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Controversy continues over HPV vaccine and cervical cancer

HPV vaccine. Copyright: <a href=''>jarun011 / 123RF Stock Photo</a>Controversy continues over the human papillomavirus (HPV) vaccine used to prevent cervical cancer in women. Reports suggest India’s health ministry will not include it under the country’s universal immunisation programme (UIP).

Estimates suggest 1 in 53 women in India will develop cervical cancer in their lifetime. It is believed 423.2 million women aged fifteen and over are at risk. 67,500 women lose their lives to the disease every year – a rate of one death every eight minutes.

Countries where HPV vaccines have been introduced have witnessed positive results. In the United States, a 2012 study found that, within six years of being introduced, the Gardasil vaccine had cut HPV infection in women by 64 percent among 14-19 year old females and 34 percent among 20-24 year-olds. Despite this, use of HPV vaccines remains controversial.

“Stop this move”

The news comes a month after Ashwani Mahajan, national co-convener of the Swadeshi Jagaran Manch (SJM), wrote to Prime Minister Narendra Modi, urging the government not to include the HPV vaccine in the UIP. The SJM is an economics-focused affiliate of the Rashtriya Swayamsevak Sangh (RSS), one of the most prominent members of the Sangh Parivar family of Hindu nationalist groups. The RSS is considered to be an influential forebearer of India’s ruling Bharatiya Janata Party (BJP).

“Swadeshi Jagaran Manch requests you stop this move,” Mahajan wrote in his letter to Modi. He added that the group “[recommends] the strongest action against groups that pervert science, which brings ignominy to the scientific community in the country and sells the country to vested interests.”

The ministry acknowledged the SJM’s concerns at the time the letter was sent. It would now appear they have taken the group’s statement to heart.

The Indian Express quotes an anonymous health ministry official as saying ‘we are not going ahead with [the vaccine] now.’ This is despite the matter still being under the consideration of National Technical Advisory Group on Immunisation (NTAGI). The health ministry will reportedly shelve the vaccine regardless of the NTAGI’s decision.

A subcommittee of the NTAGI has already recommended introducing the HPV vaccine under the UIP.
Micrograph of a human papillamovirus.

The HPV vaccine

HPV refers to a group of more than 150 different viruses which are often sexually transmitted. HPV is strongly linked with cervical cancer, with two strains of it – types 16 and 18 – believed to cause 70 percent of cervical cancer cases. HPV has also been linked to cancers of the anus, penis, vagina,  vulva and head and neck. Two further strains are implicated in many of these cancers and in genital warts.

As previously reported by Health Issues India, the country’s high mortality rate from cervical cancer, which contributes to 17 percent of all cancer deaths in the country, can be attributed to the lack of a nationwide screening program for HPV. Compounding this problem is the lack of availability of a HPV vaccine except through the private sector, at a cost of Rs 2,700 per dose.

Despite what proponents consider to be clear public health benefits, uptake of the vaccination remains controversial in India. Some accuse the vaccine of being ineffective, despite clinical trials indicating the vaccine is 99 percent effective in preventing cancers caused by HPV 16 or 18.  

Protection for life?

The SJM letter dismisses the vaccine as being non cost-effective, despite a 2013 study concluding HPV vaccination to be cost-effective in low and middle income countries. Cost-effectiveness is one of the common challenges to the vaccine being introduced in India, with some expressing a preference for screening programmes and public health campaigns without necessarily including the vaccine.

MSD, which markets Gardasil in India, disputes this. Dr Anuj Walia, regional director of MSD’s Asia Pacific Medical Affairs division, says “women who go in for screenings may not maintain the three-year regimen of getting checked again” whereas “the vaccine gives protection for the next 10 years.” Many think that, in fact, it protects for life.

Put simply, there is more evidence than not that HPV is an effective preventative measure against cervical cancer. For thousands of women to die from a disease whilst a treatment is within reach is unacceptable.

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