{"id":27648,"date":"2021-11-17T10:36:04","date_gmt":"2021-11-17T10:36:04","guid":{"rendered":"https:\/\/news.cancerresearchuk.org\/?p=23791"},"modified":"2024-11-03T15:14:09","modified_gmt":"2024-11-03T15:14:09","slug":"that-is-what-i-dream-indias-journey-to-rolling-out-the-hpv-vaccine","status":"publish","type":"post","link":"https:\/\/ogkologos.com\/en\/that-is-what-i-dream-indias-journey-to-rolling-out-the-hpv-vaccine\/","title":{"rendered":"\u201cThat is what I dream\u201d: India\u2019s journey to rolling out the HPV vaccine"},"content":{"rendered":"
\"A<\/div>\n

Globally, cervical cancer is the fourth most common cancer in women.<\/span><\/p>\n

It\u2019s unusual, as cancers go, in that 99% of cases worldwide are caused by a virus called human papillomavirus (HPV). In many countries around the world, people are given a vaccine to prevent HPV at an early age.<\/span><\/p>\n

You may have seen this vaccine<\/span> in the news recently<\/span><\/a>, when ground-breaking research proved, for the very first time, that the UK\u2019s HPV vaccination programme<\/span> reduced cervical cancer cases by almost 90% in women in their 20s who were offered it at age 12 to 13.<\/span><\/p>\n

The mounting evidence continues to point us in one direction \u2013 that cervical cancer is highly preventable. But despite this, across the globe, someone dies every 2 minutes from the disease.<\/span><\/p>\n

In 2020 alone, it\u2019s estimated that over 600,000 women worldwide were diagnosed with the disease, and over 340,000 died because of it.<\/span><\/p>\n

Dr Ishu Kataria is one of the people trying to change those figures. Kataria is a senior public health researcher at the<\/span> Research Triangle Institute (RTI) International<\/span><\/a> Center for Global Noncommunicable Diseases<\/span>. In addition, she<\/span> works with the World Health Organization to help<\/span> prevent the spread of infections<\/span><\/a> like HPV around the world.<\/span><\/p>\n

Why is an HPV vaccination programme so important?<\/span><\/h2>\n

HPV is extremely common, infecting the skin and the cells lining the inside of the body. Most of the time the HPV infection doesn\u2019t cause any problems and clears up by itself. It\u2019s only when certain types, or strains, of the virus can\u2019t be fought off by the body\u2019s immune system, that it can cause damage that can lead to cancer.<\/span><\/p>\n

HPV vaccines offered in the UK protect against the main cancer-causing strains of the virus: HPV 16 and 18.<\/span><\/p>\n

\u201cBecause HPV is a major cause of cervical cancer, a vaccine against HPV will help prevent a woman from getting cervical cancer in the future, which is actually a disease that can become fatal, particularly if it progresses to later stages.\u201d explains Kataria. \u201cWe see a lot of deaths that happen across the globe due to cervical cancer. But the vaccine can actually prevent most cases of the disease if we give it to girls before they are exposed to the virus.\u201d<\/span><\/p>\n

Previous results<\/span><\/a> had confirmed that HPV vaccination is effective in preventing HPV infection, genital warts and precancerous cell changes in the cervix. Now, evidence continues to indicate that the HPV vaccine is highly effective at preventing cervical cancer.<\/span><\/p>\n

What\u2019s more, a year ago, on 17<\/span>th<\/span> November 2020, the World Health Organization (WHO) announced an ambitious plan: to create<\/span> a \u2018cervical cancer-free future\u2019<\/span><\/a>. A strategy which hopes to see cervical cancer become the first cancer to be \u2018eliminated as a health problem\u2019 on a global scale.<\/span><\/p>\n

to ensure 90% of girls are vaccinated, 70% of women are screened and 90% of women with<\/span> pre-cancerous cervical cell changes<\/span> receive treatment.<\/span> These are milestones to be achieved by 2030 in order to make sure the world is on the right track<\/span> to dramatically reduc<\/span>ing<\/span> cervical cancer burden.<\/span><\/p>\n

\n

It’s #CervicalCancer<\/a> Awareness Month!<\/p>\n

Cervical cancer could be the first cancer EVER in the world to be eliminated, if<\/p>\n

9⃣0⃣% of girls are vaccinated
7⃣0⃣% of women are screened
9⃣0⃣% of women with cervical disease receive treatment pic.twitter.com\/Ewsm6jN0UT<\/a><\/p>\n

\u2014 World Health Organization (WHO) (@WHO) January 8, 2021<\/a><\/p>\n<\/blockquote>\n

A year on, and the<\/span> COVID-19<\/span> pandemic has slowed down progress for the WHO\u2019s plan. Considerable steps forward have been made with the launch of<\/span><\/span> new guidelines<\/span><\/span><\/a> to inform cervical screening and<\/span><\/span> several trials<\/span><\/span><\/a> exploring the use of single dose HPV vaccines. But despite th<\/span>ese<\/span> advan<\/span>ces<\/span>,<\/span><\/span> and<\/span> the<\/span><\/span> slowly decreasing trends<\/span><\/span><\/span><\/a> in cervical cancer rates globally, this isn\u2019t equal around the world. Cervical cancer still has some of the highest case numbers of all cancer types, with some countries seeing an increase in incidence rates in the last two decades. Cervical cancer remains a substantial health problem for women globally.<\/span><\/span><\/p>\n

