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Delhi, 1st state to launch HPV vaccine for cervical cancer, sees numbers fall. Blame pandemic

New Delhi: The Human Papilloma Virus (HPV) vaccination drive in Delhi, which is aimed at preventing cervical cancer among young women, has been one of the casualties of regular classes in schools being suspended for the Covid-19 pandemic, said senior government officials.

The officials said they haven’t been able to collate data on HPV vaccination since April 2020, largely because of the focus on Covid-19 management. When it is done, the numbers would be very low, they said. 

They said that around 13,000 girls aged between 11 and 13 years — mostly in batches from schools — were administered HPV vaccines free of cost in Delhi between November 2016 and March 2020.

Delhi became the first state in the country in November 2016 to launch HPV vaccination as a public health programme. In 2017 and 2018, Punjab and Sikkim, too launched their own programmes. 

Not only has closed schools hit the HPV vaccination drive hard, its roll-out across the country — The Union government is yet to include HPV vaccination in the universal immunisation programme (UIP) — is fiercely opposed by the Rashtriya Swayamsevak Sangh (RSS) and its affiliate, the Swadeshi Jagran Manch (SJM), who highlight the vaccine’s potential adverse effects and question its utility.

India has a high caseload of cervical cancer, and it ranks second among all cancers in Indian women, after breast cancer. And HPV is believed to be associated with more than 80 per cent cervical cancer cases.

As part of the government programme, girls aged between 11-13 years are eligible to be vaccinated free of cost at the Delhi State Cancer Institute, through its centres in east Delhi’s Dilshad Garden and west Delhi’s Janak Puri, said a government circular which ThePrint has seen.

The centres are currently functional, but the turnout has dropped, said senior government officials in Delhi.

During the nationwide lockdown during the first wave of the pandemic in March 2020, physical classes were suspended in schools across states. Between March 2020 and December 2021, regular classes in Delhi’s schools were suspended for around 90 weeks. Currently, they are suspended again, due to the third wave of Covid-19.

Also read: India lagging in cervical cancer prevention, needs more screening, vaccination, experts say

Numbers picked up before pandemic

Between November 2016 and March 2017, around 1,200 girls were administered HPV vaccination under the government programme in Delhi. The number rose to 3,700 in the period between April 2017 and December 2018. Around 8,100 were vaccinated between January 2019 and March 2020, said senior government officials, citing government records.

“The vaccination drive was clearly picking up each year. Once the vaccine was introduced into the state’s public health profile, a large number of agencies, including the state government, municipal bodies and non-governmental organisations joined hands in creating awareness. Most awareness programmes would take place in public schools,” said a senior official in the Delhi government who did not wish to be identified.

The official further said, “But schools are closed now. So, the numbers have severely declined. We have not been able to summarise data for nearly two years now because a large part of the system is engaged in Covid-19 management. Records are maintained. We can summarise the data later. But we can tell you that the numbers are very low.”

Another senior government official said, “The HPV vaccine centres are open, but the turnout is low. It is largely because we no longer see batches of students coming from schools in the city. People can personally come to these centres and get the vaccines for free. But such cases are rare. The centres now see people once in a while.”

ThePrint reached to Delhi government spokespersons and the office of health minister Satyendar Jain through phone calls and text messages for comments on their plan to revive the HPV vaccination drive, if any. No response was received from them till the time of publishing this report.

Resistance against HPV vaccine

The HPV vaccine has been facing strong resistance from the Rashtriya Swayamsevak Sangh (RSS) ever since the Union government expressed plans in December 2015 to introduce it in the universal immunisation programme and asked the sub-committee of the technical advisory group to look at the incidence of cervical cancer in India and take a call on the vaccine at the earliest, senior officials said.

In December 2016, the Swadeshi Jagran Manch (SJM), a cultural-economic organisation and an RSS-affiliate, wrote to the prime minister, highlighting risks of the vaccine, potential adverse effects and questioning its utility. Acting on a complaint to the Prime Minister’s Office (PMO) by the SJM, the health ministry asked the drugs regulator to look into the matter and take “necessary actions”.

“We still have the same stand on the issue. The vaccine has major safety concerns,” Ashwani Mahajan, national co-convener of the Swadeshi Jagran Manch, told ThePrint.

Controversy regarding the vaccine surfaced in India in 2009, when a clinical trial project anchored by a US-based NGO to give the HPV vaccine to 32,000 children in Andhra Pradesh and Gujarat ran into rough weather after some deaths were reported. The project had to be discontinued and was cited by activists as an instance of multinational companies exploiting the poor for their clinical trials. 

But in its report published in 2011, a copy of which ThePrint has seen, the Union government, based on the findings of a committee it had set up, said that the deaths were unrelated to the HPV vaccination drive.

“Several developed countries have not introduced it in their national healthcare programmes. India should also not introduce this vaccine in its universal immunisation programme,” said Mahajan.

Approval for inclusion in UIP awaited

According to records of the World Health Organization (WHO), over 100 countries across the world have fully or partially introduced HPV vaccines in their national healthcare schedules — they include the US, UK, Canada, Australia, South Africa, Brazil, Argentina, New Zealand, Spain, Portugal, France and Japan.

India is not one of them, according to records of the central government and the WHO.

In January 2018, the National Technical Advisory Group on Immunisation, the highest technical body on vaccination, gave its approval to the introduction of the cervical cancer vaccine in India’s universal immunisation programme, subject to the outcome of a 2012 case in the Supreme Court regarding adequate clinical trials of the vaccine — which still remains pending.

“Health is a state subject in India. But as far as the question regarding the Union government adding or not adding the vaccine in the universal immunisation programme is concerned, there is a due process to be followed,” said a senior central government official.

ThePrint has sought comments from the Union health ministry, too, through an email. They did not respond till the time of publishing this report.

Nearly 4,20,000 cervical cancer cases at any point of time

HPV is a group of more than 150 viruses that cause ‘papilloma’, or warts, in parts of the body, including the genital areas. It is primarily spread by skin-to-skin contact and is responsible for a number of diseases, including cancers, especially cancer of the cervix (the neck of the uterus).

Cervical cancer ranks second among all cancers in Indian women, after breast cancer. HPV is believed to be associated with more than 80 per cent cervical cancers.

According to government data, an estimated 1,23,907 new cervical cancer cases are detected annually in India. Every year, 77,348 deaths occur from it. At any given point of time, nearly 4,20,000 cervical cancer cases are present in the country.

(by Saikat Niyogi)

Also read: India’s cancer problem — not enough clinical trials and lack of access to those being done

Source: The Print

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