Integrating the HPV Vaccine into India’s National Immunisation Programme

Sub: Sci

Sec: Health

Why in News

Cervical Cancer Awareness Month in January has brought renewed attention to cervical cancer, a major health concern in India. Doctors are emphasizing the importance of screening and the inclusion of the HPV vaccine in the national immunisation programme as a preventive measure.

Cervical Cancer and HPV:

Cervical cancer originates in the cervix, the lower part of the uterus.
India contributes the largest share of the global cervical cancer burden; nearly 1 in every 4 deaths globally due to cervical cancer (as per The Lancet study).
Almost all cervical cancer cases (99%) are linked to infection with high-risk HPV, an extremely common virus transmitted through sexual contact.
It is the third most common cancer among Indian women, with an incidence rate of 18.3% and a mortality rate of 9.1% as per GLOBOCAN 2020.
HPV is responsible for 99.7% of cervical cancers worldwide.
It is a significant cause of cancer among Indian women.
The HPV vaccine prevents HPV infections by stimulating the immune system to produce antibodies that neutralize the virus.
It can prevent more than 90% of cancers associated with HPV.

Status in India:

HPV vaccines are available only via private practitioners despite recommendations from the National Technical Advisory Group for Immunisation (NTAGI).
The NTAGI has suggested:
- A one-time catch-up vaccination for girls aged 9–14 years.
- Routine vaccination for girls aged 9 years.
Introduced in India in 2008, the vaccine is costly, limiting its accessibility.
Some states like Punjab and Sikkim have incorporated it into their immunisation programmes.

Approved HPV Vaccines in India:

Gardasil (quadrivalent vaccine): Protects against HPV-6, 11, 16, and 18.
Cervarix (bivalent vaccine): Focuses on HPV-16 and 18.
Cervavac (India’s first indigenously developed vaccine): Targets high-risk HPV types 16 and 18, priced at ₹2,000 per dose.
Protects against cancers of the cervix, vagina, vulva, penis, anus, and certain head and neck cancers caused by HPV. Effective when administered before exposure to HPV.
Papumpare district, Arunachal Pradesh: Highest incidence rate in Asia (27.7).
Most cervical cancer cases are diagnosed at advanced stages (60% locally advanced stage).

About Human Papillomavirus (HPV):

It is a common virus with over 100 strains, some of which can lead to cervical cancer and other cancers, as well as genital warts. HPV types 16 and 18 are responsible for around 70% of cervical cancer cases worldwide.

About HPV Vaccine:

The HPV vaccine is designed to prevent infections from high-risk HPV strains linked to cancer. It works best when administered before exposure to the virus, ideally during pre-adolescence (ages 11-13).
“Valent” in HPV Vaccines: The term “valent” refers to the number of different HPV (Human Papillomavirus) strains a vaccine targets. Each type of HPV vaccine is designed to protect against specific strains known to cause cervical cancer and other HPV-related diseases.

Bivalent Vaccine

Targets: HPV types 16 and 18.
Coverage: Provides protection against the two strains responsible for about 70% of cervical cancer cases.
Example: Cervarix.

Quadrivalent Vaccine

Targets: HPV types 6, 11, 16, and 18.
Coverage: In addition to cervical cancer, it protects against strains causing genital warts (types 6 and 11).
Example: Gardasil.

Nonavalent (Nine-valent) Vaccine

Targets: HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58.
Coverage: Offers the broadest protection, covering about 90% of HPV-related cancers and diseases.
Example: Gardasil 9.