, cervical cancer<\/span> it is the third most common cance<\/span>r<\/span> and<\/span> accounts for the second highest number of cancer deaths in the country<\/span>.<\/span> In fact,<\/span> almost a quarter (<\/span>2<\/span>3<\/span>%<\/span>)<\/span> of cervical cancer cases and deaths<\/span> around the world<\/span> are estimated to occur in India.<\/span> People are screened for cervical cancer but right now<\/span> \u2013 in the<\/span> country that contains<\/span> almost<\/span> a<\/span> fifth (18%)<\/span> of the global population<\/span> \u2013 there\u2019s no consistent national<\/span> HPV vaccination<\/span> programme.<\/span><\/span><\/p>\n

This is where Kataria and her team have stepped in. They\u2019re embarking on a unique research project, funded by Cancer Research UK, to assess the feasibility of introducing the HPV vaccine into India\u2019s National Immunisation Programme.<\/span><\/p>\n

\u201cWhat our project is aiming to do is to understand what the level of vaccine preparedness is and help to develop the evidence to encourage state Governments who are intending to introduce the HPV vaccine.\u201d<\/span><\/p>\n

The scale of public health in India<\/span><\/h2>\n

In a country as large as India, it\u2019s an ambitious goal. India is around 13 times larger than the UK, with a population that\u2019s about 20 times greater, at well over 1 billion people.<\/span><\/p>\n

India\u2019s divided up into 28 different states \u2013 some of them small, like Sikkim (just a bit more than the City of Glasgow), and some very big, like Uttar Pradesh (similar to the combined population of the UK, Ireland, France, Spain, Portugal and Poland).<\/em><\/span><\/p>\n

\"Infographic<\/p>\n

Copy this link and share our graphic.<\/a> Credit: Cancer Research UK.<\/p>\n<\/div>\n

Unlike the UK, where the majority of healthcare services are provided centrally through the NHS, the different states in India control their healthcare and are guided by the national Government. This means that the administration of the HPV vaccine can vary between states \u2013 in some states it\u2019s delivered routinely, while in others, the vaccine programme doesn\u2019t exist.<\/span><\/p>\n

Because HPV tends to be sexually transmitted, the vaccine is given to adolescent girls between the ages of 9 \u201314. According to the most recent census, there are over 74 million girls in India. For context, the total population of Britain and Ireland stands just shy at around 72 million people.<\/span><\/p>\n

Reaching all 74 million girls will be no easy feat, but Kataria and her team are ready to take on the challenge.<\/span><\/p>\n

Looking at the history books<\/span><\/h2>\n

Since 2008, 2 HPV vaccines have been made available in India, a quadrivalent vaccine (Gardasil), which protects against 4 strains of HPV, and a bivalent vaccine (Ceravix), which protects against 2. Both of these vaccine<\/span> offer protection against the high risk strains HPV 16 and 18<\/span>.<\/span> But just because the vaccines are<\/span> available<\/span><\/em>, it doesn\u2019t mean they are<\/span> accessible<\/span><\/em>.<\/span><\/p>\n

\u201cGenerally, the HPV vaccine is available through a mode which is in a private fashion,\u201d explains Kataria, \u201cso it\u2019s not affordable for everyone.\u201d<\/span><\/p>\n

However, price isn\u2019t the only obstacle.<\/span><\/p>\n

In 2009, 2 states launched a project to examine the feasibility and acceptability of integrating a vaccination programme into public health services. \u201cBut what happened was there were some health issues at the time that were wrongly attributed to HPV vaccination,\u201d explains Kataria. \u201cThe trial was stopped and it created a lot of mistrust among the population.\u201d<\/span><\/p>\n

Since then, 3 states in India have successfully implemented HPV vaccination programmes. Although this is good progress, Kataria emphasises that it\u2019s essential that all adolescent girls have access to the vaccine.<\/span><\/p>\n

The project so far<\/span><\/h2>\n

Kataria and her team are really trying to understand what needs to be done to ensure all adolescent girls have access.<\/span><\/p>\n

\"A<\/p>\n

Dr Kataria is a senior public health researcher at the Research Triangle Institute (RTI) International Center for Global Noncommunicable Diseases.<\/p>\n<\/div>\n

This means speaking to people at national, state and district level Government, as well as people within charities and government-associated organisations. From these conversations, the team will develop recommendations and key messages that advocates and policymakers can use to call for nationwide access to HPV vaccinations.<\/span><\/p>\n

The people that the team have spoken to so far are all in agreement that a national vaccine programme would be the best way to administer the vaccine. \u201cHistorically, immunisation is something that India has sorted out pretty well, and we get<\/span> good coverage<\/span> around it.<\/span><\/p>\n

\u201cAnd because of COVID-19, it has given the Government confidence that they can actually vaccinate people that are not part of the usual routine immunisation groups of infants and children.\u201d<\/span><\/p>\n

