The debate over the use of vaccines to prevent cervical cancer in India came to the fore again last week when the Ministry of Health and Family Welfare indicated that it was unlikely to include Human Papilloma Virus or HPV vaccines in the national immunization programme.

The health ministry’s decision comes even though the National Technical Advisory Group on Immunisation is still considering the introduction of the vaccine into the programme. However, the Swadeshi Jagran Manch, an affiliate of the Rashtriya Swayamsevak Sangh, wrote to Prime Minister Narendra Modi in early December calling such a move an “unmitigated disaster” and asking for the vaccine to kept out of the public health programme.

A few days later, Dr. Soumya Swaminathan, deputy director general of the World Health Organisation and former director general of the Indian Council of Medical Research, told The Indian Express that the vaccine should be introduced in India since it could help avert a large number of cervical cancer deaths in the country.

Cervical cancer is the second leading cause of cancer deaths among women in India. More than 122,000 women in India are diagnosed with cervical cancer and more than 67,000 dies of the disease every year. About 25% of all cervical cancer deaths in the world occur in India.

The most common cause of cervical cancer is HPV. There are more than 100 types of the virus, of which at least 13 are known to cause cancer. Two strains – type 16 and type 18 – cause about 70% of all cervical cancer. This makes cervical cancer one of two vaccine-preventable cancers. The other is the cancer of liver – the Hepatitis B vaccine helps prevent it.

There are two kinds of cervical cancer vaccines currently widely available. Cervarix manufactured by GlaxoSmithKline is a bivalent vaccine that protects against infection by two HPV strains – type 16 and type 18. The other vaccine is Gardasil manufactured by Merck, which is a quadrivalent vaccine that provides protection against four HPV strains – types 16, 18, 6 and 11.

Types 6 and 11 cause genital warts that are additional risk factors for cervical cancer. The vaccines are usually administered to girls and women between the ages of nine and 26. The vaccines do not treat pre-existing HPV infections and so must be administered before initiation of sexual activity.

India approved the two HPV vaccines in 2008 and they have been available in the private medical sector. However, the vaccines are expensive, priced at between Rs 2,000 and Rs 3,000 for a single dose. The vaccination consists of a series of two or three doses depending on age.

The government has been considering introducing the vaccines into the public health programme, which would allow women and girls from poor households to access them. The government had tied up with the Global Alliance for Vaccines and Immunization to procure the vaccine at subsidized rates.

Among the many factors that are considered while introducing a vaccine into the public immunisation programme are vaccine efficacy, vaccine safety and how cost effective it is.