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

PURPOSE: 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. METHODS: 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. RESULTS: 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 (β = -15.4, p < 0.001). The interaction term was positive (β = 36.1, p < 0.001, ΔR 2 = 6.4%). Bidirectional stratification revealed divergent patterns. In low-HDI countries, higher vaccination coincided with lower EAPC (β = -7.15, p = 0.005). In high-HDI countries, a positive association emerged (β = 6.53, p < 0.001). HDI effects attenuated across vaccination quartiles: strong negative associations in low-vaccination contexts (Q1: β = -29.06, R2 = 39.7%) to non-significance in high-vaccination settings (Q4: β = -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. CONCLUSION: 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.