Kataria explains that the COVID-19 vaccination programme has further improved the infrastructure, making it easier to introduce new vaccines.<\/span><\/p>\n

So, what\u2019s the catch?<\/span><\/p>\n

Challenges at every level<\/span><\/h2>\n

Kataria describes how there are challenges, or barriers, to the expansion of an HPV vaccination programme, at each level.<\/span><\/p>\n

The first obstacle to overcome is personal.<\/span><\/p>\n

\u201cI think one of the key things is that with the way we function as a society in India, the adolescent girls don\u2019t have an entirely independent choice about HPV vaccination.\u201d<\/span><\/p>\n

Kataria explains that often the choice ultimately lies with the parents, who she calls the decision makers. \u201cAnd a lot of people will have questions,\u201d she says. \u201cAnd since these questions will be related to adolescent girls, they may be based around sexual implications as people may think it can lead to promiscuity.<\/span><\/p>\n

\u201cExperts have said that even more than the logistics of the vaccination programme itself, the communication and social mobilisation strategy will be key in all this setup.\u201d<\/span><\/p>\n

When interviewing a state immunisation officer in one of the North East states, Kataria heard how there would need to be people, including the state organisation officers, medical professionals and technical experts who could go as a team and hold a session to clear any doubts for the school authorities and local community to feel secure with the vaccination programme.<\/span><\/p>\n

For Kataria, it helped to reiterate just how important communication is going to be. \u201cIt\u2019s something that needs to be really well done \u2013 myths and misconceptions that people will have about the vaccine is also a key barrier that we need to overcome.\u201d<\/span><\/p>\n

But even if the young women who are eligible for the vaccine, and their families, consent to the vaccine, the puzzle isn\u2019t complete.<\/span><\/p>\n

The next hurdle is cost. \u201cWe were actually told by a lot of health care providers that they themselves wouldn\u2019t recommend the vaccine, because they think a lot of people can\u2019t afford it.\u201d<\/span><\/p>\n

However, there may be a solution on the horizon,<\/span> as a vaccine produced in India<\/span><\/a> is expected to be approved in the near future. This could provide a more cost-effective alternative to the other vaccines currently available.<\/span><\/p>\n

A vaccine produced locally could<\/span> also address<\/span> hesitancy at a Government level, Kataria comments. \u201cThe Government have a large focus on indigenous vaccines. We\u2019ve seen that with COVID-19, a vaccine has been developed indigenously in the country and is being administered to the population successfully, safely and effectively.\u201d<\/span><\/p>\n

When this HPV vaccine is launched into production, with a significant cut in the cost, Kataria notes that there will be a surge in the motivation of the Government of India to integrate the HPV vaccine into the National Immunisation Programme.<\/span><\/p>\n

Kataria adds that there are lots of valuable lessons to learn from the states that already have an immunisation programme.<\/span><\/p>\n

\u201cBoth states of Sikkim and Punjab use schools as a vehicle to initiate vaccination. And they have found this strategy very successful, because there is an opportunity to get teachers and parents involved. The students place a lot of trust in teachers, so both these states have seen very high uptake through school-based vaccinations, and this method will need to be prioritised by other states as well.\u201d<\/span><\/p>\n

Looking forward<\/span><\/h2>\n

There\u2019s still a way to go before any results of Kataria\u2019s research project can be published, turned into policy briefs, and discussed with advocates and policymakers, but the team are gathering invaluable information every day.<\/span><\/p>\n

And with the challenges that exist at each level, the solutions seem to point in one direction \u2013 that working together to get HPV vaccination included in the National Immunisation Programme would bring India closer to ensuring that cervical cancer is \u2018eliminated\u2019.<\/span><\/p>\n

Despite the scale of the challenges, Kataria remains wholly optimistic. \u201cIndia will definitely start HPV vaccination through its national immunisation programme. And we will have the girls who are in the eligible age category getting vaccinated. That is what I hope. And that is what I dream, and I\u2019m quite optimistic that that will eventually happen.\u201d<\/span><\/p>\n

Lilly<\/em><\/p>\n

More on this topic<\/h3>\n<\/p>\n

Source<\/a><\/p>","protected":false},"excerpt":{"rendered":"

Globally, cervical cancer is the fourth most common cancer in women. It\u2019s unusual, as cancers go, in that 99% of cases worldwide are caused by a virus called human papillomavirus (HPV). In many countries around the world, people are given a vaccine to prevent HPV at an early age. You may have seen this vaccine […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_monsterinsights_skip_tracking":false,"footnotes":""},"categories":[5137],"tags":[],"class_list":["post-27648","post","type-post","status-publish","format-standard","hentry","category-world-news"],"_links":{"self":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/27648","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/comments?post=27648"}],"version-history":[{"count":1,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/27648\/revisions"}],"predecessor-version":[{"id":45095,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/posts\/27648\/revisions\/45095"}],"wp:attachment":[{"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/media?parent=27648"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/categories?post=27648"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ogkologos.com\/en\/wp-json\/wp\/v2\/tags?post=27648"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}