‘Felt like tiny pinprick’: Delhi schools push to win parents’ trust on cervical cancer vaccine

Delhi Chief Minister Rekha Gupta during the launch of a Human Papillomavirus (HPV) vaccination drive for 14-year-old girls at the Delhi government-run Guru Teg Bahadur Hospital in New Delhi. Express Photo by Amit Mehra.

Teachers and school principals across several schools told The Indian Express that concerns about safety, fertility and a lack of awareness about cervical cancer continued to hold parents back, even after several rounds of awareness sessions. Their accounts suggest that building trust through simple language, personal stories and sustained awareness efforts will be key to reaching the government’s ambitious vaccination targets.

Back at the school, when the Class 10 student was made class monitor, girls began approaching her with questions, the most common being: “Does it hurt?”

“I told them there was nothing to worry about. Everyone is scared of injections. I told them it was just like a tiny pinprick,” she said.

Her father had heard about the vaccine through friends who work at AIIMS. “When the school informed us about the drive, he immediately said, ‘Yes, go ahead’. I wasn’t scared,” the girl said.

Before any girl received the vaccine, a consent form had to be signed. Routed through the government’s U-WIN portal, it asks a parent or guardian to declare they understand why the child’s personal data is being collected, and that they are aware of “the risks and benefits of the vaccine(s) to be administered”.

But signing a consent form did not necessarily mean trust.

Response on the ground

At Fatehpur Beri, when the principal convened a meeting for hesitant parents and students in the school library, the girl and three other vaccinated students were asked to stand before the gathering.

“The principal asked us in front of everyone whether we had fever, allergy or any health problems,” she recalled. “We told them nothing had happened.”

For many parents in the room, it was perhaps the first time they were hearing directly from a child who had already taken the vaccine.

The school’s science teacher quickly realised that ‘Human Papillomavirus’ meant little to many families. Even cervical cancer was unfamiliar.

So, she abandoned medical jargon altogether. She began calling it “bachchedani ke muh ka cancer” — cancer at the mouth of the womb.

“We had to speak in the language people understood,” she told The Indian Express.

Before any girl received the vaccine, a consent form had to be signed. Express Photo by Amit Mehra

The teacher also had a personal reason for encouraging girls to take the vaccine — her sister had tested positive for HPV.

Months of training sessions — online and offline, working through PowerPoint slide decks on HPV, cervical cancer and the questions parents were likely to ask, gave her the vocabulary and her sister’s diagnosis gave her the reason to use it.

During a school assembly, she told her students about her decision to get vaccinated.

“The training helped us understand how to explain it simply,” she said,  but it was the personal disclosure, students and colleagues said, that made parents in the room understand better.

Soon, the response spilled out of the classroom and onto the walls. “Students designed posters and charts in schools explaining cervical cancer,”she said, describing rows of hand-drawn diagrams of the reproductive system and slogans urging classmates not to be afraid of “the pinprick.”

The exercise, she said, “created more confidence in students and in parents”.

Slowly, the girls in her class began coming forward. “We would escort the students to the nearby dispensary almost every alternate day with whoever would come forward,” the teacher said.

The response, however, was not the same everywhere.  Barely 25 km away, at a CM Shri school in North Delhi, around 20 to 25 girls were eligible for the vaccine. Fourteen parents signed consent forms. Yet, not a single girl, teachers said, has been vaccinated so far.

Among the eligible girls was a 14-year-old whose parents still did not sign the consent form.   “My khala (aunt) said I might get sick after the injection,” the student recalled. “My mother said we should wait and see what happens to the other girls first.”

Two of her friends had also been keen to get vaccinated, she said, until their parents changed their minds after hearing similar stories doing the rounds in the neighbourhood.

A government school in Northeast Delhi’s Yamuna Vihar tells another story.

Extensive awareness campaigns here were held in the school — doctors visited, morning assemblies were devoted to the vaccine, school counsellors spoke to students.   Still, of roughly 259 eligible girls, the principal said, only close to 60 eventually got the shot.   “I honestly didn’t expect the numbers to be so low,” she said.

The bottlenecks

Across the three schools, language was a serious hurdle.

While some teachers explain what HPV and cervical cancer are in simple terms, others reach for family memory instead — mothers, aunts, grandmothers who fell ill.

