Why in the news?
"Indian Government Unveils Three-Phase HPV Vaccination Drive for Girls 9-14 to Combat Cervical Cancer"
What is cervical Cancer?
About:
- Cervical cancer develops in a woman's cervix and is the fourth most common cancer among women globally, ranking as the second most prevalent in India.
- India bears the largest share of the global burden of cervical cancer, contributing to nearly 25% of related deaths, as per The Lancet study.
- Almost all cervical cancer cases (99%) are linked to high-risk Human Papillomavirus (HPV), a common virus transmitted through sexual contact.
- Effective primary prevention approaches, such as HPV vaccination, and secondary prevention measures, including screening for and treating precancerous lesions, can prevent the majority of cervical cancer cases.
- When diagnosed early, cervical cancer is one of the most successfully treatable forms of cancer, highlighting the importance of timely detection and effective management.
- India records approximately 1.25 lakh cases and about 75,000 deaths each year, constituting about 20% of the global burden for cervical cancer.
Types of Strain
- Nearly 85% of all cervical cancers are attributed to persistent infections with specific high-risk HPV strains.
- A total of at least 14 HPV types have been recognized as oncogenic, indicating their potential to cause cancer.
- Notably, HPV types 16 and 18, identified as the most oncogenic, are accountable for approximately 70% of all cervical cancer cases worldwide.
Status in India
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- Cervical cancer holds the position of being the second-most common cancer among women in India, predominantly impacting those in the middle-aged demographic.
- In the year 2022, India recorded 1,23,907 new cases of cervical cancer, accompanied by 77,348 deaths attributed to the disease.
- India's contribution to the global burden of cervical cancer is significant, constituting one-fifth of the total cases reported worldwide.
CERVAVAC: India’s first indigenous HPV vaccine
About:
- CERVAVAC stands as India's indigenously developed quadrivalent human papillomavirus (qHPV) vaccine, designed to combat four strains of the virus: Type 6, Type 11, Type 16, and Type 18.
- A quadrivalent vaccine operates by eliciting an immune response against four different antigens, which may include various viruses or other microorganisms.
- CERVAVAC demonstrates efficacy against the specified HPV strains, marking a significant advancement in the prevention of HPV-related infections and cervical cancer.
- The vaccine is structured on Virus-Like Particles (VLP), a methodology akin to the Hepatitis B vaccination. This approach involves mimicking the viral structure to induce an immune response without live viruses, contributing to the vaccine's safety and effectiveness.
Significance:
- Following approval from the Drug Controller General of India (DGCI), the government gained the capability to procure CERVAVAC in bulk. This strategic move facilitates the vaccination of approximately 50 million girls within the specified age group.
- The vaccine demonstrates optimal efficacy when administered before the initiation of the first sexual intercourse. This underscores the crucial importance of timely vaccination for maximum effectiveness.
- CERVAVAC holds significant promise in the endeavor to eliminate cervical cancer. Its potential impact on public health underscores the importance of incorporating it into the Universal Immunisation Programme (UIP).
- Offering CERVAVAC at a lower cost than existing vaccinations could enhance accessibility and affordability, contributing to broader coverage and the overall success of vaccination efforts under the Universal Immunisation Programme (UIP).
Global Scenario:
- Presently, India has access to two globally licensed vaccines: the quadrivalent vaccine (Gardasil, manufactured by Merck) and the bivalent vaccine (Cervarix, produced by GlaxoSmithKline).
- These existing vaccines, however, come with a considerable cost. The quadrivalent and bivalent vaccines are recognized for their efficacy but are financially burdensome, posing challenges to widespread accessibility.
- Despite their availability, neither the quadrivalent nor the bivalent vaccine is currently included in India's national immunization program. This exclusion has implications for the broader population's access to these preventive measures against HPV.
- The introduction of CERVAVAC, an indigenously developed quadrivalent HPV vaccine, holds potential advantages, especially in terms of cost-effectiveness and inclusion in national immunization efforts. Its approval and procurement signify a crucial step in addressing cervical cancer risks among the population.
Steps to Eliminate Cervical Cancer:
- HPV Vaccination:
- Persistent high-risk HPV infection, compounded by factors like low socioeconomic conditions and smoking, contributes to cervical cancer.
- Early detection through HPV vaccination, screening, and timely treatment can prevent and cure the disease.
- Opportunity for Early Detection and Treatment:
- Cervical cancer features a 10–15 year pre-invasive phase, providing an opportunity for early detection and outpatient treatment.
- Early-stage management boasts a cure rate exceeding 93%, underscoring the significance of timely interventions.
- Elimination Potential of Cervical Cancer:
- Cervical cancer stands as the only non-communicable disease with the potential for elimination, aligning with Sustainable Development Goal 3.4.
- The World Health Organisation (WHO) sets ambitious targets for cervical cancer elimination, including 90% vaccination of girls by 15, 70% screening at 35 and 45, and 90% treatment for pre-cancer and cancer cases. The aim is for fewer than four cases per 100,000 women.
- Emphasis on Simplicity: The approach emphasizes simple, scalable interventions like HPV vaccination, screening, and early diagnosis.
- Government Initiatives for Cancer Screening:
- The Government of India actively implements cancer screening, incorporating visual tests and HPV tests in primary health centres.
- Evidence-based management algorithms guide treatment, and indigenous kits and vaccines support resource-scarce settings.
- Role of Technological Advancements:
- Technological advancements include innovations like single-dose HPV vaccination, self-sampling for HPV testing, and the integration of Artificial Intelligence (AI) technologies to enhance cervical cancer prevention.
- These developments, coupled with increased HPV vaccine uptake, hold promise for resource-limited settings.
- Urgent Need for Population-Level Awareness and Strategies:
- Addressing cervical cancer necessitates increasing awareness through strategic campaigns.
- Encouraging the uptake of the HPV vaccine and overcoming hesitancy are critical components.
- Implementing age-appropriate screening and fortifying pre-cancer treatment processes is imperative.
- Partnerships and capacity building play a pivotal role in achieving success.
- Comprehensive Approach to Strengthen Cervical Cancer Care:
- Consistent efforts are required for accurate diagnosis, emphasizing the importance of strengthened cancer registries.
- Strategies to reduce the financial burden on patients are essential for comprehensive care.
- Building robust health systems involves connecting all care pathways, incorporating digital technologies, and fostering collaborations.
Conclusion:
The alarming statistics of new cases and deaths underscore the urgent need for preventive measures. Early detection through screening and HPV vaccination presents a pivotal opportunity, with a high cure rate when managed at early stages. The proposed targets by the WHO, along with government initiatives, provide a comprehensive roadmap for intervention. To achieve success, sustained efforts are required, encompassing awareness campaigns, vaccine promotion, collaboration, and innovative approaches to eliminate cervical cancer.
