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Empowering Women’s Health: Exploring the Impact of HPV Vaccination on Cervical Cancer Prevention in India

    Behind the statistics lies a poignant truth: cervical cancer claims the lives of thousands of Indian women each year. Cervical cancer ranks as the most common cancer in women worldwide, with a concerning rise in new cases annually. Human papillomavirus (HPV) is the causative agent for about 99.7% of cervical cancer. Most of the HPV infections subside spontaneously, but few persist as high-risk types, which are oncogenic in nature and may cause cancer in the throat and anogenital regions. 

    Yet, amidst the shadows, a ray of hope emerges- the HPV vaccine. Getting vaccinated with the HPV vaccine can help both men and women from getting cervical cancer. Currently, there are three effective prophylactic HPV vaccines that target the specific HPV types that lead to cervical cancer. Let us uncover the pivotal role of HPV vaccination in reshaping the chronicles of women’s health in India.

    Epidemiology 

    Cancer casts a dark shadow across the world, taking millions of lives each year. About 8 million people die, and 14 million new cases of cervical cancer are presented annually. In developing countries like India, it is a harsh reality for many women. It is reported that approximately 1 in 53 Indian women during their lifetime get cervical cancer compared with 1 in 100 women in more developed countries of the world. India carries a heavy burden, with a quarter of the world’s cervical cancer cases happening right here.

    Why does cervical cancer hit countries like India so hard? What stops the help from reaching those who need it most? And most importantly, what can we do to change this story?

    We are only left with these tough questions. Behind the numbers and the sad stories, there is a chance for things to get better with the hope of cervical cancer vaccines. We can toil towards a future where cervical cancer is not a death sentence but a battle we can win together.

    HPV vaccines

    The HPV vaccine is designed to shield against the main culprits of cervical cancer: HPV types 16 and 18. These two types cause about 70% of all cases of cervical cancer. So, by targeting these specific types, the vaccine aims to prevent infection and reduce the risk of developing cervical cancer. In simple terms, there are three types of HPV vaccines approved by the FDA:

    1. Gardasil 9 (9vHPV): This vaccine protects against nine types of HPV, including HPV-6, 11, 16, 18, 31, 33, 45, 52, and 58. It is effective in preventing infections that can lead to cervical cancer and genital warts.
    1. Gardasil (4vHPV): This vaccine targets four types of HPV—HPV-6, 11, 16, and 18. It is been around since 2006 and is known to prevent most cases of HPV-related cancers and genital warts.
    1. Cervarix (2vHPV): Cervarix also protects against HPV-16 and HPV-18, the types most commonly associated with cervical cancer. It is another option for preventing HPV infections.

    In India, two types of HPV vaccines are commonly used:

    1. Gardasil (Quadrivalent): This vaccine has been available in India since 2008. It protects against HPV-6, 11, 16, and 18, targeting the strains responsible for the majority of cervical cancers and genital warts.
    1. Gardasil 9 (Nonvalent): Introduced in India in 2018, this vaccine provides protection against nine HPV types, including the four covered by the quadrivalent vaccine plus additional high-risk types (HPV-31, 33, 45, 52, and 58) that contribute to cervical cancer.

    Additionally, India has its own indigenous HPV vaccine called Cervavac Injection (Quadrivalent), which became available in the market in January 2023. It also targets HPV-6, 11, 16, and 18, making it a more affordable and accessible option for preventing HPV-related diseases.

    Current Status of HPV Vaccination in India

    In 2008, efforts to vaccinate teenage girls against HPV began in India with two types of vaccines. By 2018, a new vaccine was also licensed. Initially, vaccination programs in Andhra Pradesh and Gujarat showed promise but were temporarily halted due to reported deaths (which were later found to be unrelated to the vaccine). This pause resulted in some participants only getting one dose instead of the recommended two or three.

    However, since 2016, successful vaccination drives in Punjab and Sikkim, along with government-supported efforts in Delhi, have shown high coverage and safety. There is also hope that even a single dose of the vaccine could offer strong protection.

    In January 2023, the Indian Ministry of Health and Family Welfare wrote to seven state governments, spanning from Himachal Pradesh in the north to Tamil Nadu in the south, urging them to prepare for the roll-out of HPV vaccination for girls aged 9–14 years. This marks the first phase of India’s planned introduction of the HPV vaccine. Once these states have covered the targeted age group, HPV vaccination will become part of their routine immunisation programs. Similar efforts are planned for additional states and union territories in 2024 and 2025. Ultimately, it is estimated that 68 million girls in India will have been vaccinated against HPV. Subsequently, an additional 11.2 million girls aged 9 years will be targeted annually for routine HPV vaccination.

    Points to Note:

    Does HPV affect only women? HPV does not affect only women. While HPV infections are more commonly associated with cervical cancer in women, they are also common among sexually active men. In many cases, HPV infections in men don’t show symptoms and may go away on their own as the immune system fights the infection. However, persistent infections can lead to various types of cancer and warts.

    Barriers to HPV Vaccination in India

    Efforts to expand HPV vaccination in India face several barriers:

    1. Affordability: Foreign-made vaccines like Cervarix and Gardasil have been pricey, making them inaccessible to many. The introduction of the indigenous Cervavac, promised to be more affordable, addresses this issue.
    1. Stigma and Misconceptions: There is a stigma around discussing reproductive health issues in India, including cervical cancer. Misplaced beliefs about cancer being contagious or a death sentence hinder discussions and prompt delays in seeking medical care.
    1. Cultural Beliefs: Some parents fear that offering HPV vaccination might encourage sexual activity among adolescents. Low awareness about cervical cancer and its vaccination further contributes to fear and misconceptions, reducing vaccine uptake.
    1. Gender Bias: HPV vaccination efforts have primarily focused on women, overlooking the fact that HPV can cause cancer in men too. Lack of awareness has resulted in minimal uptake of HPV vaccination among men.
    1. Screening Concerns: HPV vaccination could potentially reduce cancer screening rates as it might create a false sense of security. With low screening rates already in India, efforts to strengthen screening services are crucial.
    1. Healthcare System Challenges: Despite successful vaccination drives in certain states, there is a need to integrate HPV vaccination into the Universal Immunisation Programme to enhance accessibility and uptake. Strengthening public-private partnerships and establishing a referral system could further improve awareness and accessibility.

    Overcoming barriers

    To scale up HPV vaccine implementation in India, we need to focus on public education about HPV and the vaccine, reduce vaccine costs, improve access, and encourage strong physician endorsements. Government initiatives like endorsements, tailored messaging, early vaccination promotion, community engagement, and data monitoring (making HPV cancer notable in hospitals) are also essential. By addressing these factors with simple steps forward, we can effectively increase HPV vaccine uptake, reduce cervical cancer rates, and improve women’s health outcomes nationwide.

    Conclusion

    The most important things you can do for cervical cancer prevention are to get vaccinated against HPV, have regular HPV screening tests, and consult the doctor if your screening test results seem abnormal. HPV vaccination has the power to greatly reduce cervical cancer cases in India. But to make this happen, we need to tackle the obstacles that stop people from getting vaccinated. It is time for everyone involved, from governments to communities, to step up and make women’s health a top priority. Let’s work together to ensure that every woman in India has access to life-saving HPV vaccination and a healthier future.