The science teacher at Fateh Beri school points to another hurdle: bandwidth.

“Teachers treated it like another duty,” she said. “Lists were prepared. Data was sent. But when students didn’t go for vaccination, there wasn’t much follow-up. No one has taken them to the dispensary yet.”

Twice a week, outside her regular classes, she tries to fold HPV into lessons on cells and cancer that students are already studying, but says the school simply doesn’t have the staff to do sustained, individual follow-up.   “We have very few teachers. Every teacher already has a heavy workload. Sometimes programmes become administrative exercises… we complete the paperwork because that’s what we’re required to do,” she said.

⠀

In Yamuna Vihar, the principal identifies “suspicion” as another hurdle.

“They (parents) felt developed countries conduct research here because we have such a large population… Some believed private companies were driving the programme… Others worried about fertility: What if my daughter cannot have children later?”

“The biggest issue is awareness,” she said. “Unless parents understand, nothing changes.”

She believes public messaging around HPV has never matched the scale of the campaign. “There should have been much more publicity. People need confidence that this is genuinely in their children’s interest.”

“The girls listened to us in school when we tried to amplify the awareness around HPV,” she said. “It was the parents who needed convincing,” she added.

“The kids who come to our school are first generation learners. They come from labour class families… it is harder for us to impart the idea of a vaccine to them than it is for schools in the private sector,” the principal said.

The stakeholders

Outside Delhi’s government schools, the campaign begins much earlier than the classroom. Every morning, ASHA (Accredited Social Health Activist) workers fan out through narrow lanes carrying lists of names of adolescent girls in their respective neighbourhoods. Their job: explain what HPV is, persuade parents and, and then get them to actually make the trip to the dispensary.

By 9.30 am, Poonam Sharma (43), an ASHA worker for about a decade now, is already knocking on doors in Nangloi.
“We explain that this vaccine protects girls from cervical cancer. But if I explain it to eight or ten families, maybe only one or two eventually go,” she said.

Outside Delhi’s government schools, the campaign begins much earlier than the classroom. Express Photo by Amit Mehra.

The reasons, she added, are rarely medical. “Rumours travel faster than the government,” she said.   “They tell us the vaccine isn’t good. They say girls won’t be able to have children later. Sometimes parents understand everything I explain. Then they speak to a neighbour, and the neighbour tells them not to get the vaccine.”

When persuasion fails, she calls in reinforcement: “I ask the ANM (auxiliary nurse midwife) to speak to them. Sometimes they listen to her.”

In the months since the drive began, Poonam estimated she has spoken to nearly a hundred families. But only around 12 girls in her neighbourhood have been vaccinated, she claimed.   Unlike the pulse polio campaign, she points out, the HPV drive has had no memorable public jingle, no slogan to trail it into every home.

So, she has found another way to build trust. “I tell them I have a daughter too… I have got her vaccinated. When they hear that, they feel more confident.” she added.

Nearly 20 km away, in Kailash Nagar, Ashu (33), has spent seven years working in the same neighbourhood. Unlike in Nangloi, almost all eligible girls in her area have now been vaccinated.

For Ashu, the difference is familiarity.

“We’ve been visiting these families for years. We work on family planning, malaria, leprosy, routine immunisation, pregnancy, polio. They know us. Trust is built long before any vaccine arrives,” she said.

“Five fingers are never the same. Some families agree immediately. Some don’t. It also depends on how we explain it. If we don’t speak patiently, how will they ever reach the dispensary?”

Inside Delhi’s private schools, the same stakeholders show up in a different light.

At ITL Public School in Dwarka, HPV awareness didn’t begin with the government’s campaign,  it had been part of the school’s annual adolescent health programme for several years.

Instead of hurried classroom announcements, the school brings doctors, alumni and parents into its auditorium, usually on a Saturday, so working parents can attend.   “The biggest questions are always the same,” said Surabhi, a teacher who is in charge of the vaccine programme in school. “Parents ask whether the vaccine is safe. They ask whether it will affect fertility.”  Increasingly, the answers come from former students, many now MBBS graduates, who return to speak to parents and girls. “They immediately connect, because these are girls who once studied in the same classrooms,” Surabhi said.

Unlike government schools, ITL doesn’t take the students to the dispensary.

“We can only create awareness,” she said. “The decision ultimately belongs to the family.”