The Dilemma on HPV Vaccine

Why in news?

• A new vaccine against HPV Virus has been proposed for introduction into the Universal Immunisation program (UIP).
• But there is considerable opposition for such a move.

What is the HPV?

• ‘Human Papilloma Virus (HPV)’ causes penile cancer in men and cervical, vaginal, anal & vulvar cancer in women.
• It can also cause throat or rectum cancer in both men and women.
• The virus is transmitted through intimate contact like - sexual intercourse, oral or anal sex.
• It poses a higher risk for HIV-infected persons, smokers, and people dependent on hormonal contraceptives.

What is the current status of the Vaccination drive?

• The Vaccine - In India, two vaccines namely “Gardasil” & “Cervarix” are available.
• These vaccines protects against almost 90% of genital warts in men and women.
• The HPV vaccine is given thrice within six months to girls aged 9-13 years, before they become sexually active.
• Post-vaccination, a girl should ideally undergo pap smear tests every three years to check for pre-cancerous or cancerous cells.

• Government Policy - Punjab and Delhi have already begun vaccination for girls.
• National Technical Advisory Group on Immunisation (NTAGI) has proposed the inclusion of these vaccines in UIP for nationwide implementation.
• However, the medical community in India is divided over the vaccine’s utility.

How prevalent is cervical cancer?

• While globally, cervical cancer is the fourth most frequent cancer in women - among Indian women, it is the second most frequent.
• The number of deaths from cervical cancer annually is 74,000 and India accounts for a third of these deaths.  
• Nearly 366 million Indian women aged 15 years and above are at risk from cervical cancer.
• While there has indeed been a fall in the incidences lately, it is still high with 1.32 lakh new cases being diagnosed every year.
• Particularly women from rural areas where sanitation and hygiene standards are low are at a greater risk.

What are the views opposing HPV vaccination?

• The cost of the vaccine (around 12k per person) and the budget to cover a huge population are the major challenge in India.
• With 6.2 crores Indian girls aged 9-13 years, the cost to the government will be over Rs 56,000 crores.
• Also there is no data to suggest that they comprehensively prevent invasive cervical cancer as evaluation requires long testing periods.
• HPV vaccine has also been found to have side-effects such as regional pain syndrome and neurological problems in some cases. 
• Contrarily, India is already witnessing a declining trend in cervical cancer due to better nutrition, hygiene & reproductive patterns.
• Hence, a case for improving these aspects further, rather than expose the entire population to the vaccination holds ground.

What are the views supporting HPV vaccination?

• ‘WHO Global Advisory Committee for Vaccine Safety (GACVS)’ had concluded that there the HPV vaccines are safe.
• 71 countries had introduced HPV vaccine in their immunisation programme for girls and 11 countries included boys too.
• Australia was the first country to introduce HPV vaccination in its school program and now has the lowest level of cervical cancer.
• Indian Case – In India there is already enough manpower and cold storage for vaccines.
• Hence, some argue that the prevention cost will be lower than treatment cost.
• As, awareness on prevention of HPV infections and safe sex is low in India, there is a view that it can’t be solely relied to fight HPV.

Source: Indian Express