Vaccination Against Cervical Cancer Is Tricky Business, Despite Being Second Most Common Cancer In Indian Women

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New Delhi: The recent decision in principle of the Ministry of Health to remove a vaccine against the Human Papilloma Virus (HPV) as part of the universal immunisation programme (UIP) was reported in many sections of the media as giving way to the will of extra state bodies at the cost of women’s health.

The economic wing of the RSS, Swadeshi Jagran Manch wrote to the PM citing safety and cost concerns of the vaccine. After the PMO received the letter, the vaccine which is aimed at treating the second most common cancer in women with over 1,22,844 affected women every year, is considered to be removed from the vaccine program.

The matter is still under consideration of the technical advisory body on immunisation but highly placed sources in the ministry say that regardless of what the National Technical Advisory Group on Immunisation (NTAGI) decides, will not become a part of UIP anytime soon.

Earlier an NTAGI subcommittee had recommended that India should introduce HPV. “We are not going ahead with it now,” said a top health ministry functionary in reply to a question on HPV introduction.

HPV Virus and its incidence in India

HPV comprises a group of more than 150 viruses that cause papilloma or warts in parts of the body, including genital areas. They spread by skin-to-skin contact and are responsible for a number of diseases, including cancers, though they are most commonly associated with cancer of the cervix (neck of the uterus).

HPV is a necessary cause for cervical cancer but not sufficient cause. WHO recommends HPV vaccination for the prevention of cervical cancer. Its 2017 position paper on HPV identifies the primary target population as girls aged aged 9-14, prior to becoming sexually active.

According to a 2015 article in the International Journal of Women’s Health, “Every year in India, 122,844 women are diagnosed with cervical cancer and 67,477 die from the disease. India has a population of 432.2 million women aged 15 years and older who are at risk of developing cancer. It is the second most common cancer in women aged 15-44 years.

The number of deaths from cervical cancer annually was 74,000. Nearly 366 million Indian girls and women aged 15 years and above are at risk from cervical cancer.

While India has seen a fall in the incidence of cervical cancer over the last three decades, the number of cases remains high in rural areas, and where sanitation and hygiene are low. These were among the reasons for the NTAGI to propose the HPV vaccination programme for girls.

What did the SJM say and why?

In the letter, SJM national co-convener Ashwani Mahajan wrote: “It is our concern that this programme will divert scarce resources from more worthwhile health initiatives diverting it to this vaccine of doubtful utility and that its adverse effects will erode confidence in the national immunisation programme and thereby expose children unnecessarily to the risk of more serious vaccine-preventable disease.”

 “Swadeshi Jagran Manch requests you to stop this move to introduce Human Papilloma Virus (HPV) vaccine in India and we recommend 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 letter added.

In India, currently the vaccine is marketed by two companies, Gardasil and GlaxoSmithKline. The HPV vaccine is given thrice within six months to girls aged 9-13 years, before they become sexually active. A single shot of Gardasil costs approximately Rs 3,000 and Cervarix, about Rs 2,000.

In his letter to Modi, Swadeshi Jagran Manch national co-convener Ashwani Mahajan, too, drew attention to the high cost of the vaccine. At three shots of Gardasil at MRP for 6.2 crore Indian girls aged 9-13 years, the cost to the government will be over Rs 56,000 crore.

Each girl requires three shots but not everyone is convinced of the efficacy of the treatment. “At present, no data suggests that either Gardasil or Cervarix can prevent invasive cervical cancer as the testing period is too short to evaluate the long-term benefits of HPV vaccination. The longest available follow-up data from phase II trials for Gardasil and Cervarix are 5 and 8.4 years respectively,” a 2013 study by specialists at the Tata Memorial Hospital (TMH), Mumbai, said.

India is already witnessing a declining trend in cervical cancer due to better hygiene, changing reproductive patterns, improved nutrition and water supply.  “It’s better that we strengthen the reasons behind this trend rather than expose the entire population to the vaccine. It has not been proven to prevent a single cervical cancer death,” Professor Rajesh Dikshit.

Furthermore, a WHO position paper published in May 2017 noted that the “WHO Global Advisory Committee for Vaccine Safety (GACVS), which regularly reviews the evidence on the safety of HPV vaccines” had concluded in January 2016 that the “available evidence did not suggest any safety concern”.

 

 

References

www.9news.com

http://indianexpress.com

www.indiatoday.in

http://indianexpress.com

 

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