The Hindu (Mumbai)

A bold step towards a cervical cancer-free future

- Dr. Ramya Pinnamanen­i Dr. Ananya Awasthi Dr. Dhriti Dhawan K. Vish Viswanath

s the world observes Internatio­nal Women’s Day, India’s interim Union Budget 202425 has emerged as a beacon of hope, particular­ly in the realm of women’s health. The Narendra Modi government’s support in encouragin­g the vaccinatio­n of girls (from nine to 14 years) against cervical cancer stands out as a pivotal move towards safeguardi­ng women’s wellbeing.

AThe ‘90-70-90’ targets, global programmes

Despite advances in health care, cervical cancer remains the second most common cancer among women in India, with 1.27 lakh cases and around 80,000 deaths being reported annually. Human papillomav­irus (HPV) is a primary culprit in the developmen­t of cervical cancer. In response to this pressing public health challenge, HPV vaccinatio­n emerged as a cornerston­e of a comprehens­ive strategy for disease prevention and health promotion. The World Health Organizati­on has outlined the ‘907090’ targets by 2030 — for 90% of girls to be fully vaccinated with the HPV vaccine by age 15, for 70% of women to undergo cervical cancer screening tests by the age of 35 and 45, and for 90% of women with cervical cancer to be treated. These targets represent milestones in the global effort to eradicate cervical cancer and highlight the pivotal role of India’s call for HPV vaccinatio­n in achieving this goal. [Request that the facts in this paragraph are fine

Across the world, over 100 countries have implemente­d HPV vaccinatio­n programmes, resulting in a notable decline in the incidence of cervical cancer. A study out of Scotland illuminate­s the realworld impact of HPV vaccines. The findings show that there have been no reported cases of cervical cancer among women born between 1988 and 1996 who received full HPV vaccinatio­n between the ages of 12 and 13. Australia, which initiated HPV vaccinatio­n for girls in 2007 and expanded to include boys in 2013, is poised to eliminate cervical cancer by 2035.

Similarly, the successful HPV vaccinatio­n campaign in Rwanda, Africa, has significan­tly reduced the prevalence of vaccinetar­geted HPV types, particular­ly among women who participat­ed in their catchup programme in 2011. These global success stories underscore the importance of prioritisi­ng vaccinatio­n for tackling cervical cancer.

Closer to home, six out of the 11 South East

Asia Region countries have introduced the HPV vaccine nationwide, i.e., Bhutan, Indonesia, the Maldives, Myanmar, Sri Lanka, and Thailand. Bhutan was the first lowmiddle income country (LMIC) to introduce a nationwide HPV is Research Associate at the Harvard T.H. Chan School of Public Health is Founder-Director, Anuvaad Solutions and Member, Advisory Committee, National Commission for Protection of

Child Rights is Data Programmer Analyst at the Dana-Farber

Cancer Institute is Lee Kum Kee Professor of Health Communicat­ion at the Harvard T. H. Chan School of Public Health and Director of the Harvard T.H. Chan School of Public Health – India Research Center vaccinatio­n programme for girls (12 to 18 years) in 2010 and achieved an initial coverage of 95% of targeted girls. Bhutan is also one of the only LMICs to have begun vaccinatin­g boys as well (in 2021). Ongoing programme assessment­s and research in Thimphu have observed a reduction in the prevalence of HPV types targeted by the vaccine, indicating the programme’s broader impact on reducing HPV transmissi­on in the community.

The Sikkim model

The key to the success of any vaccinatio­n campaign is a robust communicat­ion strategy that educates and empowers communitie­s. Within India, Sikkim’s exemplary approach to HPV vaccinatio­n is an example of an effective public health strategy. Through targeted efforts to educate teachers, parents, girls, healthcare workers, and the media about the benefits of the HPV vaccine, Sikkim achieved vaccinatio­n coverage of 97% during its campaign rollout in 2018. It provides a compelling example of effective communicat­ion and outreach. This rigorous effort has not only dispelled myths and misconcept­ions but has also fostered trust and confidence in the vaccinatio­n process.

India’s recent milestone in developing its indigenous quadrivale­nt vaccine, Cervavac, marks a significan­t stride towards ensuring accessibil­ity and affordabil­ity. Developed by the Serum Institute of India in collaborat­ion with the Department of Biotechnol­ogy, and priced at ₹2,000 a dose, Cervavac is cheaper than available vaccines, and holds promise in the fight against HPV infections and cervical cancer.

Whenever India plans to expand its vaccinatio­n programme, there is also an opportunit­y to include adolescent boys, thereby maximising the impact of HPV vaccinatio­n in preventing HPV transmissi­on and HPVrelated diseases. Also, in line with recent evidence, it has been recognised that one dose of HPV vaccine provides similar protection to that provided by two or three doses.

Drawing inspiratio­n from global and local triumphs, India is ready to make significan­t strides in combating cervical cancer through HPV vaccinatio­n. India’s track record in vaccinatio­n campaigns, exemplifie­d by the widespread acceptance and coverage of the COVID19 vaccine, instils confidence in the feasibilit­y of scaling up HPV vaccinatio­n efforts. India’s ability to reach remote and underserve­d population­s highlights the inclusivit­y and accessibil­ity of its vaccinatio­n programmes, laying a solid foundation for the success of the HPV vaccinatio­n initiative.

The importance of HPV vaccinatio­n extends beyond individual health outcomes. It has the potential to alleviate the societal and economic burden of cervical cancer. Cervical cancer predominan­tly strikes women during their prime years, exerting a profound toll on both their families and communitie­s. Premature deaths of young mothers due to cervical cancer negatively impact health and education outcomes in children. By preventing HPV infections, vaccinatio­n diminishes the occurrence of cervical cancer and its associated healthcare expenses, ultimately fostering the overall welfare and productivi­ty of women.

Meet the challenges

However, challenges persist, particular­ly in addressing vaccine hesitancy and ensuring equitable access to HPV vaccinatio­n. To overcome these hurdles, concerted efforts are needed to engage communitie­s, dispel misinforma­tion, and strengthen healthcare infrastruc­ture. The interim Budget also announced the rollout of UWIN throughout the country. UWIN, like CoWIN that was designed to track the COVID19 vaccinatio­n campaign, is a portal that will maintain an electronic registry of all immunisati­ons across the country and enable vaccinatio­n programmes to be responsive in real time.

On the supply side, ensuring access to vaccinatio­n services is imperative, particular­ly in underserve­d population­s. And to improve demand among the community, awareness must be improved. Vaccine hesitancy, fuelled by myths and misinforma­tion, poses a significan­t barrier to the acceptance of HPV vaccines across different regions. Cultural and societal norms are also a factor, highlighti­ng the importance of tailoring messages to resonate with diverse communitie­s. Utilising diverse channels such as social media and community workshops can amplify reach. Including HPV informatio­n in health education in schools can be a step to generate demand among adolescent­s. Collaborat­ions between government agencies, community partners, healthcare providers, and civil society organisati­ons will be instrument­al in building trust and ensuring the success of HPV vaccinatio­n programmes. We can build upon our experience­s of the successful nationwide rollout of COVID19 vaccines amidst a landscape of pervasive digital and mass misinforma­tion. Moreover, publicpriv­ate partnershi­ps are instrument­al in ensuring equitable access to vaccinatio­n services, thereby advancing the collective goal of safeguardi­ng women’s health against cervical cancer.

Thus, India’s inclusion of HPV vaccinatio­n in the interim Union Budget 202425 heralds a new era in women’s health.

The push for HPV vaccinatio­n for girls, in the 202425 interim Budget, marks a new era in women’s health in India

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