Indonesia’s New Strategy to Eliminate Cervical Cancer by 2030
Indonesia is embarking on a bold public health initiative to eliminate cervical cancer as a major threat to women’s health by 2030. Central to this effort is the nationwide rollout of DNA-based testing for cervical cancer, a move that aligns with global best practices and the World Health Organization’s (WHO) targets. The government’s plan aims to dramatically improve early detection, increase vaccination rates, and ensure timely treatment, addressing a disease that remains the second most common cancer among Indonesian women.
Why Cervical Cancer Remains a Major Health Challenge in Indonesia
Cervical cancer is primarily caused by persistent infection with high-risk types of the human papillomavirus (HPV), a virus transmitted through sexual contact. According to the International Agency for Research on Cancer (IARC), Indonesia reported approximately 36,000 new cases and 21,000 deaths from cervical cancer in 2022, making it the second most common cancer among women after breast cancer. The country’s age-standardized incidence and mortality rates for cervical cancer are among the highest in Southeast Asia, with a significant proportion of cases diagnosed at advanced stages when treatment is less effective.
Several factors contribute to this high burden:
- Low screening rates: In 2020, less than 10% of women aged 30-50 underwent available free screenings.
- Late diagnosis: About 70% of cervical cancer cases are detected at advanced stages.
- Barriers to screening: These include low public awareness, cultural taboos, discomfort with internal examinations, and lack of family support, especially from husbands.
- Limited access to advanced screening methods: Most health facilities have relied on visual inspection with acetic acid (VIA), a method that, while affordable and accessible, is less sensitive than modern alternatives.
These challenges are compounded by Indonesia’s vast geography, disparities in healthcare access between urban and rural areas, and socioeconomic factors that limit women’s ability to seek preventive care.
From VIA to DNA: The Shift in Screening Technology
For years, Indonesia’s primary method for cervical cancer screening has been VIA, a simple and low-cost test where acetic acid is applied to the cervix and healthcare workers visually inspect for abnormal changes. While VIA is easy to deploy, especially in rural settings, it has limitations in sensitivity and specificity, leading to missed cases or unnecessary follow-ups.
Recognizing these limitations, the Indonesian Ministry of Health is now moving to implement HPV DNA testing as the primary screening tool for women aged 30 to 69. This method detects the presence of high-risk HPV DNA in cervical samples, identifying women at risk before cellular changes or cancer develop. The new approach will combine VIA and DNA testing (co-testing), which is considered more accurate and effective in early detection and prevention.
Siti Nadia Tarmizi, Director of Noncommunicable Diseases Prevention and Control at the Ministry of Health, explained at a recent press briefing:
“We will begin to roll out HPV DNA co-testing with VIA nationwide starting in 2025.”
This decision follows successful pilot programs in Greater Jakarta and an expansion to 25 regencies and cities across 16 provinces in 2024. Early results show that about 2.5% of women screened with the co-testing method were found to have HPV infections, underscoring the importance of more sensitive screening tools.
How DNA-Based Screening Works and Why It Matters
HPV DNA testing is a molecular diagnostic technique that identifies the genetic material of high-risk HPV types in cervical samples. Unlike VIA or Pap smears, which rely on visual or cytological changes, DNA testing can detect infections before any visible or microscopic abnormalities appear. This allows for earlier intervention and reduces the risk of progression to cancer.
Key advantages of HPV DNA testing include:
- Higher sensitivity and specificity: It is more accurate in detecting women at risk, reducing false negatives and unnecessary treatments.
- Longer screening intervals: A negative HPV DNA test provides reassurance for up to 5-10 years, compared to 3 years for Pap smears.
- Potential for self-sampling: Innovations such as urine-based or self-collected vaginal samples can make screening more accessible and less invasive, addressing cultural and logistical barriers.
These benefits are particularly important in Indonesia, where many women are reluctant to undergo pelvic exams due to discomfort, embarrassment, or social stigma. By offering less invasive options and more accurate results, the new screening strategy aims to boost participation and catch disease earlier.
Aligning with Global and Regional Targets
Indonesia’s cervical cancer elimination efforts are closely aligned with the WHO’s 90-70-90 targets for 2030:
- 90% of girls fully vaccinated against HPV by age 15
- 70% of women screened with a high-performance test by ages 35 and 45
- 90% of women with pre-cancer treated and those with invasive cancer managed
These targets are part of a global strategy to reduce cervical cancer incidence to below 4 per 100,000 women. Indonesia’s National Cervical Cancer Elimination Plan (2023-2030) and the broader National Cancer Action Plan (2024-2034) both prioritize these goals, with a focus on expanding screening, vaccination, and treatment services nationwide.
Expanding HPV Vaccination: Protecting the Next Generation
Vaccination against HPV is the most effective way to prevent cervical cancer. Indonesia introduced HPV immunization in 2016, initially targeting girls in select cities. In 2023, the program was expanded nationally for girls aged 11-12 (fifth and sixth grade) through the School Children Immunization Month (BIAS) program. The two-dose vaccination coverage has already surpassed 90%, with nearly 2 million girls immunized out of a 2.15 million target.
Building on this success, the government plans to:
- Introduce a single-dose HPV vaccine for fifth-grade girls, following WHO recommendations that a single dose offers comparable protection to two doses.
- Provide catch-up immunization for girls under 15 who missed earlier doses.
