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(This story has been republished from FIT's archives following the DCGI authorizing the manufacture of India's first indigenous vaccine to treat HPV and cervical cancer.)
(Last week of April is observed as World Immunisation Week by World Health Organisation. The theme this year is #VaccinesWork. FIT is republishing this article to create awareness about the importance of vaccinations)
What happens when it’s recommended that 9-year-old girls get vaccinated against a sexually-transmitted virus? We get squeamish.
Doctors are asking for all girls after the age of nine to be given vaccine for HPV (human papillomavirus), which causes cervical cancer. The reason is that kids one day will grow up and have sex and therefore, it’s important to protect them from this harmful virus. There has been some push to include the HPV vaccine as part of the country’s universal immunisation programme.
However, there still are a lot of questions that people have in mind and not everyone is convinced. Why now? Our pre-teens aren’t having sex right now. Can we get the vaccine later in life? Does it have side effects? What is HPV and how harmful is it? Our explainer as we observe Cervical Cancer Prevention Week.
Cervical cancer, mainly caused by HPV, is the leading cancer in Indian women, the second most common cancer in women worldwide, and the fifth most common cancer in humans.
Too caught up to read? Listen to the story:
In India, there are 74,000 deaths caused by cervical cancer and 1.32 lakh new cases diagnosed every year. Nearly 366 million Indian girls and women aged 15 years and above are at risk from cervical cancer.
Gynaecologists we spoke with vouch for the vaccine and several studies have been published which call it an effective option.
HPV is the most common sexually-transmitted infection (STD) globally. Most people are infected at some point in their lives.
HPV is a group of more than 150 related viruses. Most HPV infections are usually harmless and go away by themselves, but some types can lead to cancer or genital warts. Nearly all cervical cancer is due to HPV of two types, HPV16 and HPV18.
To be most effective, the vaccine is recommended to be given between the ages of nine and 13. One obvious factor is to immunise before they get sexually active. But also, younger girls will develop immunity better.
If an adult who is not sexually active and is getting a shot, and a child is getting a shot, the vaccine is more effective in the latter, she adds.
The dose is also lesser for children between ages 9 and 11, they get two shots. From year 11 and above, three shots within 6 months are given.
Dr Chitra Setya, a senior gynaecologist, says that school-going children are also more accessible.
The vaccine can be given to women up to the age of 45. And you can get it whether or not you’re sexually active.
You can continue with normal activities, sexual or otherwise, during the course of your vaccination.
It doesn’t have side effects. Depending on the individual, even if it does, they are mild and temporary like any other vaccine.
Many doctors and public health experts are in favour of the vaccine being introduced as part of the Universal Immunisation Programme. The Indian Council of Medical Research (ICMR) has been the driving force behind the vaccination programme.
The Delhi and Punjab governments have already started vaccinating girls aged 11-13 from November 2016.
However, some oncologists from Mumbai’s Tata Memorial Centre feel that HPV vaccine is not needed. They cite the sharp fall in the number of cervical cancer cases without medical intervention, attributing it to increased awareness, particularly of personal hygiene. They also questioned the efficacy and safety of the vaccine.
As a counter to this, the WHO and ICMR say that evidence suggests that there is no safety concern.
There are two brands of the vaccine available. A single shot of Gardasil costs approximately Rs 3,000 and Cervarix, about Rs 2,000. So yes, it is a costly intervention.
Recently, RSS’s economic wing, the Swadeshi Jagran Manch, asked Prime Minister Narendra Modi to not include the vaccine, saying it would “divert scarce resources from more worthwhile health initiatives to (a) vaccine of doubtful utility”.
For people who are against the vaccine, the high cost is their strongest argument. But experts in favour argue that it’s an effective tool to combat a dangerous cancer.
“When it comes to protecting the whole country, the government has to prioritise. But see this cancer affects women when they are young. We lose one mother every eight minutes, usually in their 30s or 40s, often just at the time when families need them the most,” Dr Ranjana Sharma puts it into perspective.
Gynaecologists don’t think so. They believe that access to healthcare is a bigger problem than hygiene in rural areas.
Cervical cancer has a high mortality rate, if the vaccine isn’t made widely available, in rural areas people won’t even know about cervical screening.
Cervical cancer screening, such as a pap smear, can detect early cancer or abnormal cells that may develop into cancer.
In urban areas, people are accessing the vaccine in private healthcare, but for rural areas a programme is needed since the costs are high.
She adds that hygiene plays a role but there are more important risk factors including sex at an early age, multiple partners, and poor immune function and urban areas have all these factors too.
HPV is a virus that any sexually active human can contract, male or female. Men run the risk of penile cancer and other problems like warts because of HPV and that can have implications in the mouth and lungs as well.
If you are a parent of a pre-teen, educate yourself, weigh your options and make a balanced decision based not on morality but facts.
(FIT is reproducing the story first published on 22nd December 2017 for Cervical Cancer Prevention Week. Cervical cancer is the second most common cancer among women in India.)
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Published: 21 Dec 2017,05:56 PM IST