July 15, 2024
📰 FEATURE STORY
Should India go ahead with its cervical cancer vaccine programme?
It’s an almost entirely preventable disease, yet cervical cancer kills one woman every seven minutes in India. That’s about 21% of all cervical cancer deaths in the world. That makes it the second-most common cancer in Indian women.
The government is pushing for a comprehensive vaccination effort against the human papillomavirus (HPV), which causes the majority of cervical cancer cases. However, there are doubts about whether a government-sponsored vaccination programme should be the way to go.
Context
When Bill Gates visited India earlier this year, he and Prime Minister Narendra Modi reportedly spoke about a plan to roll out a vaccine against cervical cancer for all girls between 9 and 14 years old. That came on the heels of Finance Minister Nirmala Sitharaman’s interim Budget announcement of something similar.
Globally, there’s an all-out effort to eliminate vaccine-preventable cancer among women. In March, the World Health Organisation and Gavi announced new policies, including nearly $600 million in additional funding to eliminate cervical cancer.
Last year, 1.23 lakh Indian women were diagnosed with cervical cancer, with 80,000 deaths. India bears one-fifth of the global burden of cervical cancer. We also have the highest number of deaths. One of the reasons is the abysmally low screening rates and little awareness about the disease. Most patients are diagnosed during stage 3 or 4. According to some experts, part of the reason is that women’s health is simply not given top priority.
While developed countries have seen a decline in cervical cancer, low and middle-income countries are lagging behind. Poverty is the critical factor. Women diagnosed with cancer in rural and remote areas are often stigmatised, and screening was only recommended in the national guidelines in 2017.
The HPV vaccine isn’t new to India. Two were licensed in 2008 – Gardasil and Cervarix. Studies showed both provide about 90% protection with antibodies stable for at least a decade. However, they weren’t included in the universal immunisation programme. The state governments of Punjab and Sikkim introduced it into their immunisation programmes in 2016. In 2022, India launched a homemade vaccine called Cervavac, developed by the Serum Institute of India (SII).
In her first speech as an MP earlier this month, Sudha Murthy spoke in Parliament about the necessity for a cervical cancer vaccination programme for girls between the ages of 9 and 14. Some social media users criticised her speech, citing previous examples of opaque vaccine trials gone wrong. Should there be a government-sponsored HPV vaccine programme?
VIEW: It’s a necessity
The statistics on cervical cancer in India paint a grim picture. It’s especially bad, given that there are vaccines that can prevent the disease, but most people don’t have access to it. It’s the biggest reason why a government-backed national vaccination programme is necessary. Cervavac from SII has been a long time coming and is the first indigenous HPV vaccine to be approved. It’s also included in the immunisation programme.
Once vaccines become widely available through the government, they will be a game changer. They’ve been proven to be reliable. Estimates show that efforts to scale up vaccination to cover 80-100% of the target population combined with two screenings per lifetime will be a big step forward in eliminating it in the decades ahead.
Having a locally made vaccine for a country as large as India will also help shift global supply. If the vaccine can be provided for the region, the global market dynamics will be drastically better for all countries. Simply put, HPV vaccination is India’s best defence in preventing HPV-related cancers. India has an impressive track record with its childhood immunisation programmes and the recent Covid-19 vaccination campaign.
COUNTERVIEW: Some uncertainties linger
When Sudha Murthy gave her speech in Parliament, some were sceptical, even angry at her suggestion for an HPV vaccination programme. Why? It’s perhaps the bad experiences from vaccine trials in the past. To some, the path to an HPV vaccine is one of greed by pharmaceutical companies and a lack of accountability. For starters, there’s a lack of domestic competing vaccines. Competiting vaccines could’ve put pressure on Cervavac’s price.
There’s a lot of misinformation around reproductive health issues in India, especially in rural areas where access to healthcare is spotty. It’s a significant barrier. There are misplaced cultural beliefs that offering HPV vaccines might lead to an increase in sexual activity. It remains to be seen if India’s public health system is up to the task of eliminating stigmas and increasing awareness about prevention.
HPV vaccine trials in the past haven’t exactly been transparent. In 2007, the Program for Appropriate Technology in Health (PATH), funded by the Bill and Melinda Gates Foundation, conducted human trials for Gardasil and Cervarix. The project was criticised for its execution, lack of patient consent, and including tribal and vulnerable populations. The death of seven girls who got the vaccine didn’t help matters. A Parliamentary panel accused PATH of violating local regulations and being a commercially driven exercise.
Reference Links:
- Homegrown solution to India’s cervical cancer dilemma – ET Health World
- Cervical cancer kills one woman every seven minutes in India – but screening rates are abysmally low – Scroll
- India resolves to reduce cervical cancer by vaccinating girls – Gavi
- Sudha Murthy’s speech in Parliament is what all women want to hear – Times of India
- Barriers to scaling up HPV vaccination in India – Hindustan Times
- Social media slams Sudha Murthy push for cervical cancer vaccine; yet WHO recommends it – The Federal
- Cervical cancer: Big Pharma’s greed-driven unethical games in India – The Federal
What is your opinion on this?
(Only subscribers can participate in polls)
a) India should go ahead with its cervical cancer vaccine programme.
b) India shouldn’t go ahead with its cervical cancer vaccine programme.
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