On September 1, 2022, Union Minister of State (Independent Charge) Science & Technology, Dr Jitendra Singh, announced India’s first indigenously developed Quadrivalent Human Papilloma Virus (qHPV) vaccine ‘Cervavac’ for the prevention of cervical cancer. This vaccine has been developed by the Serum Institute of India (SII). SII has also been granted market authorisation to manufacture the vaccine by the Drugs Controller General of India (DCGI) in July 2022. SII worked jointly with the Government of India’s Department of Biotechnology (DBT) and Biotechnology Industry Research Assistance Council (BIRAC) along with the Bill and Melinda Gates Foundation through its partnership programme titled ‘Grand Challenges India’.
As per indications from SII, the cost of this indigenous vaccine would be approximately between Rs 200 and Rs 400, and the production of the vaccine is expected to be started by the end of 2022 as compared to approximately Rs 2,000 to Rs 4,000 per dose, produced by foreign manufacturers. Cervavac indigenous vaccine is significantly cheaper, and trials have demonstrated a robust antibody response that is nearly 1,000 times higher than the baseline against all targeted HPV types, and in all doses and age groups.
Human Papilloma Virus
The human papilloma virus is a group of over 200 related viruses. According to the National Cancer Institute (NCI), more than 40 types of HPV are spread through sexual contact. Out of the 40, two cause genital warts, and about a dozen of HPV cause different types of cancer, including cervical cancer. Significantly, almost all cervical cancers are caused by HPV and the vaccine protects against two of the cancer-causing strains, which are HPV 16 and HPV 18. About 83 per cent of invasive cervical cancers in India and 70 per cent of cases worldwide are attributed to these two strains.
Most people do not develop any symptoms of infection, and hence, are not aware that they have the virus. The body’s immune system mostly clears the virus out, which means it does not do any harm to the individual. However, the virus could sometimes take years before it causes any symptoms.
Fatality Rate of Cervical Cancer
According to the World Health Organization (WHO), despite being largely preventable, cervical cancer is the fourth common cancer among women, globally. In 2018, an estimated 57,000 women were diagnosed with the disease and it accounted for 3,11,000 deaths across the world. India accounts for about a fifth of the global burden of cervical cancer, with over 1.25 lakh cases and around 75,000 deaths per year. It is the second most common cancer of women in India. The cancer kills one woman every eight minutes in India despite being preventable if detected early and managed effectively. According to a report in the Indian Journal of Gynaecologic Oncology (December 2021), cervical cancer accounted for 9.4 per cent of all cancers and 18.3 per cent of new cases, in 2020, in India. It means that more than one lakh young women are being subjected to intense mental and physical stress for a disease that could easily be prevented by vaccination and regular screening. As for boys and males, there are no recommendations to vaccinate them in India as yet.
Prevention of the Human Papilloma Virus
The most promising intervention for preventing cervical cancer is vaccination against human papilloma virus (HPV). Screening and vaccination are two powerful tools that are available for preventing cervical cancer. However, there is little awareness among women about the prevention of cervical cancer and less than 10 per cent of Indian women get the screening test done. All women between the age of 30 and 49 years must get screened for cervical cancer, even if they have no symptoms. It should be made mandatory to get adolescent girls vaccinated with the HPV vaccine.
The HPV vaccines are given in two doses. As per the data, the antibodies that develop after having taken both the doses could last up to six to seven years. Booster shots may not be required.
Challenges
The biggest challenge for the government would be adequate resources and manpower for vaccinating the massive demographic and adolescent girls aged between 9 and 15 to ensure that they are protected from HPV early on. The government need to spread awareness about the disease as well as the vaccine in the community. The union government plans to target girls in the 9–14 years age group for vaccination against cervical cancer. Before the rollout of this vaccine, the Centre also plans to launch a massive sensitisation programme to educate parents and school authorities. School-based vaccination programmes are expected to work effectively as the government wants to provide government-aided schools with vaccines free of cost. Private healthcare facilities and NGOs would also be involved for an effective rollout of the vaccine.
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