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HPV vaccine is expensive and available only to the well-off. Including it in the National Immunisation Programme can drastically bring down cervical cancer cases.
According to medical professionals, cervical cancer is the most preventable female cancer. It is a slow progression cancer, taking about a decade for the virus to become cancerous. According to the Centre for Disease Control and Prevention, 93 per cent of cervical cancer cases can be prevented if detected early through regular screening and HPV vaccination. Regardless of this, in India, cervical cancer is the second most common cancer in women. Worldwide, India has the highest burden of it.
On December 19, 2017, the National Technical Advisory Group on Immunization (NTAGI) – the highest advisory body on immunization in India, recommended the inclusion of Human Papilloma Virus (HPV) vaccine for girls in the National Immunization Programme (NIP) to fight this staggering number of deaths caused by the cancer of the cervix.
99 per cent of cervical cancer is caused by HPV viruses. There are various strains of the HPV, of which strain 16 and 18 cause more than 70 per cent of cervical cancer. Vaccines protecting against HPV 16 and 18 are available in the market. They are recommended for use by international bodies like WHO and UNICEF. 64 countries have adopted HPV vaccination in their immunization programs and the vaccine is approved for use in over 100 countries.
However, in India, the recommendation to include HPV vaccine in NIP met with protest by the RSS economic wing, Swadeshi Jagran Manch (SJM).The SJM wrote to Prime Minister Narendra Modi alleging doubt on the HPV vaccines safety, efficacy and cost effectiveness. No implementation of NTAGI recommendation has taken place so far.
Dr Ramesh Sarin, an oncologist at the Indraprastha Apollo Hospitals Delhi, talking about the concern on the efficacy and safety of the vaccine says that the HPV vaccine is safe for use. It is proven that if you take the vaccine it reduces your chances of getting cervical cancer. It is not 100 per cent because it protects against only few strains of HPV viruses, but it does reduce the chance of getting cervical cancer up to 80 per cent.
Despite no national level implementation of the vaccination, Punjab and Delhi are two states which have successfully included HPV vaccine in their state immunization programs. Talking on the same, the Punjab Health Ministry informs, “According to our study, in a scenario where 70 per cent vaccination coverage is achieved, the number of cases in Punjab are estimated to come down from 1140 to 400, saving 733 lives.”
Poor women cannot afford the HPV vaccine which middle class urban women can.
Approximately 80 per cent of cervical cancer cases and 85 per cent of cervical cancer related deaths occur in the developing world, according to National Cervical Cancer Coalition (NCCC). Within the developing world, similar inequity between the rich and urban and the poor and rural women is present. Prevalence of cervical cancer in socio-economically weaker section of women in India is higher compared to urban area.
Dr Sarin informs us that cervical cancer is much more prevalent in rural and socio-economically weaker sections of women. These women lack awareness and access to proper healthcare facilities. Most of them come to know that they are suffering with cancer in stage 3 which reduces their survival rate drastically. They cannot afford the HPV vaccine which is available in the private sector and can be accessed by the urban middle class women.
Australia, which has the lowest number of cervical cancer cases could also become the first country to eradicate cervical cancer, according to International Papilloma Virus Society. HPV vaccine was invented in Australia. It was also the first country to include it in its school program. The country also has a strong nationwide screening program in place.
High rates of cervical cancer in India can be attributed to a dire dearth of proper screening and treatment program nationwide, especially in rural parts where the occurrence of cervical cancer cases is highest.
The Punjab Health Ministry says, “The routine immunization program in the country is steered from the national level. The vaccine as well as logistics are procured and supplied by the Government of India. This lowers the price of vaccine as well as overall operational cost.” Thus a national level implementation will reduce the expense of buying these vaccines.
Apart from vaccination, there is also a need for a strong, national level, screening program as the vaccine is preventive (protects one from acquiring HPV virus) and not corrective (is not used if you have already acquired the virus) in nature. The state needs to develop a scientific attitude and give priority to the health sector that it deserves. Bhutan, our neighbor and a low-middle income country successfully included HPV vaccine in its nationwide immunization program in 2011 to fight the high rates of deaths caused by cervical cancer.
Image source: pixabay
Tahira is an aspiring journalist and a student of journalism at Jamia Millia Islamia University.
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