- Expand vaccination to boys, potentially as early as 2026, to accelerate progress toward herd immunity and reduce HPV transmission.
Dr. N. Paranietharan, WHO Representative to Indonesia, praised these efforts:
“Indonesia’s national HPV vaccine rollout represents a significant commitment to public health and gender equity. The single-dose schedule will bring greater efficiency, lower costs and accelerate protection for Indonesian girls and women, advancing our shared goal of eliminating cervical cancer.”
Barriers to Screening and Vaccination: Cultural, Social, and Economic Factors
Despite these advances, Indonesia faces persistent barriers to achieving high screening and vaccination coverage. Studies and surveys highlight several key challenges:
- Low awareness and knowledge: Many women and families lack information about HPV, cervical cancer, and the benefits of screening and vaccination.
- Cultural taboos and stigma: Internal examinations are often viewed as embarrassing or inappropriate, and discussing sexual health remains sensitive in many communities.
- Lack of family support: Women often need encouragement from husbands or family members to seek preventive care.
- Economic barriers: While government programs offer free screening and vaccination, out-of-pocket costs for follow-up care or private services can be prohibitive, especially for low-income families.
- Healthcare system limitations: Shortages of trained healthcare workers, limited laboratory capacity, and uneven distribution of services between urban and rural areas hinder access.
Research in urban Jakarta found that while attitudes toward prevention are generally positive, actual practices lag behind. Only about 30% of women reported favorable preventive behaviors, and vaccination uptake remains low outside government programs. Socio-demographic factors such as education, income, and parental support—especially from mothers—play a critical role in shaping knowledge, attitudes, and practices.
Innovations and Partnerships: Making Screening More Accessible
To overcome these barriers, Indonesia is leveraging technological innovations and partnerships with local biotechnology companies. For example, Nusantics, an Indonesian biotech firm, has developed the PathoScan hrHPV qPCR Kit, which can detect 14 high-risk HPV types with high sensitivity. The company is also piloting urine-based HPV DNA tests, offering a less invasive alternative for women uncomfortable with traditional sampling methods.
Other innovations include the use of artificial intelligence (AI) tools like Cerviray A.I., which can assist healthcare workers in interpreting screening results and provide telemedicine support for remote consultations. While these technologies are still being evaluated, they hold promise for expanding access and improving diagnostic accuracy, especially in underserved areas.
Integrating Screening into Broader Health Programs
Indonesia’s strategy also involves integrating cervical cancer screening into broader health initiatives. For example, the new DNA-based screening will be included in President Prabowo Subianto’s flagship free birthday checkups, making it part of routine preventive care for women aged 30-69. The Ministry of Health is also repurposing laboratory equipment from the COVID-19 response, such as RT-PCR and GeneXpert machines, to support HPV testing.
These efforts are supported by international organizations like WHO and UNFPA, which provide technical assistance, training for healthcare workers, and guidance on evidence-based protocols. The government’s National Cancer Action Plan also emphasizes strengthening health infrastructure, expanding partnerships, and ensuring equitable access to services across the country.
Regional and Global Context: How Indonesia Compares
Indonesia’s approach reflects a broader shift across Asia and other low- and middle-income countries (LMICs) toward more effective cervical cancer prevention. According to a review by The Lancet, only a handful of Asian countries have achieved high HPV vaccination and screening coverage, and most still rely on VIA or cytology rather than DNA-based tests. Barriers such as affordability, supply shortages, and lack of awareness are common across the region.
However, Indonesia’s commitment to the WHO’s 90-70-90 targets, its rapid expansion of vaccination programs, and its adoption of high-performance screening methods place it among the regional leaders in cervical cancer elimination efforts. The country’s experience also highlights the importance of political will, multisectoral partnerships, and community engagement in overcoming persistent challenges.
Looking Ahead: Challenges and Opportunities
While Indonesia’s plans are ambitious, several challenges remain:
- Scaling up laboratory capacity: Ensuring that HPV DNA testing is available and affordable nationwide, including in remote and rural areas.
- Training and retaining healthcare workers: Building a skilled workforce to deliver screening, vaccination, and follow-up care.
- Addressing social and cultural barriers: Sustained public education campaigns and community engagement are needed to change attitudes and encourage participation.
- Ensuring sustainability: Long-term funding, robust surveillance systems, and integration with universal health coverage are essential for maintaining progress.
Opportunities for innovation—such as self-sampling, AI-assisted diagnostics, and digital health platforms—can help bridge gaps in access and quality. Partnerships with local industry, civil society, and international agencies will be critical to achieving the 2030 elimination goal.
In Summary
- Indonesia is rolling out nationwide HPV DNA-based cervical cancer screening for women aged 30-69, starting in 2025, to meet the goal of eliminating cervical cancer by 2030.
- The new screening strategy combines VIA and DNA testing, offering higher accuracy and the potential for less invasive, self-sampling methods.
- HPV vaccination coverage among girls has surpassed 90%, with plans to expand to boys and adopt a single-dose schedule for greater efficiency.
- Barriers to screening and vaccination include low awareness, cultural taboos, economic constraints, and healthcare system limitations.
- Innovations in diagnostics, integration with broader health programs, and strong political commitment are driving progress.
- Indonesia’s efforts align with WHO’s 90-70-90 targets and set an example for other countries in the region.
- Continued investment, community engagement, and multisectoral partnerships are essential to sustain momentum and achieve the vision of a cervical cancer-free future for Indonesian women.
