This piece was originally published by Cancer Research UK.
Globally, cervical cancer is the fourth most common cancer in women.
It’s unusual, as cancers go, in that 99% of cases worldwide are caused by a virus called human papillomavirus (HPV). In many countries around the world, people are given a vaccine to prevent HPV at an early age.
You may have seen this vaccine in the news recently, when ground-breaking research proved, for the very first time, that the UK’s HPV vaccination programme reduced cervical cancer cases by almost 90% in women in their 20s who were offered it at age 12 to 13.
The mounting evidence continues to point us in one direction – that cervical cancer is highly preventable. But despite this, across the globe, someone dies every 2 minutes from the disease.
In 2020 alone, it’s estimated that over 600,000 women worldwide were diagnosed with the disease, and over 340,000 died because of it.
Dr Ishu Kataria is one of the people trying to change those figures. Kataria is a senior public health researcher at the Research Triangle Institute (RTI) International Center for Global Noncommunicable Diseases. In addition, she works with the World Health Organization to help prevent the spread of infections like HPV around the world.
Why is an HPV vaccination programme so important?
HPV is extremely common, infecting the skin and the cells lining the inside of the body. Most of the time the HPV infection doesn’t cause any problems and clears up by itself. It’s only when certain types, or strains, of the virus can’t be fought off by the body’s immune system, that it can cause damage that can lead to cancer.
HPV vaccines offered in the UK protect against the main cancer-causing strains of the virus: HPV 16 and 18.
“Because HPV is a major cause of cervical cancer, a vaccine against HPV will help prevent a woman from getting cervical cancer in the future, which is actually a disease that can become fatal, particularly if it progresses to later stages.” explains Kataria. “We see a lot of deaths that happen across the globe due to cervical cancer. But the vaccine can actually prevent most cases of the disease if we give it to girls before they are exposed to the virus.”
Previous results had confirmed that HPV vaccination is effective in preventing HPV infection, genital warts and precancerous cell changes in the cervix. Now, evidence continues to indicate that the HPV vaccine is highly effective at preventing cervical cancer.
What’s more, a year ago, on 17th November 2020, the World Health Organization (WHO) announced an ambitious plan: to create a ‘cervical cancer-free future’. A strategy which hopes to see cervical cancer become the first cancer to be ‘eliminated as a health problem’ on a global scale.
To get there, WHO has devised the 90-70-90 targets to ensure 90% of girls are vaccinated, 70% of women are screened and 90% of women with pre-cancerous cervical cell changes receive treatment. These are milestones to be achieved by 2030 in order to make sure the world is on the right track to dramatically reducing cervical cancer burden.
A year on, and the COVID-19 pandemic has slowed down progress for the WHO’s plan. Considerable steps forward have been made with the launch of new guidelines to inform cervical screening and several trials exploring the use of single dose HPV vaccines. But despite these advances, and the slowly decreasing trends in cervical cancer rates globally, this isn’t equal around the world. Cervical cancer still has some of the highest case numbers of all cancer types, with some countries seeing an increase in incidence rates in the last two decades. Cervical cancer remains a substantial health problem for women globally.
In India, cervical cancer it is the third most common cancer and accounts for the second highest number of cancer deaths in the country. In fact, almost a quarter (23%) of cervical cancer cases and deaths around the world are estimated to occur in India. People are screened for cervical cancer but right now – in the country that contains almost a fifth (18%) of the global population – there’s no consistent national HPV vaccination programme.
This is where Kataria and her team have stepped in. They’re embarking on a unique research project, funded by Cancer Research UK, to assess the feasibility of introducing the HPV vaccine into India’s National Immunisation Programme.
“What our project is aiming to do is to understand what the level of vaccine preparedness is and help to develop the evidence to encourage state Governments who are intending to introduce the HPV vaccine.”
The scale of public health in India
In a country as large as India, it’s an ambitious goal. India is around 13 times larger than the UK, with a population that’s about 20 times greater, at well over 1 billion people.
India’s divided up into 28 different states – some of them small, like Sikkim (just a bit more than the City of Glasgow), and some very big, like Uttar Pradesh (similar to the combined population of the UK, Ireland, France, Spain, Portugal and Poland