The highest technical body on vaccination has given its approval to the introduction of the cervical cancer vaccine in India’s universal immunisation programme, subject to the outcome of a case in the Supreme Court.
While the minutes of last month’s meeting of the National Technical Advisory Group on Immunisation (NTAGI) show that the group decided to accept the recommendation of its subcommittee citing vast amounts of scientific and public health evidence in its favour, in real terms the recommendation may mean little as the government of India is unlikely to move on it anytime soon.
“It(the time lag) has got nothing to do with the letter of the Swadeshi Jagran Manch (SJM) to the prime minister opposing the vaccine. There is a lot of due process involved, clearances etc that will take time,” said a senior official of the union ministry of health.
SJM, the economic wing of RSS, had written to the prime minister last month against the introduction of the vaccine in the national programme citing safety and cost concerns.
Human Papilloma Virus, commonly known by its abbreviation HPV, is a group of more than 150 viruses that cause papilloma or warts in parts of the body, including genital areas. They spread by skin-to-skin contact and are responsible for a number of diseases, including cancers, though they are most commonly associated with cancer of the cervix (neck of the uterus).
The minutes of the December 19 meeting of NTAGI that were uploaded on Wednesday read: “The NTAGI endorsed the STSC recommendation for introduction of HPV with certain points in mind as follows:
a) An effective communication strategy has to be in place with all the important information. It was stressed that communication should bring out. That cervical cancer is the disease caused by HPV infection which is transmitted sexually.
b) The vaccination is recommended for both boys and girls. However, as girls bear direct burden of the disease and given current costs, introduction of vaccine will be done for girls in the initial period.
c) Vaccine does not eliminate the need for screening and screening should be done regularly in the susceptible population after the age of 30 years.
d) The public must be informed of the goals, delivery and potential impact of the vaccination programme.”
The Scientific and technical sub committee (STSC) had recommended that the Human Papilloma Virus Vaccine should be introduced in the immunisation programme. The NTAGI recommendation is subject to the judgement of the Supreme Court in a case pertaining to illegal clinical trials of the vaccine in India. The group which includes the secretary health, secretary biotechnology and secretary health research (currently the last two portfolios are held by the same person) apart from the drug controller general of India and several other senior scientists stressed upon the need to monitor Punjab which has already included the vaccine in its public health programme.
It added: “Studies need to be done to understand the protective efficacy of vaccine among married vs unmarried population. This is important because uninformed rollout is unfair for the recipients.”
Included in the evidence that NTAGI considered before making the recommendation is a detailed account of the cervical cancer incidence in India. As per the population based cancer registries reports, globally, cervical cancer is the 4th most common cancer in women. In India, cervical cancer is the 2nd most common cancer in women and the country contributes to largest proportion of global cervical cancer burden. Nearly 99,099 estimated cervical cancer cases and 66,552 deaths due to cervical cancer occur annually. At any given point of time, nearly 4,18,175 cervical cancer cases are present in country.
“These facts imply that there is significant burden of HPV disease in the country. Amongst all cancer cases in females, cervical cancer is responsible for nearly 10.8 % cases. Cervical cancer occurs predominantly in age group of 35-64 years (74% of total cervical cancer cases) Between different parts of the country, there is a six fold variation in the incidence in cervical cancer (age adjusted rate of 4.9 per 100,000 in Dibrugarh, Assam to 30.2 per 100,000 in Papumpare District, Arunachal Pradesh),” read the minutes of the meeting.