Building a healthier future: HPV vaccination crusade

India, the world’s most populated country has over 510 million women aged 15 years and older who are at risk of developing cervical cancer. Cervical cancer ranks as the second most frequent cancer among women in India and also the second most frequent cancer among women between 15 and 44 years of age. About 5.0% of women in the general population are estimated to harbour cervical human papillomavirus (HPV) 16/18 infection at a given time, and 83.2% of invasive cervical cancers are attributed to HPVs 16 or 18.

In light of these statistics, India's pioneering initiative to encourage vaccination against HPV, which leads to cervical cancer, among young girls aged 9-14 signifies a monumental stride towards health equity. This initiative is not merely a health campaign; it's a beacon of hope, empowerment, and progress in the ongoing battle against one of the most preventable, yet deadly cancers affecting women worldwide. It reflects India’s broader commitment to preventive healthcare, targets one of the most preventable yet prevalent malignancies affecting women, setting a new standard in public health policy.

Cervical cancer, dubbed a silent epidemic in India, accounts for a substantial number of cancer-related deaths among Indian women annually. Current estimates indicate that every year 1,23,907 women are diagnosed with cervical cancer and 77,348 die from the disease. Further, the socio-economic ramifications extend beyond the immediate families, affecting communities and the nation at large.

Therefore, the vaccine, proven to be effective against the strains of HPV most commonly linked to cervical cancer, represents a significant advancement in our ability to protect future generations from this disease. The HPV vaccine, is proven to reduce the incidence of cervical cancer by nearly 90%, particularly if women are vaccinated when they are younger. In 2020, the World Health Organization (WHO) launched the 90-70-90 targets, aiming to have 90% of girls vaccinated against HPV, 70% of women screened for HPV by age 35 and again at 45 and 90% of women with pre-cancer treated or with invasive cancer managed.

Over the years, vaccinations for cervical cancer, the second most frequent cancer among women in India, after breast cancer, have not picked up pace because of the costs involved--approximately ₹4,000 per jab and two to three doses. Often, another concern has been that infections due to certain strains may not be covered by the vaccine.

Yet now, the government's plans to encourage the vaccination of young girls, is a commendable step that aligns with global health recommendations. In addition, as a responsible nation, it is our collective duty to ensure that no girl is left behind, for any reason and every daughter of India in the prescribed age group receives the vaccination. Towards it, dispelling myths and educating communities about the vaccine's safety and benefits are crucial to achieving high vaccination rates.

The global context offers valuable insights and best practices that can inform India's approach. Numerous countries that have successfully integrated HPV vaccination into their national immunisation programmes, provide compelling evidence of the vaccine's impact on reducing cervical cancer rates.

Approximately 125 countries have implemented HPV vaccines, reaching one in three girls aged 9-14 globally. Encouragement and support are needed to persuade remaining countries to adopt HPV vaccines into their routine immunisation programmes. Cambodia's ministry of health has introduced a one-dose HPV vaccine for nine-year-old girls nationwide, aiming to address the 1,135 new cervical cancer cases and 643 deaths annually. Across Africa, 27 countries have integrated HPV vaccines into national immunisation programmes, and 34 have initiated cervical cancer screening, with 14 utilising HPV DNA testing, a more effective screening method. In Nigeria, with assistance from WHO and partners, over 35,000 health workers have been trained for a cervical cancer vaccination campaign, with the potential to protect over 16 million girls by 2025.

The World Economic Forum's recent report on closing the women's health gap discusses the importance of addressing health disparities, including the success of HPV vaccination programmes in various countries. For example, Scotland has seen significant declines in cervical pre-cancer rates among women due to its effective HPV vaccination programme. Similarly, in the United Kingdom and Australia, comprehensive vaccination strategies have led to lowered HPV infection rates and are projected to significantly reduce cervical cancer incidence. These examples underscore the potential impact of well-implemented HPV vaccination initiatives, emphasising the importance of such programmes in improving women's health and closing the health gap globally.

The economic implications of HPV vaccination extend beyond direct health care savings, potentially influencing broader economic stability and workforce participation.

This bold initiative initiated by our nation, is more than a health campaign; it's a movement towards a healthier, more equitable future for Indian women. It embodies a comprehensive approach to healthcare, aiming to uplift and empower women across the nation.

By investing in preventive health care, India can reduce the long-term costs associated with treating advanced cervical cancer, thereby alleviating the economic burden on families and the health care system. Moreover, by prioritising the health of young girls, this initiative sends a powerful message about the value of women in society, promoting gender equity and empowering women to lead healthier, more productive lives.

The decision to vaccinate young girls against cervical cancer is a step in the right direction. It reflects a commitment to leveraging scientific advancements for the greater good, prioritising preventive care, and addressing gender disparities in health. As we rally behind this cause, we move closer to a future where cervical cancer is no longer a threat to women's lives and well-being in India. This initiative is not just about vaccination; it's about shaping a healthier, more equitable society for generations to come.

This article is authored by Dr Preetha Reddy, executive vice chairperson, Apollo Hospitals Group.