Studies indicate that the incidence of cervical cancer is inversely proportional to the human development index of countries.
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The story so far:
The government has announced that it will roll out vaccines for the prevention of cervical cancer to girls aged between 9 and 14 years through schools. The National Technical Advisory Group for Immunisation (NTAGI) had recommended the introduction of the Human Papillomavirus (HPV) vaccine in the Universal Immunisation Programme (UIP). The UIP is one of the largest public health programmes which offers free vaccines for at least 12 diseases, and has successfully eradicated diseases like polio and maternal and neonatal tetanus.
Why is it important to launch the HPV vaccine?
Cervical cancer is preventable and curable if it is detected early and managed effectively. It is the second most common cancer in women in India, and the cause of a large number of deaths annually. It is caused by infection with the human papillomavirus, and there are vaccines to protect against cancerous HPV. A recent study in The Lancet shows that India accounts for the highest number of cervical cancer cases in Asia, followed by China. more than 58% of all cases of cervical cancer and deaths globally were estimated in Asia with India accounting for 21% of cases and 23% of deaths, followed by China (18% and 17%). According to the paper, globally, there were an estimated 6,04,127 cervical cancer cases in 2020, with an incidence rate of 13.3 new cases per 1,00,000 women a year. In India, the incidence rate is 18 per 1,00,000 women, and in 2019, according to The World Health Organization (WHO) estimates, over 45,000 women died of the disease. The WHO has specified that countries must reach and maintain an incidence rate of fewer than 4 new cases per 1,00,000 women a year by 2030. To achieve that goal, one of the most important things required is that 90% of girls will have to be vaccinated with the HPV vaccine by the age of 15.
When will it be rolled out?
The indigenous HPV vaccine, called CERVAVAC, is likely to be rolled out by mid-2023. The vaccine has got the approval of the Drugs Controller General of India and was cleared by the government advisory panel, NTAGI, for use in the UIP programme. A one-time catch-up vaccine will be given to 9-14 year old adolescent girls, before it is introduced at nine years. States and Union Territories have been asked to issue directives to appropriate authorities for organising HPV vaccination centres in schools, and identifying a nodal person in each government and private school to facilitate the vaccination after collating the number of 9-14 year olds.
What happens to girls who don’t go to school?
The government has clarified that girls who do not attend schools will be given the vaccines by community outreach and mobile health teams. Together with vaccination, screening programmes need to be conducted regularly to detect early signs of the disease that will allow time for treatment. The Ayushman Bharat Health and Wellness centres, announced in 2018, are already screening for common cancers like oral, breast and cervical, with over 5 crore women being screened for cervical cancer till November 2022. Screening has to be increased exponentially, say doctors. A WHO paper in 2021 said fewer than 1 in 10 women had been screened for cervical cancer in the last five years. Besides, widespread vaccination, the WHO’s strategy targets for cervical cancer elimination by 2030 include screening of 70% women with a high performance test by 35 years of age and again by 45 years of age. It has also set a cervical cancer treatment target of 90% of women identified with the disease.
What are the challenges?
According to The Lancet study, the burden of cervical cancer remains high in Asia and Africa, and that in many countries, the incidence and mortality of the disease remain much higher than the threshold set by the WHO initiative on cervical cancer elimination. The study identified substantial geographical and socioeconomic inequalities in cervical cancer globally, with a clear gradient of increasing rates for countries with lower levels of human development. In 2022, India ranked 132 out of 191 countries on the Human Development Index. However, health experts say the fact that India’s fertility rate is declining due to a variety of factors, including improved literary rate, increase in the age of marriage and so forth, should prompt everyone in the ecosystem, from the government, doctors to ground level health workers to launch campaigns on cervical cancer awareness, push vaccinations and screening for all girls.
What lies ahead?
Once the vaccine is launched through the UIP, which is a well-oiled network in India, it should reach the maximum number of the targeted population. The surveillance systems and infrastructure used for COVID-19 vaccinations may also be customised to improve HPV vaccination, monitor national cervical screening programmes and improve health system capacity to deliver more efficient preventive services, says The Lancet study.
