Mumbai: More than a decade after many countries introduced the human papillomavirus (HPV) vaccine, India rolled out a vaccination programme targeting 14-year-old girls on Feb 28. Public health experts have welcomed the decision, but many believe a few more steps are needed to ensure that the vaccination programme, which aims to stamp out cervical cancer, is a success.
According to a statement released by Jan Swasthya Abhiyan, a coalition of groups working in the health sector, the ongoing rollout must be accompanied by independent monitoring of the vaccination programme, stronger screening systems and safeguards against coercive implementation.
JSA’s policy note said scientific evidence supports HPV vaccination in reducing high-risk HPV infection and precancerous lesions, and pointed to growing long-term evidence from countries such as Sweden and the UK showing a reduction in cervical cancer incidence. “At the same time, vaccination should not be projected as a standalone solution,” said Dr Abhay Shukla of JSA.
Cervical cancer remains a major public health issue in India, with an incidence of 18.7 per 100,000 women and an estimated 80,000 deaths annually; it disproportionately affects poorer and rural women. Screening for women aged 30 to 65 is essential and cannot be replaced by vaccination, said the JSA statement.
Ideally, said JSA office-bearers, the HPV vaccination programme should be paired with expanded cervical cancer screening, follow-up and treatment services. “Vaccination and screening are complementary rather than substitutes,” said the statement.
There is, for instance, a need for increased govt investment in screening methods such as Pap smear, visual inspection and HPV testing, along with timely and affordable treatment pathways.
One of the demands made by JSA is independent evaluation of the vaccination drive. Watch groups led by civil society, women’s groups, frontline workers and public health practitioners could independently monitor implementation as well as check consent practices, track adverse events to the vaccine.
State and national-level bodies should closely monitor adverse events following immunisation, according to the health activists.
Dr Shukla said national-level discussions sought to raise ethical concerns over informed consent, citing the experience of the 2009 HPV vaccine demonstration project, where a parliamentary standing committee found violations, including consent forms being signed by hostel wardens or teachers instead of parents.
Vaccination should be voluntary, not compulsory, and there must be written and verbal informed consent in local languages along with parental consent.
