Only One Indian State Provides Free Vaccines Against This Potentially Fatal Disease. Why?

According to the World Health Organisation, one woman is diagnosed with cervical cancer every minute in the world. It is the fourth most frequently occurring cancer in women, with the occurrence of nearly 570,000 new cases in 2018 across the globe.

Moreover, nearly 311,000 women lost their lives due to cervical cancer in the same year. Most of these incidences (84%) and deaths (88%) occurred in lower-resource countries.

India contributed to nearly 97,000 new cases and 60,000 deaths in the year 2018. More than a quarter of deaths due to cervical cancer across the globe happen in India. This is despite the fact that cervical cancer is one of the preventable diseases; if preventive measures and regular screenings are undertaken.

Most of the cases of cervical cancer are attributed to Human Papilloma Virus (HPV) infections, with HPV strain 16 and 18 responsible for more than 70% of Cervical Cancer lesions. As per Indian studies, 82.7% invasive cervical cancer lesions show the presence of either HPV 16 or 18 strains.

On the contrary, vaccines to prevent HPV 16 and 18 infections are available in the market. One of the key preventive strategies to reduce the burden of cervical cancer is to vaccinate young girls against HPV 16 and 18.

Indian Academy of Paediatrics recommends HPV vaccine in the immunisation schedule for children. However, despite a large number of cervical cancer incidence in-country and recommendations from the professionals, the situation of country-wide HPV immunisation is still bleak.

The HPV Immunisation was either rolled-out on a pilot basis or only in certain districts in various states of the country like Punjab, Andhra Pradesh, Gujarat, whereas on an opportunistic basis in Delhi.

The state health department of Sikkim started the state-wide HPV immunisation program in 2018, providing free of cost HPV vaccination to all the eligible girls in the state. Representational image.

On the other hand, Sikkim realised the need to reduce cervical cancer incidence and became the only state in the country to initiate a comprehensive immunisation program.

The state health department of Sikkim started the state-wide HPV immunisation program in 2018, providing free of cost HPV vaccination to all the eligible girls in the state.

This was first ever full-fledged state-level HPV immunisation program which successfully vaccinated nearly 24,000 girls with the first dose of vaccine. The second round of shots is to be delivered between April and May 2020.

The marks of success of government-led HPV immunisation programs can be drawn from several other countries.

In 2008, England propelled the HPV immunisation programme which was steered by Public Health England.

The data reveals a fall in the incidence of HPV infections from 15% in 2014 to nearly 2% in 2018 among 16-18-year-old sexually active women.

This steep fall in infections is expected to translate in steeper fall in cervical cancer incidence in the near future. Moreover, owing to the current impact of the intervention, the vaccination drive was also extended to boys, to prevent the incidence of various anogenital cancers ad warts in England.

Similarly, the National HPV vaccination programme was introduced in New Zealand in 2008. The research revealed that women who were vaccinated with at least one dose of HPV vaccine (protecting against 4 types of HPV strains) prior to 18 years of age had 31% lower incidence of high-grade cervical cancer abnormalities between ages 20-14 yrs.

Researchers at the University of Otago believe this would translate in the reduction of cervical cancer incidence in the coming years.

HPV immunisation has shown quite positive results in bringing down the HPV infections in sexually active women. This is expected to translate into a reduced Cervical Cancer incidence in the same cohort of girls, the evidence of which is expected in years to come when the vaccinated cohort cross the age of 30 as most cases of cervical cancer are concentrated between the ages of 30-49 years.

Nevertheless, the inclusion of HPV vaccination in the Universal Immunisation schedule in India could help reduce the burden of Cervical Cancer in the country, along with more comprehensive screening and awareness drives.

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