POV: NO CURE IN THIS PREVENTION POLICY
In December 2017, the Union ministry for health and family welfare decided to cancel the introduction of a vaccine for the sexually transmitted Human Papilloma Virus (HPV). The vaccine is used to prevent cervical cancer among women and, ideally, should be administered before the woman becomes sexually active—to adolescent girls. The decision to cancel its introduction in the public health system was reportedly taken after the RSS-affiliate Swadeshi Jagran Manch wrote to Prime Minister Narendra Modi arguing that it was of doubtful utility, with adverse effects, will divert scarce resources from worthwhile initiatives, will erode confidence in the national immunisation programme and thus expose children to the risk of more serious vaccinepreventable diseases.
The HPV vaccine was launched in the global market more than 10 years ago and has been accepted by several countries as part of their health programmes. According to the World Health Organization, India, with an age-standardised incidence ratio for cervical cancer at 22 per 100,000 women per year (compared with 14 per 100,000 women globally) and 25 per cent of HPV-related deaths globally, was perceived as the perfect ground for the introduction of this vaccine.
After observational trials of the HPV vaccine began in Andhra Pradesh and Gujarat in 2009, mainly on tribal girls, seven girls died after vaccination. The deaths and the circumstances surrounding them were investigated by a standing committee on health and family welfare and an NGO working in the health sector. These pointed to several lapses—the way consents were obtained, ignoring the problems related to menstruation faced by some girls after they were injected the vaccine, and attributing these deaths to unrelated causes. It was pointed out that since the observational studies were carried out by an organisation associated with pharma companies that manufactured the drugs, there was also a conflict of interest.
Despite these concerns, in November 2016, the Punjab government went ahead and on a trial basis administered the vaccine to all girls studying in grade six in government schools across two districts with the provision to cover the entire state in a phased manner.
The opposition to the introduction of the HPV vaccine has come from several quarters. Some Left-oriented health activists fear that the vaccine could be used as a short-term solution for all things related to women’s health issues, leaving a host of gynaecological concerns unattended. Further, the doctors’ fraternity feels that it is too early to determine the vaccine’s efficacy and it is too expensive an intervention for most Indians. (In the private sector, the vaccine costs Rs 2,800-3,300 per dose. The two doses needed will cost Rs 5,600-6,600.) Some public health activists have been arguing that an improved personal hygiene, availability of running water and better nutrition may be more cost-effective measures to lower the incidence of cervical cancer. Access to screening, awareness and education programmes would also prevent cervical cancer deaths, they argue. However, the contrary view is that the vaccine is a prevention and not a cure for the disease. There is no link between poor hygiene and HPV or cervical cancer. It is also argued that the vaccine is administered to adolescents between nine and 14 years, but cervical cancer generally strikes women who are above the age of 45-50. Does one have to wait for 30-35 years to establish that the vaccine is effective? There is also an unspoken ‘moral’ argument against the vaccine: it will encourage promiscuous behaviour among the youth since they will lose their fear of cervical cancer.
The health watchdogs have important roles to play in this debate. However, when those having limited scientific understanding jump on the bandwagon to oppose efforts to introduce new inventions, the situation becomes murky. We need to sift through the arguments for and against the HPV vaccine with the help of good science.
When those of limited scientific understanding oppose efforts to introduce a cervical cancer vaccine, the situation is bound to turn murky