HPV vaccination can significantly reduce cervical cancer cases in India

Mumbai: Dr Rohit Ghatule, Director, Medical Affairs, MSD India in an interaction with ETHealthworld’s Prabhat Prakash emphasised the need for ramping up HPV vaccination as HPV infections are responsible for approximately 98.4 per cent of all cases of cervical cancer in India and the importance of vaccinations and health literacy, addressing cultural and religious beliefs to improve vaccine acceptability. Edited excerpts.

HPV-related cancer mortality in India is about 60 per cent. One woman in India succumbs to HPV-related cancer every eight minutes. How is the HPV vaccine reducing HPV-related mortality?
The HPV vaccine can reduce HPV-related mortality by preventing infections with high-risk types of HPV. It is also highly effective at preventing infections with the nine common types of HPV that causes approximately 98.4 per cent of all cases of cervical cancer from an Indian perspective. Other types of cancers, such as anal, vaginal, vulvar, and oropharyngeal cancer, can also be prevented. Through herd immunisation against HPV infection, there is long-term protection against developing any HPV-related diseases many years down the line.


If the HPV vaccine is included in the National Immunisation Programme (NIP). What role could it play in reducing the HPV burden in the country?
Through HPV vaccination, there will be a significant reduction in cervical cancer cases in the country. Currently, cervical cancer is one of the most common cancers in Indian women and a majority of these are caused by HPV. There will also be a reduction in other HPV-related cancers (anal, vaginal, vulvar, oro-pharyngeal and diseases like genital warts) and there will be improved health outcomes for women. Since treating HPV-related diseases is expensive in the country, including the HPV vaccination in the National Immunisation Programme (NIP), will help save the cost of treatment, it will also decrease the burden on hospitals thereby improving the quality of life.

How can HPV vaccine awareness and acceptability be increased in semi-urban and remote areas of the nation?
The Government of India has announced the HPV vaccine in NIP beginning in the second half of 2023. This move by the Indian government will increase vaccine awareness in the country. HPV vaccine awareness and acceptability can be a complex challenge that requires a multi-faceted approach. Some things that can be attempted are engaging with local community leaders, healthcare providers, and other stakeholders to build trust and support for HPV vaccination programmes. There is also a need for highlighting the importance of vaccinations and health literacy, addressing cultural and religious beliefs to improve vaccine acceptability. Also, by improving accessibility we can ensure that the HPV vaccine is available and accessible in semi-urban and remote areas which is critical to increase uptake. Lastly, we can increase vaccine awareness and acceptability through collaborations with private sector organisations and non-governmental organisations.

What are the clinical differences between Gardasil-4 and Gardasil-9?
Gardasil 4 (G4) is primarily for girls/women aged 9-45 years. Its dosage schedule for girls aged 9-14 is 2 doses, once in six months. The G4 is for the prevention of cervical, vulvar, and vaginal cancer, precancerous or dysplastic lesions, genital warts (condyloma acuminata) and infection caused by HPV types 6, 11, 16 and 18 (which are included in the vaccine).

Gardasil 9 (G9) is a unisex vaccine for girls/ women aged 9-26 and boys aged 9-15. Its dosage schedule for girls/women is three doses (0, 2 & 6 months) and for boys it is three doses (0, 2 & 6 months). For girls, the G9 is for the prevention of cervical, vulvar, vaginal, and anal cancer; precancerous or dysplastic lesions; genital warts; and persistent infections caused by HPV serotypes 6, 11, 16, 18, 31, 33, 45, 52, and 58. For boys, it is for the prevention of external genital lesions and persistent infections and the following diseases caused by HPV types are included in the vaccine: anal cancer caused by HPV types 16, 18, 31, 33, 45, 52, and 58 genital warts (condyloma acuminata) caused by HPV types 6 and 11 and the following precancerous or dysplastic lesions caused by HPV types 6, 11, 16, 18.