Good News! Indigenous HPV Vaccine on Shelf by this Year End what India Must do to Hasten Cervical Cancer Elimination by 2030?

Abstract

In May 2018, the WHO announced a global call for action to make elimination a reality and calling for all stakeholders to unite behind this common goal. Vaccination against HPV and screening and treatment of pre-cancer lesions are cost-effective ways to prevent cervical cancer. Human papillomavirus (HPV) vaccines, introduced in many countries in the past decade, have shown promising results in decreasing HPV infection and related diseases, such as warts and precancerous lesions. However currently, vaccine’s coverage, in low- and middle-income countries including India is very low to show any impact in the next 2-3 decades. Govt. of India had launched a National Cancer Control Programme in 1975, revised its strategies in 1984-85 and again under National Health Policy 2017. While it stresses on primary prevention for Tobacco related cancers, addresses only secondary prevention of cancer of the uterine cervix, mouth, breast etc. and tertiary prevention of therapeutic services including pain relief. Cervical cancer is the fourth most common cancer among women globally, with an estimated 604 000 new cases and 342 000 deaths in 2020. About 90% of the new cases and deaths worldwide in 2020 occurred in low- and middle-income countries. India accounts for about a fifth of the global burden of cervical cancer with about 1.25 Lakh cases and 67,000 deaths every year. Cervical cancer in India ranks as the second most frequent cancer among women between 15 and 44 years of age. Most cervical cancers are associated with human papillomaviruses, a sexually transmitted disease. HPV vaccination has been attempted in the sates of Delhi, Punjab, Odisha on a pilot project mode. So far, the cost of the vaccines (US 60-80 $) has been prohibitive for an average Indian. Coupled with Poor awareness even among educated and affordable population and the cultural hurdles of vaccinating young girls for a condition that manifests after 40 years is a communication challenge. The first hurdle in India of production of affordable indigenous HPV vaccine has been achieved (5 September 2022) recently opening a big opportunity. Governments (both federal and provincial) must make all-out efforts vaccinate all eligible females of the country; we owe it Indian women! In my opinion India must introduce pan-gender vaccination programs and start tracking all HPV-related (head and neck and anal) cancers and evaluate impact of HPV every decade for the next 50 years. A Mission mode is required to cover all the eligible in the next 2-5 years paid by the government (for at least below poverty line -BPL) families and provision of education through education system and social mobilization on a large scale are the key strategies to achieve this goal. This manuscript is a review the status of Cervical cancer, screening and diagnostic efforts, HPV vaccination status and recommends the way ahead to achieve national commitment for elimination of HPV related cervical and other cancers by 2030. Materials & Methods: GOI annual reports, HPV vaccination project efforts and outputs and Program implementation plans and Campaign approaches of vaccination under NHM, Indigenous vaccine producers’ statement and DCGs clearance.