Tens of thousands of doctors across India are being trained to promote the HPV vaccine, in a push to eliminate cervical cancer in the country.
They will check with mothers attending medical appointments that they intend to vaccinate their daughters, and visit schools and community centres armed with facts and slideshows to counter vaccine disinformation.
One in five cervical cancer cases worldwide occur in India – and the overwhelming majority of those are caused by the human papillomavirus, or HPV.
HPV vaccination has become routine practice in many countries and has been available in India privately since 2008, but with low take-up.
Sutapa Biswas, co-founder of the Cancer Foundation of India, said imported vaccines were expensive and people were reluctant to spend money on prevention. Misinformation surrounding deaths during, but unrelated to, an HPV vaccine trial in the country had left it with “baggage”, she said.
However, India has recently started manufacturing its own cervical cancer vaccine, and the government is expected to make it part of the national vaccination programme later this year or early next year.
Biswas said it had been frustrating to know a vaccine was available but was not being used. “So many times [we would hear] all kinds of excuses – ‘the cost is so high, we cannot vaccinate’. But the cost of treating cancer is way higher.”
Now, she said: “Everything is kind of converging and we want to make the most of this opportunity. We are also keeping the pressure on the government so that we don’t miss this chance.”
Last year about 11,000 members of the Federation of Obstetric and Gynaecological Societies of India (Fogsi) underwent virtual training. About 100 of those trainees have now become the National HPV Faculty and will each train 500 general physicians from the Indian Medical Association over the next six months.
The idea, Biswas said, “is to build confidence”. Training includes practical information on dosages, details of the World Health Organization’s push to eliminate cervical cancer, and advice on how to answer common questions.
The implementation of India’s cervical screening programme had been sluggish, she said. Most cancers are diagnosed late, and most people’s experiences of the disease relate to death.
Many non-specialist doctors “didn’t even know that a cancer could be eliminated and vaccination could be such a gamechanger”, Biswas said.
After the training, doctors are asked to approach their community in their local language to give short presentations.
The Covid-19 pandemic, and associated vaccination campaigns, had helped, Biswas said – even in less-educated rural communities people now understood the link between viruses and vaccines. “Now, when we are talking in the community, we can [explain] there’s a virus causing cervical cancer – that’s why we are here, we have a vaccine.”
Training was also offered separately to local civil society organisations, she said “on how to understand this and talk about it so there is no backlash”.
Dr Priya Ganeshkumar, the gynaecologist and cancer specialist leading the project within Fogsi, said gynaecologists were well placed to do advocacy work.
Families often returned to the doctor who had delivered their baby when their daughters started having periods, or in subsequent pregnancies “so we have a lot of scope for talking about this vaccine”, she said. It might be “the daughter is sitting with the mother, and [we can] proactively ask the question ‘hey, girl – what’s your age?’ [and ask the parent] ‘Did you vaccinate your child?’”.
While many gynaecologists were already aware of the HPV vaccine, she asked: “Did they emphasise it?” The training, she said, helped them to understand the importance of raising it with patients and to not assume that vaccination was the job of a paediatrician. The HPV vaccine is typically given to preteens, later than most childhood vaccinations.
The potential was vast, Ganeshkumar said. “We all know about cervical cancer – India is a hub of it. Every seven to eight minutes, a lady in India is dying due to cervical cancer, when it is preventable.”
Cancer Research UK is providing about a quarter of the project’s funding. Its chief executive, Michelle Mitchell, said it was part of efforts towards “a future where almost nobody develops cervical cancer”.
