across all age groups. The modelling also suggests HPV vaccine uptake would require to reach 90% equitably, and eligibility for the catch-up vaccine would need to be widened.^[15].

There is no doubt this will require a dramatic turnaround. Inequalities continue to present in multiple ways, driven by poverty, ethnicity, disability, and location. For example, in 2024/25, vaccine coverage ranged from 74.6% in the most deprived areas to 90.7% in the least deprived^[16]. For S1 pupils, coverage ranged from 61.1% in Caribbean or Black ethnic groups to 74.1% in White ethnic groups. And within the White ethnic group there are extremes of inequality: Gypsy/Traveller ethnicity had vaccine coverage of 22.7%, whilst coverage was highest in Irish ethnicity at 85.2%.

In screening, the statistics present a similarly alarming picture. In 2024/25, there was an 11-point gap between the least and most deprived groups^[17]. The highest rates of inequality exist between women aged 50-64^[18], but the gap exists across all age groups. And while robust statistical data does not exist to allow us to quantify the inequalities brought about by disability, ethnicity and geography, we know from patient experiences and qualitative research that all of those factors can and do deter women from taking up their screening invitations^[19].

There are myriad and well-documented reasons for these persistent trends. All of these can, individually or in combination, result in predictable groups of underserved women who are not screened or vaccinated. In some cases, the women who would benefit most from these services are among those least likely to receive them.

For example, extensive research^[20] suggests that women and girls who experience gender-based violence are more likely to have abnormal findings following a cervical screening than the general population, and yet these women face many screening barriers^[21]. Likewise, evidence shows women^[22] are more likely to be at risk from cervical cancer and yet find it difficult to access screening.

To these familiar and longstanding barriers, we now also must add a growing mistrust of institutions and public health messaging. It is important not to overstate these trends, but there is considerable evidence that online misinformation has an impact; this is clearly set out in the Scottish Health Information Integrity Strategy ^[23].

These are the challenges; however, we already have significant work underway to address them. It is not possible to document all the initiatives that will play a part in supporting this work; however, a few are set out below.

Scotland’s 5-year Vaccination and Immunisation Framework and Delivery Plan^[24], published in 2024 aims to deliver a world-leading, person-centred vaccination and immunisation service which is designed and delivered in ways that meet the needs of everyone in society. The Scottish Equity in Screening Strategy^[25] was published in 2023 and details a vision to achieve equity in all six national screening programmes. Finally, the refreshed Digital Health and Care Strategy published in October 2021^[26] made a commitment to develop a fully interactive ‘Digital Front Door’ that could transform how users interact with a range of healthcare services.

This cervical cancer elimination action plan has been created to complement rather than duplicate these efforts; the aim is to bring work together into a cohesive whole and drive additional action only where this is needed.

The plan outlines a three-year programme of work to accelerate progress to 2030^[27] and lay the foundations for population wide elimination by 2040. It has two purposes:

• To set out the long-term transformation required across vaccination, screening, treatment, data and digital infrastructure.
• To take forward immediate, practical actions that will raise uptake now.

Our approach is rooted in five principles:

• Equity — every eligible woman must benefit from prevention.
• Accessibility — services must meet people where they are.
• Sustainability — progress must be maintained to 2040 and beyond.
• Collaboration – true success will hinge on an expanded network of expertise and lived experience, built with those who truly understand the barriers, or have the power to overcome them.
• Innovation – we will look for new and better ways to deliver vital services that will help eliminate cervical cancer.

In the summer, to underpin the actions set out here, we will publish a delivery framework that will commit to clear operational milestones, timelines, and responsibilities for the first year of the plan. The framework will be updated annually thereafter. This will ensure every action in the plan is supported by defined targets and a transparent route to delivery. As with the plan itself, the framework will be driven by the principles set out above, and it will serve as a clear indicator that they are being embedded throughout implementation.