The Power of Normalizing HPV Vaccination

About Author: Dr Indu Aggarwal is serving as the Head of the Department of Preventive Oncology at Rajiv Gandhi Cancer Institute and Research Centre (RGCIRC), Rohini. With more than three decades of experience, Dr. Aggarwal specializes in both Obstetrics & Gynaecology and Preventive Oncology. Through her efforts, she continues to contribute significantly to the field of healthcare, particularly in the critical areas of cancer awareness and prevention.

Cervical cancer poses a significant health challenge in India, and it remains the most prevalent gynaecological cancer in the country.  According to Globocan 2020 estimates, India accounts for 21% of the global burden of cervical cancer, with more than three-quarters of cases diagnosed at an advanced clinical stage, leading to poor prospects of survival. Shockingly, approximately 200 women succumb to cervical cancer daily, underscoring the urgency of preventative measures. The need to address and eliminate cervical cancer has never been more urgent, and normalizing vaccination as a pivotal strategy is a critical step in this direction.

Human papillomavirus (HPV) infection is a well-established cause of cervical cancer, and its involvement in other anogenital and head and neck cancers has been increasingly recognized. The World Health Organization (WHO) has taken a decisive step in the battle against cervical cancer by approving a strategy in 2020 aimed at its global elimination.

The elimination strategy hinges on a three-pillar approach, targeting vaccination, screening, and treatment. By ensuring 90% of girls are fully vaccinated with the HPV vaccine by age 15 years, 70% of women screened using a high-performance test by the age of 35, and again by the age of 45, and 90% of pre-cancer cases are treated, we can pave the way to eradicate cervical cancer by 2030.

The ideal time to administer the HPV vaccine is before an individual is sexually active because the chances of prior exposure to HPV are the least. While regular health check-ups and screening are crucial for early detection of cervical cancer, it is still important to get HPV vaccination as a preventive measure. It’s essential to recognize that despite the prevalence of HPV infections and the body’s natural immune response, this response is often insufficient to control new and persistent infections, unlike the robust and enduring immune response triggered by HPV vaccines.

Current Progress and Challenges in India

While about 125 countries have incorporated the HPV vaccine into their national immunization programs, India lags behind with critically low vaccination rates. Presently, less than 2% of Indian women have ever been screened, highlighting the long journey ahead to meet the 2030 elimination target.

A significant breakthrough in the fight against cervical cancer is the WHO’s Strategic Advisory Group of Experts (SAGE) recommendation for a single-dose HPV vaccine, providing solid protection. This flexibility allows countries to choose between a one- or two-dose schedule for girls aged 9 – 14 and women aged 15 to 20, a crucial step towards accelerating global cervical cancer elimination. This can give a significant impetus to the nationwide coverage of HPV vaccination, especially in a highly populated country like India.

Barriers and Solutions

The primary barrier to HPV vaccination in India is its exclusion from the National Immunization Program, limiting accessibility and awareness. The high cost of the vaccine, cultural and social stigmas, and misinformation about safety and efficacy further hinder its uptake, particularly among lower-income families.

Normalizing cervical cancer vaccination in India necessitates a multi-faceted approach. Leveraging India’s successful track record in childhood and COVID-19 vaccination, the inclusion of the HPV vaccine in the national immunization schedule is imperative. This requires strong political will, bureaucratic support, and an effective public awareness campaign to dispel myths and misconceptions.

To eliminate cervical cancer, it is crucial to address the barriers hindering vaccination in India. By creating awareness, normalizing vaccination, and fostering collaboration among governments, NGOs, and concerned organizations, we can make significant strides towards a future free from the devastating impact of cervical cancer. The time to act is now.

**Views expressed by the author are her own.