HPV vaccination: key factors studied

Published in The Hindu on September 11, 2008

Nearly 1.30 lakh women are diagnosed with cervical cancer every year in India and about 75,000 deaths due to cervical cancer each year. — Photo: WHO

A formative study was completed recently to understand the various facets of the society and health systems prior to introducing a vaccine that can prevent Human papillomavirus (HPV) infection that is responsible for causing cervical cancer in women.

The results of the study were presented to the government very recently. The study was started late last year and undertaken in one district each in Andhra Pradesh (Khammam) and Gujarat (Baroda). The tribal, rural and urban populations were studied in both the districts. Group discussions with about 400 people, including girls, teachers, parents, community leaders and health workers were held.

Representative States

“We chose these two States and the two districts as they represented a national scenario. They were neither highly nor underdeveloped States and districts,” said Dr. Nita Mawar, of the Division of Social and behavioural Research at National AIDS Research Institute (NARI), Pune. She was a Co-principal investigator of the study.

With nearly 1.30 lakh women diagnosed with cervical cancer every year in India and about 75,000 dying from it, efforts are under way to explore the possibility of introducing the vaccine in India. The formative study that was undertaken formed the first step in this process.

Key driver

“The formative study findings will be a key driver for future planning on taking this project to the next level which is the demonstration project,” noted a PATH official to this Correspondent by email.

The vaccine, manufactured by two pharmaceutical companies and licensed and used in many developed countries, is given to teenagers before they become sexually active.

Since the virus which causes cervical cancer is transmitted through the sexual route, the only way to prevent the disease is to vaccinate girls before they become sexually active.

“The age group to be vaccinated will be guided by the Drug Controller General of India’s recommendations,” the official noted. But it appears that the plan is to vaccinate girls who are 10-14 years old. “The idea is to vaccinate girls before they have had any sexual encounter,” Dr. Mawar explained. “And in India, girls are sometimes married the moment they attain menarche (13-14 years).”

But the awareness about the disease and route of transmission is low in the community.

Low awareness

“We found very little awareness in girls and the community about cervical cancer. They often confused it with uterine cancer. They did not know about the symptoms, cause and treatment of the disease. And most importantly, about a vaccine that can prevent cervical cancer,” she said. “Most felt that hygiene played a role in causing the disease.”

While the vaccine would be provided free of cost during the demonstration study, the current plan is not to provide it free like other vaccines when it is commercialised.

Same districts

The demonstration study will be undertaken only after the government licences the vaccine. And it will be undertaken in the same districts where the formative study was conducted.

“The demonstration project aims to evaluate effectiveness (coverage), cultural appropriateness (acceptability), feasibility and cost of the HPV vaccine delivery strategy,” the PATH official added.

“People expect the government to provide the vaccine free of cost. But if they have to pay, they said they can afford it if it is priced between Rs.10-100 for the three injections,” Dr. Mawar said. Three injections are required, one each at 0, 3 and 6 months.

Willingness to pay

“But as they are aware that cancer treatment is expensive, they are open to the idea of vaccination,” she said.

According to Dr. Mawar, the formative study helped to understand that awareness of the disease, the route of transmission and the availability of a vaccine to prevent it are very low.

“Awareness building on all aspects of cervical cancer is required. This should be done before the vaccine is introduced,” she said.

The formative study was undertaken jointly by PATH and NARI.

The prospects of introducing a cervical vaccine are taken up by PATH in collaboration with the Indian Council of Medical Research (ICMR).