As the world observes International Women’s Day, India’s interim Union Budget 2024-25 has emerged as a beacon of hope, particularly in the realm of women’s health. The Narendra Modi government’s support in encouraging the vaccination of girls (from nine to 14 years) against cervical cancer stands out as a pivotal move towards safeguarding women’s well-being.
The ‘90-70-90’ targets, global programmes
Despite advances in health care, cervical cancer remains the second most common cancer among women in India, with 1.27 lakh cases and around 80,000 deaths being reported annually. Human papillomavirus (HPV) is a primary culprit in the development of cervical cancer. In response to this pressing public health challenge, HPV vaccination emerged as a cornerstone of a comprehensive strategy for disease prevention and health promotion. The World Health Organization has outlined the ‘90-70-90’ targets by 2030 — for 90% of girls to be fully vaccinated with the HPV vaccine by age 15, for 70% of women to undergo cervical cancer screening tests by the age of 35 and 45, and for 90% of women with cervical cancer to be treated. These targets represent milestones in the global effort to eradicate cervical cancer and highlight the pivotal role of India’s call for HPV vaccination in achieving this goal.
Across the world, over 100 countries have implemented HPV vaccination programmes, resulting in a notable decline in the incidence of cervical cancer. A study out of Scotland illuminates the real-world impact of HPV vaccines. The findings show that there have been no reported cases of cervical cancer among women born between 1988 and 1996 who received full HPV vaccination between the ages of 12 and 13. Australia, which initiated HPV vaccination for girls in 2007 and expanded to include boys in 2013, is poised to eliminate cervical cancer by 2035.
Similarly, the successful HPV vaccination campaign in Rwanda, Africa, has significantly reduced the prevalence of vaccine-targeted HPV types, particularly among women who participated in their catch-up programme in 2011. These global success stories underscore the importance of prioritising vaccination for tackling cervical cancer.
Closer to home, six out of the 11 South East Asia Region countries have introduced the HPV vaccine nationwide, i.e., Bhutan, Indonesia, the Maldives, Myanmar, Sri Lanka, and Thailand. Bhutan was the first low-middle income country (LMIC) to introduce a nationwide HPV vaccination programme for girls (12 to 18 years) in 2010 and achieved an initial coverage of 95% of targeted girls. Bhutan is also one of the only LMICs to have begun vaccinating boys as well (in 2021). Ongoing programme assessments and research in Thimphu have observed a reduction in the prevalence of HPV types targeted by the vaccine, indicating the programme’s broader impact on reducing HPV transmission in the community.
The Sikkim model
The key to the success of any vaccination campaign is a robust communication strategy that educates and empowers communities. Within India, Sikkim’s exemplary approach to HPV vaccination is an example of an effective public health strategy. Through targeted efforts to educate teachers, parents, girls, health-care workers, and the media about the benefits of the HPV vaccine, Sikkim achieved vaccination coverage of 97% during its campaign rollout in 2018. It provides a compelling example of effective communication and outreach. This rigorous effort has not only dispelled myths and misconceptions but has also fostered trust and confidence in the vaccination process.
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India’s recent milestone in developing its indigenous quadrivalent vaccine, Cervavac, marks a significant stride towards ensuring accessibility and affordability. Developed by the Serum Institute of India in collaboration with the Department of Biotechnology, and priced at ₹2,000 a dose, Cervavac is cheaper than available vaccines, and holds promise in the fight against HPV infections and cervical cancer.
Whenever India plans to expand its vaccination programme, there is also an opportunity to include adolescent boys, thereby maximising the impact of HPV vaccination in preventing HPV transmission and HPV-related diseases. Also, in line with recent evidence, it has been recognised that one dose of HPV vaccine provides similar protection to that provided by two or three doses.
Drawing inspiration from global and local triumphs, India is ready to make significant strides in combating cervical cancer through HPV vaccination. India’s track record in vaccination campaigns, exemplified by the widespread acceptance and coverage of the COVID-19 vaccine, instils confidence in the feasibility of scaling up HPV vaccination efforts. India’s ability to reach remote and underserved populations highlights the inclusivity and accessibility of its vaccination programmes, laying a solid foundation for the success of the HPV vaccination initiative.
The importance of HPV vaccination extends beyond individual health outcomes. It has the potential to alleviate the societal and economic burden of cervical cancer. Cervical cancer predominantly strikes women during their prime years, exerting a profound toll on both their families and communities. Premature deaths of young mothers due to cervical cancer negatively impact health and education outcomes in children. By preventing HPV infections, vaccination diminishes the occurrence of cervical cancer and its associated health-care expenses, ultimately fostering the overall welfare and productivity of women.
Meet the challenges
However, challenges persist, particularly in addressing vaccine hesitancy and ensuring equitable access to HPV vaccination. To overcome these hurdles, concerted efforts are needed to engage communities, dispel misinformation, and strengthen health-care infrastructure. The interim Budget also announced the rollout of U-WIN throughout the country. U-WIN, like Co-WIN that was designed to track the COVID-19 vaccination campaign, is a portal that will maintain an electronic registry of all immunisations across the country and enable vaccination programmes to be responsive in real time.
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On the supply side, ensuring access to vaccination services is imperative, particularly in underserved populations. And to improve demand among the community, awareness must be improved. Vaccine hesitancy, fuelled by myths and misinformation, poses a significant barrier to the acceptance of HPV vaccines across different regions. Cultural and societal norms are also a factor, highlighting the importance of tailoring messages to resonate with diverse communities. Utilising diverse channels such as social media and community workshops can amplify reach. Including HPV information in health education in schools can be a step to generate demand among adolescents. Collaborations between government agencies, community partners, health-care providers, and civil society organisations will be instrumental in building trust and ensuring the success of HPV vaccination programmes. We can build upon our experiences of the successful nationwide rollout of COVID-19 vaccines amidst a landscape of pervasive digital and mass misinformation. Moreover, public-private partnerships are instrumental in ensuring equitable access to vaccination services, thereby advancing the collective goal of safeguarding women’s health against cervical cancer.
Thus, India’s inclusion of HPV vaccination in the interim Union Budget 2024-25 heralds a new era in women’s health.
Dr. Ramya Pinnamaneni is Research Associate at the Harvard T.H. Chan School of Public Health. Dr. Ananya Awasthi is Founder-Director, Anuvaad Solutions and Member, Advisory Committee, National Commission for Protection of Child Rights (Twitter/X: @AnanyaAvasthi). Dr. Dhriti Dhawan is Data Programmer Analyst at the Dana-Farber Cancer Institute. Professor K. Vish Viswanath is Lee Kum Kee Professor of Health Communication at the Harvard T. H. Chan School of Public Health and Director of the Harvard T.H. Chan School of Public Health – India Research Center (Twitter/X: @vishplus)
