Why is a vaccine that would drastically reduce the incidence of cervical cancer not a part of India's universal immunisation programme

Just Rs 13.5 crore would cover the cost of giving human papillomavirus (HPV) vaccine to all girls aged 11 in Punjab, according to one study. Now, a recent article published in  The Lancet — a peer-reviewed science journal — asks: what’s stopping state governments from making this vaccine available to adolescent girls across the breadth of the country? India has a high incidence of cervical cancer - annually, there are around 97,000 cases and over 60,000 deaths, making it the second-biggest cause of cancer-related mortality for Indian women aged 15-44 years. The burden is higher among poorer, rural households, and a majority of the cases are discovered at more advanced stages, making interventions less likely to be effective.   [caption id=“attachment_7635421” align=“alignleft” width=“380”]  Representational image. Image source: Getty Images.[/caption] Demographics, sexual health and lifestyle aside, the disease is strongly linked to certain strains of HPV. Two strains of HPV, HPV 16 and 18, cause over 70% of cases of cervical cancer in India.  

Prevention of cervical cancer  

Routine screening through pap smears, using condoms and cutting down on smoking are some of the preventative measures that can be taken to lower the likelihood of contracting HPV. However, infrastructural, financial and coverage constraints can make regular screenings difficult in many parts of the country. Using condoms also does not guarantee immunity. The best public health measure, then, appears to be immunisation. Initial studies have shown that HPV vaccines lower the likelihood of developing precancerous lesions and genital warts. It is recommended to get vaccinated young, as early as nine years old, since the mechanism is prophylactic; the vaccine will not work on strains that are already present in the body. India has approved two vaccines, but these are expensive and only available to those who can afford them. The National Technical Advisory Group on Immunisation (NTAGI) recommends including the HPV vaccine in the universal immunisation programme. However, the history of the adoption of this vaccine has been fraught with legal and human rights issues. It was alleged that the Drug Controller General of India (DCGI) did not adequately assess the safety concerns of the drugs before randomised trials were conducted. Then, in 2010, following some deaths after studies involving the vaccines, the government suspended further research into the initiative and legal proceedings have waylaid the process of getting the vaccine available under a universal coverage programme. The deaths have since been shown to be unrelated to the trials. To be sure, there are some side-effects of the vaccine, but severe side-effects are exceedingly rare. Legal tussles aside, a significant barrier is the cost of the vaccines - even in urban centres like New Delhi, chemists don’t stock the vaccine. They can, however, acquire it for you on order. Also, at Rs1,900 for a single shot (the recommendation is to get three doses), the vaccine is out of budget for many.

Cost factor

India is working on developing a vaccine of its own, and this should lower costs and make it more feasible to be provided by the government.   Currently, three doses of the vaccine are recommended to maintain immunity against the virus. However, some studies also suggest that double doses provide robust medium-term protection, and even single doses are shown to be encouraging. Further research into this may yield more cost-saving methods of administering the vaccine.   The Indian Academy of Pediatrics Committee on Immunisation (IAPCOI) recommends that those who can afford the vaccine should get it. Screenings, however modest they may have been so far, must continue since the vaccine does not guarantee complete immunity. India is in the process of developing its public health infrastructure, and all these efforts go hand in hand. Regardless of the availability of vaccines, preventative measures need to be developed to holistically strengthen the pillars of healthcare. Health articles in Firstpost are written by myUpchar.com, India’s first and biggest resource for verified medical information. At myUpchar, researchers and journalists work with doctors to bring you information on all things health. For more information, please watch our video on   Cervical Cancer: Causes, Symptoms, Prevention_._