[Answered] Discuss the role of the Universal Immunisation Programme in combating HPV infections. How can it be expanded or improved to better address cervical cancer in India?

The Universal Immunization Programme (UIP) in India plays a critical role in preventing various infectious diseases through the provision of vaccines to children. The government is planning to include cervical cancer vaccine in the programme; an inoculation campaign targeted at girls in the nine to 14 age group. The main cause is the presence of persistent high-risk type of Human Papilloma Virus (HPV) infection along with co-factors like low socioeconomic conditions, low immunity status, other genital infections, smoking etc, that facilitate initiation and progression to cancer.

Role of UIP in combating HPV infections

• Target Age Group: The proposed targets are 90 per cent girls fully vaccinated by 15 years of age with two doses of HPV vaccine; 70 per cent women screened with a high-performance test at 35 and 45 years of age; and 90 per cent of women with cervical pre-cancer and cancer receiving treatment, including palliative care, to achieve a goal of less than four cases per 1,00,000 women.
• Improved detection: The Government of India has implemented cancer screening by trained nurses even in primary health centres under the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke — the NPCDCS programme. Screening tools like visual screening tests and HPV tests are simple and easily available.
• Help to achieve SDG: Cervical cancer is the only non-communicable disease that can be eliminated, with the potential to make significant contributions to Sustainable Development Goal 3.4 of reducing premature deaths by one third by 2030.

Measures to improve the program

• Public awareness: Urgent actions are needed to raise awareness about cervical cancer, promote HPV vaccination, address vaccine hesitancy, encourage age-appropriate screening (especially with HPV testing), and enhance capacity for pre-cancer treatment and quality cancer care. Strengthening health systems is crucial to provide comprehensive services for cervical cancer prevention and treatment.
• Strengthen Health infrastructure: Consistent screening with advanced diagnostics, strengthened cancer registries, improved referrals, and financial support mechanisms are essential. Building partnerships across healthcare levels and with NGOs, innovators, and public health professionals is crucial for effective cervical cancer prevention and care.
• Indigenous development: Indigenous HPV kits and vaccines are crucial for resource-scarce areas. Innovations like single-dose vaccination, self-sampling, and AI diagnosis promise rapid progress in eliminating cervical cancer in low and middle-income countries.

Conclusion

Cervical cancer is the second-most common cancer among women in India, mostly affecting the middle-aged. With 1,23,907 new cases and 77,348 deaths in the year 2022, India contributed to one-fifth of the global burden. In order to progress toward the eradication of cervical cancer, it is equally important that we form alliances and collaborate on the most recent research as well as implement effective models for community outreach and care pathways.