# A delivery-science moonshot for prevention we already own

Source: https://onco.cc/ideas/idea-fund-prevention-moonshot/  
OnCo record `idea-fund-prevention-moonshot` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Around four in ten cancers are preventable with tools that exist now. This would fund the hard, unglamorous work of getting vaccines, screening and tobacco control to everyone, paid on results.

## Summary

An ARPA-style programme, but for implementation: it funds and rigorously evaluates ways to reach 90% HPV and hepatitis B vaccine coverage, H. pylori test-and-treat in high-incidence populations, tobacco cessation embedded in lung screening, and alcohol and obesity policy trials. Payments are milestone- and outcome-based (coverage achieved, quitters verified) rather than for papers. The scientific content is behavioural economics, health-systems engineering and policy evaluation, which conventional cancer funders rarely score well.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: A prevention-delivery programme funded at 5% of a national cancer research budget, paying on verified coverage outcomes, lifts HPV vaccine completion and lung-screening uptake in target populations by at least 15 percentage points within five years, at a cost per life-year saved below that of any recently approved oncology drug.
- Rationale: Modelling for the WHO cervical cancer elimination strategy shows vaccination plus screening eliminates a cancer within a lifetime; the constraint is delivery, not knowledge. Outcome-based funding has moved coverage in vaccination (Gavi performance-based financing) and in tuberculosis case-finding.
- Proposed test: Cluster-randomised implementation trials in three regions comparing outcome-paid delivery contracts with standard grant funding for HPV catch-up and lung screening, measuring coverage and cost per additional person covered after two years.
- Maturity: speculative
- Actor: policy

## Sources

- WHO cervical cancer elimination initiative: https://www.who.int/initiatives/cervical-cancer-elimination-initiative
- ARPA-H: https://arpa-h.gov/

## Connected records

- ideas: [Social impact bonds for cancer prevention, repaid from avoided treatment costs](https://onco.cc/ideas/idea-fund-social-impact-bonds-prevention/)
- cancers: [Cervical cancer](https://onco.cc/cancers/cervical/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Hepatocellular carcinoma](https://onco.cc/cancers/hcc/), [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- technologies: [AI in radiology](https://onco.cc/technologies/radiology-ai-screening/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [HPV & HBV vaccination](https://onco.cc/technologies/hpv-vaccine/)
- bottlenecks: [Funding follows fashion, not burden](https://onco.cc/bottlenecks/b-funding-allocation/), [Prevention we already have is not deployed](https://onco.cc/bottlenecks/b-prevention-adoption/)
- key papers: [IARC verdict: excess body fat causes 13 cancers](https://onco.cc/key-papers/paper-body-fatness-iarc-nejm-2016/)

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