Toward a Nationwide HPV Vaccination Campaign in India

Naysayers have forwarded unsubstantiated claims about lack of vaccine safety to already-settled debates about the vaccine's potential to encourage risky behaviour.

Not too long ago, leading oncologists at a cancer summit in Mumbai belittled the importance of a human papillomavirus (HPV) vaccination campaign in India. At this conference, several physicians suggested that public health efforts that have improved basic hygiene and sanitation have been enough to tackle the burden of HPV infection and cervical cancer in the country that harbours nearly a quarter of the world’s cervical cancer deaths. Thankfully, other medical providers in India have acknowledged the ridiculousness of this notion and understand the need and importance of a structured HPV vaccination program – with the Delhi State Cancer Institute (DSCI) taking the initiative to roll out the country’s first HPV vaccination campaign.

R.K. Grover, the director of DSCI and the leader of this effort, has seen significant changes in the country’s understanding of cancer since he first started practicing oncology in India in 1979, “There have been tremendous developments in the field of imaging sciences, surgical techniques, radiation treatment techniques, [and] newer anticancer drugs … all [this] research and development in the field of medical sciences [has] led to significant improvements in cure rates from different cancers over the years.”

All of the above makes India’s reluctance toward implementing a nationwide HPV vaccination campaign all the more bewildering. When DSCI began its initial announcements about the planned vaccination campaign, they met significant resistance from naysayers. From unsubstantiated claims about lack of vaccine safety to already-settled debates about the vaccine’s potential to encourage risky behaviour, the leaders at DSCI found themselves immediately on the defensive due to these unfounded attacks. But they have persisted in their efforts since, and with the help of the Delhi government and funding from Gavi (an international public-private partnership), the DSCI group ultimately hopes to help vaccinate “every girl child in the target age group in Delhi.”

In speaking about the disease burden faced by India, Grover noted that DSCI itself “[sees and treats] about 500 new cases of cervical cancer every year.” Not surprisingly, the large majority of these women are in the later stages, when the prognosis and outcomes are very poor. For these women, one can only wonder how different their tales might have been had an HPV vaccination campaign been prevalent in India during their time. Because, while “cure rates in [these late stages] are generally below 10%,” there is no way to ignore the critical fact that these women are dying of a cancer that is very preventable.

Epidemiologist Suneeta Krishnan, India’s country director for RTI International, a nonprofit research organisation, has been working with colleagues from the American Cancer Society to run advocacy workshops that aim to highlight the importance of primary prevention of cervical cancer. The ultimate goal of these workshops is to “disseminate accurate science-based information on comprehensive cervical cancer prevention and control, including HPV vaccination” among physicians and public health champions alike. And so far, in all of the interactions, those present have been “in agreement about the need to move forward with primary prevention [efforts] … [and] mentioned [that] if Delhi takes the lead, others will be emboldened to follow.”

India is no stranger to initial resistance against vaccination campaigns, with both smallpox and polio eradication efforts only seeing success thanks to strong government efforts. And it is with this knowledge and firm proof of benefits of the HPV vaccination campaign that all those working to bring this vaccination to India are forging forward.

Farah Khan is a doctor and writer.