Indian vaccine hope in cervical cancer prevention

The announcement of the scientific completion of India's first indigenously developed vaccine for the prevention of cervical cancer marks a historic milestone in the fight against cancer and the country's medical research. The probability of developing Human Papilloma Virus (HPV) associated with cervical cancer is very high (1 in every 86 female) in north-eastern states, the vaccine has brought new hopes of protection from cancer for all women at risk of the disease in the region. The affordable price of this indigenous vaccine will be a game changer in the prevention of cervical cancer. The indigenous vaccine, which will give protection against four types of HPV, to be developed by the Pune-based Serum Institute of India is expected to be made available in the affordable range of Rs 200-400. Each dose of HPV vaccine manufactured by foreign companies currently available in India costs around Rs 2,500 to Rs 3,500. The National Technical Advisory Group on Immunization (NTAGI) has recommended that the indigenously developed HPV vaccine may be considered for introduction in the Universal Immunization Programme as a two-dose regimen. The HPV Working Group of NTAGI recommended a single dose HPV vaccine having at least 2 years of evidence on sustained and adequate antibodies level and efficacy/effectiveness data after a single dose, for the girls of age group 9-14 years in routine immunization. Decks for commercial manufacture of the vaccine were cleared after the Drugs Controller General of India granted market authorization to the SII in July. About 83% of invasive cervical cancers are attributed to HPV type 16 or HPV type 18 in India, and these two HPV strains account for 70% of cervical cancer cases worldwide. The World Health Organization in its "Global strategy to accelerate the elimination of cervical cancer as a public health problem" sets targets that must be met by 2030 for countries to be on the path toward cervical cancer elimination. These targets include fully vaccinating 90% of girls with HPV vaccine by the age of 15 years, 70% of women being screened with a high-performance test by 35 years of age and again by 45 years of age, 90% of women identified with the cervical disease receive treatment (90% of women with pre-cancer treated, and 90% of women with invasive cancer managed). It is estimated that the median cervical cancer incidence rate will fall by 42% by 2045, and by 97% by 2120, averting more than 74 million new cases of cervical cancer if the countries can meet these targets. The strategy document highlighted that the annual number of new cases of cervical cancer has been projected to increase from 5,70,000 to 700,000 between 2018 and 2030, with the annual number of deaths projected to increase from 3,11,000 to 4,00,000. More than 85% of those affected are young, undereducated women who live in the world's poorest countries and many are also mothers of young children whose survival is subsequently truncated by the premature death of their mothers, it adds. The WHO data puts in perspective the importance of India's indigenous vaccine in ending the disparity in access to HPV vaccines. As of 2020, about 100 million adolescent girls received at least one dose of the HPV vaccine but 95% were in high-income countries. Around 30% of low-income countries reported having pathology services, cancer surgery, chemotherapy and radiotherapy generally available in the public sector, compared with more than 90% of high-income countries. Less than 25% of low-income countries have introduced the HPV vaccine into their national immunization schedules. SII's announcement that after the first 200 million HPV vaccine doses in India, it will supply to other countries will put India's indigenous vaccine at the centre of affordable and accessibility for adolescent girls across the globe. Successful immunization in India, therefore, will also establish India's advance in medical research and its leadership in the field of vaccination. NTAGI data show that Sikkim is the first state to introduce the HPV vaccine in the entire country. According to NTAGI, the Key lessons from Sikkim include strong political will and media sensitization to ensure a smooth rollout of vaccination. Parent-teacher meetings in all schools and one teacher made a nodal person for HPV vaccination besides same class vaccination were a favourable strategy for second dose vaccination after six months. Initially, the vaccine was introduced in 2014 but could not be continued due to hesitancy. Later, the vaccine was re-introduced in 2018 after detailed pre-roll-out preparation and leveraging lessons of 2014, NTAGI notes. All 9 to 14 years old girls were given 2 doses of vaccine separated by a minimum gap of 6 months. All Schools were included (Government as well as Private) and out-of-school girls of this age group were also covered, and the lessons learnt will be useful for the national HPV vaccination programme and in the northeast. The launching of the indigenous HPV vaccine has bolstered the fight against cancer in India.