HPV - A rollout announcement in Budget is a logical step
This article is authored by Abantika Ghosh, former journalist and healthcare lead, Chase India, New Delhi.
Basu Chatterjee’s legal drama Ek Ruka Hua Faisla (A Paused Decision), itself an adaptation of a Hollywood film, has achieved such cult status that a remake was recently announced.

In another, completely different arena, the anniversary of a paused decision will soon be celebrated when finance minister Nirmala Sitharaman announces the Union Budget on February 1.That is, unless she takes her last year’s announcement of the government “encouraging” vaccination of young girls against cervical cancer to its logical conclusion by announcing the actual rollout of a vaccination programme.
It is logical not just from a continuity perspective. The decision on Human Papilloma Virus (HPV) vaccination has basically been paused since 2017 when the National Technical Advisory Group on Immunisation (NTAGI) first decided to recommend it to the government. It raised the hackles of a certain organisation which saw a big pharma conspiracy in the conversation and took the matter to the PMO. In 2022, NTAGI reiterated that recommendation, once again raising the hopes of the medical community that India may finally be moving on this; they are yet to be realised.
It is a really long gestation period for a vaccine that can prevent cancer of the cervix which kills an estimated 77,000 Indian women every year. It is the second most common cancer among Indian women; till very recently it was the commonest. The cervix is the connection between the uterus and the vagina; but the word cervical, being more commonly used for neck pain, can sometimes be misleading for non-medical people. HPV infection is the commonest cause of cervical cancer.
In the aftermath of the outcry over HPV in 2017, the absence of the vaccine in policy announcements had led to a perception that the two were linked. What held back a policy commitment was the fact that the available vaccine options, manufactured by foreign pharmaceutical companies were prohibitively expensive for it to be included under the Universal Immunisation Programme.
That is no longer the case.
Serum Institute of India (SII) announced the launch of the indigenous HPV vaccine exactly two years ago. There are many variants of HPV vaccines in the market and pricing depends, among other things, on how many strains of the virus the vaccine can provide immunity against. Cervavax, the SII product, is priced at about half of what each dose of the cheapest foreign vaccine in the market costs. What’s more, Serum is said to be sitting on a stockpile of over five million doses of the vaccine in anticipation of a formal announcement.
The delay is perplexing because studies suggest that India has a realistic chance of eliminating cervical cancer within the next few decades. One such study which was published in The Lancet Oncology in 2019 had concluded that India could get rid of the scourge as early as 2079 if it decided to roll out the HPV vaccine. Some state governments such as those of Delhi, Punjab and Sikkim have taken the step, but short of a national rollout these numbers are starting to look difficult. Vaccination is one of the key pillars of the World Health Organization’s “90-70-90” approach to cervical cancer elimination. It refers to 90% girls being fully vaccinated within 15 years, 70% women screened using a high-performance test by the time they are 35 and then again by 45 and treatment for 90% women with pre-cancer.
Around the world, there is adequate evidence available about the immediate difference HPV vaccination makes in the incidence of this particular form of cancer. The United States, for example, introduced the vaccine in 2006 and a study published in 2019 estimated that the four-year average annual incidence rates for cervical cancer in 2011–2014 were 29% lower than that in 2003–2006. A 2023 study estimated that were China to delay the HPV decision by a further eight years, it would mean 434,000–543,000 additional cervical cancer cases, 138,000–178,000 deaths, and $2,863–4,437 million in additional costs.
Cervical cancer is one of the few cancers for which screening is possible and the government of India in 2010 had launched a programme under which all women were to be screened for the disease. Health minister J P Nadda had informed Parliament last month that till date 88 million Indian women - that’s 8.8 crore - had till date been screened for the disease. Of these 97,000 women were detected with the disease. It is estimated that only 1% Indian women have actually been screened for the disease, which is also in line with government data. According to data from the National Family Health Survey 5 (2019-2021) only 1.9% Indian women were screened for cervical cancer.
The slow pace of progress and a realisation that India’s size and scale need multiple parallel interventions rather than one overarching programme, has also propelled coalitions such as the Cervical Cancer Elimination Consortium-India (CCEC-I) under the aegis of the Sabin Vaccine Institute and the Global HPV consortium with partners such as CAPED, IIT Delhi and PATH. The Consortium is now all set to collaborate with the Government of India to pilot “100 Cervical Cancer Mukt (Cancer Free) Districts” through the SAVE Strategy: Screening, Access to Treatment, Vaccination, Education. While partnerships may hold the key to elimination of the disease, the nucleus of all such efforts is and will always have to be the government of India.
This article is authored by Abantika Ghosh, former journalist and healthcare lead, Chase India, New Delhi.
