Today marks the culmination of the fourth International HPV Awareness Campaign, coinciding with International HPV Awareness Day. Raising awareness of HPV [the human papillomavirus] is essential in the fight against cancer – most prominently cervical cancer.
As the World Health Organization (WHO) explains, “there are more than 100 types of HPV, of which at least fourteen are cancer-causing (also known as high risk type)…Cervical cancer is caused by sexually acquired infection with certain types of HPV. Two HPV types (16 and 18) cause seventy percent of cervical cancers and pre-cancerous cervical lesions. There is also evidence linking HPV with cancers of the anus, vulva, vagina, penis and oropharynx.”
Cervical cancer is one of the most common forms of cancer among women, being the fourth-most common worldwide. India Against Cancer identifies cervical cancer as being one of the five most frequent forms of cancer among Indian men and women (the others being breast, colorectal, lung and oral cavity). Among women in India, cervical cancer is the third-most common form of the disease and more women die due to cervical cancer in India than in any other country.
The handling of cervical cancer in India is, to put it lightly, problematic. While issues with the country’s cancer care infrastructure and a shortfall when it comes to human resources are undoubtedly contributing factors, in large part the problems in addressing cervical cancer can be attributed to problems surrounding HPV awareness and administration of the HPV vaccine. The HPV vaccine saves lives. This is demonstrable.
In 2019, a Lancet study found that, as Health Issues India noted, “between 2020 and 2069, failure to expand HPV immunisation will result in 44.4 million cervical cancer diagnoses. The majority of these will be in low and middle-income countries like India.
“On the other hand, expanding prevention programmes such as vaccination against HPV in the next few years could avert thirteen million cervical cancer deaths. Moving towards HPV vaccine coverage of 80-100 percent within the next few decades has the potential to drive down cervical cancer rates to the extent that the disease would almost disappear as a public health threat by the end of the century – even in countries towards the bottom of the Human Development Index (HDI). In the process, millions of cancer cases would be prevented and millions of lives would be saved.”
Despite its high burden of cervical cancer, India had failed to implement nationwide rollout of a HPV vaccine – ostensibly stemming from a trial of the HPV vaccine conducted by international organisations plagued by accusations of ethical violations and the tragic deaths of some of the participants (although none of the deaths were related to the girls having had the vaccine). Since then, however, India has made progress.
In November of 2019, The Lancet published an article highlighting that “since 2016, the successful introduction of HPV vaccination in immunisation programmes in Punjab and Sikkim (with high coverage and safety), government-sponsored opportunistic vaccination in Delhi, prospects of a single dose providing protection, and future availability of an affordable Indian vaccine shows promise for future widespread implementation and evaluation of HPV vaccination in India.”
But the country needs to expand immunisation against HPV, tackling the issue with the same ferocity and ambition as it has sought to tackle COVID-19 through large-scale vaccination. HPV awareness is crucial too – in terms of wider public acknowledgement that vaccination against HPV is safe and wider knowledge of the risks to India’s girls’ and women’s health from contracting HPV, empowering them to make the choices that can protect them.
Not only is this important among the wider public, it’s crucial for healthcare professionals too. As one study has found, “it [is] evident that there is a lack of awareness about HPV vaccination and its importance in preventing cervical cancer among healthcare professionals. Our finding clearly establishes the need to devise intervention programs to promote vaccination against HPV and periodical screening for cervical cancer among healthcare professionals.”
Administering the HPV vaccine is a boon for boys too. As explained by UK-based charity Jo’s Cervical Cancer Trust, “offering boys the HPV vaccine will help protect against a number of HPV-related cancers and conditions, including head and neck (oropharyngeal) cancers, penile cancer and anal cancer, as well as genital warts. It will also strengthen herd protection – this means helping protect anyone who is not vaccinated or…has not had all the doses.”
Ultimately, we need to do more in tackling HPV. Cancer is ruinous to individuals, families, communities and society as a whole. Efforts to prevent it typically involve behavioural adjustments, but the HPV vaccine is a medical intervention that can save lives and ought to be more widely available. HPV awareness in society is crucial too – hence why this observance is of such public health importance.
For the past year, we have been talking about disease prevention and virus awareness in the context of COVID-19 without cessation. We need to apply that standard to HPV awareness and cancer prevention through the HPV vaccine going forward.