Why isn’t the HPV vaccine on the essential drug list?

The other day I was at a function, small-talking about my current work (in cervical cancer prevention). A parent asked me “so, should I get my daughter vaccinated against HPV?”. “Of course!” I said – “unless you want her to get cervical cancer…..”


This is an easy question for parents who love their daughters.


What is great is that she was aware of the vaccine and was giving it consideration. Most people in India, the poor and under privileged, don’t know about it, wouldn’t know how to get it and can’t afford it.


Cancer incidence is rising in India, and gaining more visibility. In India 13 4420 women get cervical cancer every year, and 72, 825 women die from it, and these numbers are predicted to increase.


Low income and middle income countries now bear a majority share of the burden of cancer, but the health systems are ill-prepared to meet the challenge. Unfortunately, in India, the systemic inability to meet the challenge seems willful.


Unlike many cancers, cervical cancer is almost entirely preventable – the HPV vaccine, low cost VIA screening methods, and cryotherapy for precancerous lesions means that these 73,000 deaths are unnecessary. All these preventive measure are almost totally unavailable in the public system (except in TN).


Dying of cancer is slow and painful. With cervical cancer there is often a strong odourous discharge caused by fistula leaking urine into the vagina, infections, nausea and terrible pain. It causes a huge burden to the patient, families, communities and the health system.


This morning’s Hindu had more coverage on the PATH cervical cancer vaccine trials – discussing the recent parliamentary panel report. The report is biased and hysterical in tone, and the Hindu article follows suit. This is the same hysterical tone that has characterized the press and government coverage of the controversy.


What is missing in all this coverage is details on the benefits – the lives saved – that the HPV vaccine could bring to women and families. Of course the above-mentioned deaths are not visible to all these reporters and parliamentarians – women who die of cervical cancer die quietly at home, and in some shame and discomfort.


I would really like to shift the burden of shame right back onto the decision makers who are blocking public access to the HPV vaccine. We know that the HPV vaccine works in preventing cervical cancer. What is not clear is why the Indian government is not doing everything it can to get this vaccine into the essential drug list ASAP. This is what we need to study and assess: what are these people thinking?


I agree that the PATH study’s irregularities in seeking consent are unacceptable (but I have discussed this with other researchers – we all agree that if you assessed consent processes for all research studies you would find irregularities almost every time – unfortunately these irregularities are all too regular).


However, I don’t understand why the government finds it so egregious that a drug company would make money. Every time the government spends money on procurement, someone is making money. The government can negotiate a suitable price with Gardasil, or get local suppliers to manufacture a generic version.


What is not acceptable is doing nothing.



A blog post from Vivien Tsu (PATH) on the global advances made in HPV vaccination 15th April 2014:


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  • By India’s health care crisis? on September 22, 2013 at 4:35 am

    […] media (I have already described my frustration at the poor level of reporting on the HPV vaccine here). They point […]

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