Budget 2024: What is Centre’s plan to vaccinate girls against cervical cancer?

Nirmala Sitharaman in her Budget speech today announced that the Centre is looking at ensuring that young girls are vaccinated against cervical cancer. The development comes a month after the Union Health Ministry said it is closely monitoring incidences of cervical cancer in the country and is in regular touch with states and various health departments. Sitharaman in her interim Budget speech in the Lok Sabha said that the government will encourage vaccination for girls in the age group of 9 to 14 years for the prevention of cervical cancer. “Our government will encourage vaccination for girls in the age group of 9-14 years to prevent cervical cancer,” Sitharaman said. Sitharaman also said the Centre plans to set up more medical colleges and said that it aims to serve the people through improved healthcare services. But what is cervical cancer? How many suffer from it in India? And will the cost of the vaccines go down? Let’s take a closer look: What is it? How many suffer from it? First, let’s briefly examine the cervix. As per Mayo Clinic, the cervix is the lower part of the uterus. It connects to the vagina.

Cervical cancer is thus a growth of cells that begins in the cervix.

Most forms of cervical cancer are caused by the human papillomavirus (HPV). This is a common virus which spreads via sexual contact. While the body’s immune system usually deals with the virus, this is not the case for everyone. In a smaller percentage of people, the virus remains – and thus causes some cervical cells to become cancer cells. As per Indian Express, HPV infections can cause cancers of the anus, vagina and oropharynx in women. According to the website, women can bring down their risk of cervical scanner through regular screenings. They can also take vaccines – which have proved to be safe and effective – to  prevent HPV infection_._ News18 quoted a Scottish study as showing that an HPV vaccine can prevent cervical cancer. The study, by Public Health Scotland, found zero cases of cervical cancer in women vaccinated against HPV., [caption id=“attachment_13060712” align=“alignnone” width=“640”] The WHO recommends that 70 per cent of women undergo screeing for cervical cancer. AP[/caption] The Scottish government in 2008 had carried out an immunisation programme for girls aged 12 to 13. As per Indian Express, more than 100 countries already have HPV immunisation programmes – all of whom have seen cervical cancer cases go down. The newspaper reported that though the vaccines were initially aimed at preventing infections, they were shown to have reduced the incidence of pre-cancerous lesions. The newspaper quoted 2020 and 2021 studies from Sweden and England as showing such a vaccine given during teenage years could bring down the cervical cancer risk by more than 85 per cent by age 30. How many suffer from it in India? India is home to about 16 per cent of the world’s women, but accounts for about a quarter of all cervical cancer incidences and nearly a third of global cervical cancer deaths. Indian women face a 1.6 per cent lifetime cumulative risk of developing cervical cancer and one per cent cumulative death risk from cervical cancer, officials had stated. According to some recent estimates, every year almost 80,000 women develop cervical cancer and 35,000 die due to it in India.

As per The Hindu, just one per cent of women are screened for cervical cancer in India.

This, despite the World Health Organization recommending that at least 70 per cent of women get tested. Little wonder then that News18 quoted data from the Indian government as showing that cervical cancer ranks is the second most prevalent cancer in India. However, there is some good news. A 2023 Lancet Study showed around 52 per cent of cervical cancer cases diagnosed between 2012 and 2015 survived. The analysis was based on data from from Population Based Cancer Registries (PBCRs) across India. Ahmedabad’s urban PBCR had a higher survival rate of 61.5 per cent followed by Thiruvananthapuram (58.8 per cent) and Kollam (56.1 per cent). Tripura had the lowest survival rate of 31.6 per cent, the researchers said in their study published in the journal The Lancet Regional Health Southeast Asia. A total of 5591 cervical cancer cases from 11 PBCRs diagnosed between 2012 and 2015 were studied. The overall survival rate of 52 per cent was about six per cent higher than that recorded in the previous SurvCan survey-3, which was 46 per cent. The survey presented a 5-year cancer survival assessment for selected PBCRs in India from 1991 to 1999. Doctors have advised women over the age of 30 to get screened periodically for cervical cancer through HPV, Pap or VIA tests. They also recommended that young girls should get the HPV vaccine preferably before the age of 15 years. How much do the vaccines cost? Will their prices go down? The Serum Institute’s made-in-India vaccine against cervical cancer, CERVAVAC, is currently available in the private market for about ₹2,000 a pop. MSD Pharmaceuticals Pvt Ltd, a wholly-owned subsidiary of Merck Sharp and Dohme (known as Merck and Co, Inc in the US and Canada) continues to sell its HPV vaccine Gardasil 4 (quadrivalent vaccine) in India. That one is priced at ₹3,927 per dose. As per News18, the Centre is already in talks with the Serum Institute of India to lower the price.

“We may take steps that bring down the price of HPV vaccine,” a top government source told the outlet.

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Another official in the know said the Centre is discussing purchasing the vaccine from SII at subsidised rates. The Centre is slated to launch its programme in September – after the SII provides six crore doses. The price for the vaccine could work out to Rs 200 to Rs 250 per dose. For young girls, the vaccine may be given free of charge, as per News18. “The company is gearing up its manufacturing. The requirements have been conveyed to the vaccine maker and by the second half of the year, around September, we are expecting rollout of doses,” the source said. “The age group of 9 to 14 years consists of one-third of the Indian population and each age group has around 1.25 crore girls requiring two doses. Overall, we may need around 15 crore doses to vaccinate the age group with two doses. The full announcement of the campaign is likely to be done post elections, during the full term budget in July.” The Indian Express also previously reported the Centre is likely to launch its programme by the second quarter of 2024. The rollout would cover all eligible girls in three phases over three years. The vaccine would also be included as part of routine immunisation for girls at age nine. Meanwhile, SII CEO Adar Poonawalla posted on X:

I applaud the Indian government's announcement to vaccinate girls aged 9-14 against cervical cancer. Let's pledge to prevent HPV and ensure easy access to vaccination. Extending health cover for ASHA and Anganwadi workers, setting up more medical colleges, and streamlining…

— Adar Poonawalla (@adarpoonawalla) February 1, 2024

In January, a senior doctor told PTI that AIIMS-Delhi and the Indian Council of Medical Research have begun a multi-centre trial to evaluate three indigenous human papillomavirus tests for detecting cervical cancer so that they meet international quality standards. The trial, which began on 22 January, aims to develop an accurate and affordable test which can be integrated into the National Cancer Screening Programme, Dr Neerja Bhatla, Head of Department of Obstetrics and Gynaecology at AIIMS said. “The present indigenous tests available have not yet been validated for conformity with international standards,” she said. The Rajya Sabha was told in March 2023 that the National Technical Advisory Group on Immunization recommended the introduction of HPV vaccine in the universal immunisation with “a one-time catch-up for 9-14 year-old adolescent girls followed with routine introduction at nine years” in June 2022. “The present indigenous tests available have not yet been validated for conformity with international standards,” she said. The Visual Inspection with Acetic Acid (VIA) test for cancer detection which has a risk of false positive is being used under the national programme currently and it is not accurate, Bhatla said. To validate these tests, the Biotechnology Industry Research Assistance Council (BIRAC) has collaborated with WHO’s International Agency for Research on Cancer (IARC). The agency would be providing around 1,200 samples for testing, she said. The three HPV tests will be conducted at three separate laboratories of the All India Institute of Medical Sciences (AIIMS), the National Institute of Cancer Prevention Research in Noida and the National Institute for Research in Reproductive and Child Health in Mumbai, she said. With inputs from agencies