Jyotsna Govil
Chairperson, Indian Cancer Society, Delhi Branch
The launch of HPV vaccine program by the Prime Minister in Ajmer on 28th February is a cherished milestone in the journey of public health approach to cervical cancer prevention. Watching the event on television, I was struck by the way Mr. Modi humanised the proceedings by interacting with the young girls.
India has a long history of eradicating and eliminating serious disease burdens through well-planned and well-executed campaigns. From the eradication of smallpox in the 1950s to the more recent Pulse Polio drives, these campaigns were designed for success. That same discipline and public trust will now determine the success of HPV vaccination.
I commend the governments, both at the Centre and in the States, for joining hands to take this forward in campaign mode.
The Indian Cancer Society has long been concerned about the devastation caused by cervical cancer. The statistics on files represent real women to us. We are aware that families fall apart with the death of a mother. We are aware of the pain women bear silently. Most women are taken to treatment centres only when the disease has progressed beyond cure.
Women do not complain loudly. They do not speak easily about pain in their private parts. When “visual inspection” is recommended because it is inexpensive, we feel it compromises a woman’s dignity. When better and more scientific tests like the Pap smear were known since the 1950s to have transformed screening, diagnosis, and outcomes in Europe and America, why did we continue relying on less effective methods simply because they were cheaper? Are the lives of Indian women less valuable?
The Indian Cancer Society raised funds to support Pap testing and now HPV DNA screening tests. We conduct secondary screening to identify and treat lesions with thermal ablation. We also provide financial support to women whose cancer has progressed beyond these simple measures.
But why allow a treatable infection to develop into such devastating disease?
The HPV vaccine has been known since 2008 and was launched in India in 2010. Campaigns were initiated in Gujarat and Andhra, where the three-dose schedule was introduced. Several thousand girls between the ages of 9 and 14 were vaccinated.
Then the anti-vaccine movement intervened. Lurid stories of suicide, drowning, and train accidents spread widely. How these tragic events were in any way related to the vaccine remains unclear to me. Earlier opportunity to scale up had to be postponed as abundant precaution. However, there was a silver lining — research was not banned. With hundreds of girls having received incomplete doses, researchers had a valuable opportunity for long-term follow-up. Girls who received a single dose grew up as healthy as those who received two or three, laying the groundwork for today’s simplified schedule.
Many stalwarts have been involved among them are Dr. Partha Basu (IARC WHO) has emphasised, India’s introduction of HPV vaccination could prevent nearly one million future cervical cancer cases. Long-term Indian research following 17,729 girls for over 15 years has shown the vaccine to be extremely safe, with a single dose providing strong protection. With simplified delivery and high coverage, he notes, India can substantially reduce its future cervical cancer burden.
My salute to the late Dr. Shankar Narayan whose research silently over the years has borne fruit and Dr. Basu for persisting with these long-term studies. Their work, along with others conducted by PATH and international collaborators, and National researchers has strengthened confidence in both efficacy and safety.
Global experience reinforces this confidence. In Australia, publicly funded school-based HPV vaccination began in 2007, later expanded to boys, and transitioned to a single-dose schedule in 2023. As Professor Deborah Bateson has pointed out, in 2021 no cervical cancer cases were diagnosed in women under 25 for the first time since records began — an achievement widely attributed to sustained high vaccination coverage.
Hong Kong offers another example. Through school-based vaccination, catch-up programmes, and innovative self-sampling screening initiatives, coverage has steadily improved. Katharina Reimer and Dr. Karen Chan have described how free vaccination for primary school girls, strong implementation research, and expanded screening access have aligned Hong Kong with WHO elimination targets.
Let us add to their success stories. Let us vaccinate daughters and screen mothers. With planning, coverage, and public trust, we can answer the WHO’s call for the elimination of cervical cancer as a major public health threat.
The introduction of vaccines into national immunisation systems in India is often time consuming because of the scientific scrutiny, supply gurantee and programmatic readiness. However, the necessary building blocks are well thought out, with a strong assurance that they will not falter once rolled out.
To prevent cancer before it begins is an extraordinary act of foresight and the government of India has to be commended for its moral clarity. As we move forward may the vaccination complement not replace screening and awareness and may future generations look back on this moment as one in which India choose prevention and we be a success story as we are for polio and small pox.
