India is always considered to have world’s highest burden of HPV-related cancer. Even the mortality from cervical cancer is higher than maternal mortality in our country.
However, Globocan 2018 data declares that the incidence of cervical cancer is on a decreasing trend in India. It may be attributed to better nutritional status, Proper hygienic conditions as well as improved reproductive factors.
The long interval between HPV infection and disease manifestation provides a wide window for screening and preventive strategies. HPV vaccination is one of them. However, in a low-resource countries like India, not only the cost of the vaccines but the costs incurred in setting up a vaccination program i.e., feasibility, affordability, and logistics of vaccine delivery, etc., must also be considered.
Another consideration is the mandated need for ongoing post-vaccination cervical screening which is non-existent in India. It is, thus, difficult to support channeling public funds toward mass immunization campaigns with either of the two HPV vaccines in India.
Also, no data in literature suggest that vaccination can replace cervical cancer screening.
Thus, there are several relevant questions that the proponents of the available HPV vaccines need to answer:
- Is it justified to propagate mass vaccination to prevent cervical cancer 30 years from now, when its incidence is already declining in most parts of India?
- Should it not be the priority of healthcare system to establish effective screening and referral systems such as with pap smear and/or visual inspection with acetic acid (VIA)-based techniques.