NTAGI has recommended inclusion of HPV vaccine in the National Immunisation Programme (NIP) but the RSS economic wing has a problem with the decision.
On December 19, 2017, the National Technical Advisory Group on Immunisation (NTAGI), the highest technical body for evaluation of vaccines for the public health system in India, recommended the inclusion of Human Pappilomavirus (HPV) vaccine for girls in National Immunisation Programme (NIP). The HPV vaccine provides protection against cervical cancer. After the recommendation was given, the RSS economic wing Swadeshi Jagran Manch wrote to Prime Minister Narendra Modi asking him not to include HPV vaccine in NIP for safety, efficacy and economic reasons. No implementation of NTAGI recommendation has taken place so far.
Dr Ramesh Sarin, an oncologist in the Indraprastha Apollo Hospitals Delhi, talking about the efficacy and safety of the HPV vaccine told, “Cervical cancer vaccine has proven its worth. It is proven that if you take the vaccine it reduces your chances of getting cervical cancer. It is not 100 per cent because it protects against only few strains of HPV viruses, but it reduces the chance of getting cervical cancer upto 80 per cent.”
99 per cent of cervical cancer is caused by HPV viruses. There are various strains of HPV viruses, of which HPV 16 and 18 cause more than 70 per cent of cervical cancer. Vaccines protecting against HPV 16 and 18 are available and are recommended to be included in NIP not just by NTAGI but also by WHO and UNICEF. 64 countries have adopted HPV vaccination in their immunisation programmes. The vaccine is approved for use in over 100 coutries.
In India, cervical cancer is the second most common cancer in women. Around 72,000 women die of it each year, according to the Cervical Cancer Free Coalition. Worldwide, India has the highest burden of cervical cancer.
According to National Cervical Cancer Coalition (NCCC), approximately 80 per cent of cervical cancer cases and 85 per cent of cervical cancer related deaths occur in the developing world. This divided is further polarized within the developing world as well.
Talking about the huge prevalance of cervical cancer in socio-economically weaker section of women, Dr Sarin informed, “Cervical cancer is much more prevalent in rural and socio-economically weaker sections of women. They lack awareness and access to proper healthcare facilities. They come to know they are suffering with cancer mostly in stage 3, reducing their survival rate drastically. They cannot afford the HPV vaccine which middle class urban women can.”
Punjab and Delhi are two states which have included HPV vaccine in their state immunisation programs. Talking on the same, the Punjab Health Ministry Department informed, “The states are free to introduce vaccines at their level, but then the cost is to be borne by the state. The vaccines, when procured by states, are much costlier than when they are procured by government of India.”
Cervical cancer is the most prevantable female cancer. 93 per cent of cases can be prevented if detected early through regular screening and HPV vaccination, according to the Centre for Disease Control and Prevention.
Australia has the lowest level of cervical cancer cases. It could also become the first country to eradicate cervical cancer, according to International Pappilomavirus Society. HPV vaccine was invented in Australia. It was also the first country to include it in its school programme. The country also has a strong nationwide screening program.
Apart from vaccination, there is a need for a strong, national level, screening program. As the vaccine is preventive (protects one from acquiring HPV virus) not corrective (is not used if you have already acquired the virus). The vaccine should be given to 9 years and older girls, before the initiation of sexual activity.
There is a dearth of proper screening and treatment programme in India, especially in rural parts. HPV vaccine can be one of the important disease control strategy. Bhutan, which has a high rate of cervical cancer, included HPV vaccine in its immunisation programme in 2015.
“India has a lot of young population. Women should demand for their right to get vaccinated”, Dr Sarin asserted.