HPV is short for human papillomavirus, a group of 150 related viruses. HPV is named after papillomas (warts) that some of the viruses from this group can cause. However, warts are not the worse problem that HPV can cause. HPV causes various types of cancer both in women and men. An HPV infection may cause cervical, vaginal or vulvar cancers in women. Men can get throat, oral or oropharyngeal cancer, anal cancer, or penile HPV cancer from an HPV infection.
Unfortunately, HPV infections are very common. HPV is so common that all men and women can expect to get it at some point in our lives. HPV is transmitted through skin-to-skin contact and through various forms of sexual contact. Symptoms may appear years after being infected and in most cases, HPV may go away on its own. However, if HPV does not go away, it can cause serious health issues like cancer.
As per the WHO HPV infections are the cause of 70% of all cervical cancers and cancerous growth in the world. Worse still, cervical cancer is the second most common cancer in women living in developing and under-developed countries. There were about 445,000 new cases of cervical cancer in 2012. 270,000 women lost their lives to cervical cancer in the same year, with 85% of these deaths occurring in the developing or under-developed countries. HPV infections are a major cancer killer in the developing and under-developed world.
Luckily, there exists a way to prevent these cancer-related deaths with the use of the HPV vaccine. The first vaccine to prevent against HPV infections was approved in 2006. This vaccine has had the potential to prevent much of the HPV associated cancers on a global basis every year. However, the adoption of this vaccine has seen large differences across geographies.
On the positive front, Australia may soon become the first country of the world to completely eliminate cervical cancer. This is because Australia has freely distributed HPV vaccines in schools. This has led to the drop in the percentage of HPV infected Australian women aged between 18 and 24 to 1.1% in 2015 from 22.7% in 2005. The HPV vaccination program has been a great success for Australia. However, other countries, even in the developed world face challenges.
In the United States, HPV infections still caused nearly 34,000 cases of cancer in 2017. Although vaccination rates are growing, as of 2017, HPV vaccination rates amongst US adolescents was only 49%. There are several reasons for the relatively low coverage of HPV vaccines in the US. Not enough doctors recommend that children and adolescents receive the vaccine. There is a lack of communication and not enough eligible patients are offered HPV vaccines when they visit their providers. Parents are still not accepting of their children receiving HPV vaccines and there is a significant cost burden to HPV vaccination. HPV vaccination costs around $400 (about INR 28,000) in the US.
India and large parts of the developing and under-developed world face a severe health crisis related to HPV infections. As per the ICO/IARC Information Centre on HPV and Cancer about 97,000 new cervical cancer cases are diagnosed annually in India. Cervical cancer is the 2nd most common female cancer among women aged 15-44 in India. India faces a high mortality rate for women detected with cervical cancer. This is because the cancer is detected at a later stage.
One of the reasons for the late detection of cervical cancer in India is the use of outdated screen strategies. The commonly used screen procedure involves staining of the cervix with acetic acid. Next, a visual examination needs to be performed and specimens collected in the cases of discoloration. However, this requires skilled technicians. Furthermore, pelvic exams are highly stigmatized and many women do not want to have them. Simpler primary cervical screening using HPV-DNA testing is being adopted in the developed world but remain cost-ineffective for India.
India faces a bigger challenge because of the extremely low HPV vaccination rates. Although India has approved HPV vaccines in 2008, the vaccines are priced between Rs 2,000 and Rs 3,000 for a single dose (about $30 - $43). There are 3 doses required. People who need these vaccines the most, simply cannot afford them. India typically tackles access to such necessary vaccination programs by providing them via government run programs.
In January 2018, the advisory body that recommends vaccines for India’s Universal Immunization Programme (UIP) recommended the introduction of the HPV vaccine in the program. UIP has been implemented to cover all districts in the India since 1989-90 and is one of largest health programme in the world. However, the government is yet to act on this recommendation and the last updated list of vaccines made available under India’s UIP does not include the HPV vaccine.
An opportunity to prevent deaths from cancer in India stays missed.
The situation remains alarming in other developing and under-developed regions of the world. Despite the WHO saying that all countries should vaccinate 9 - 14-year-old girls, only 9 low and lower-middle income countries have included the HPV vaccine in their national immunization programs.