HPV : The Vaccine India Doesn't Talk About

The Human Papillomavirus (HPV) is not one, but a group of viruses with over 170 identified strains, of which two strains (HPV16 and HPV18) have been linked with 70% of cervical cancer cases. 

While quick-reads online usually describe HPV as a sexually transmitted virus, what does that really mean? 

Is HPV transmitted via semen? Vaginal discharge? Will latex barriers prevent the transmission of HPV between two or more people?

Sure, but not necessarily. HPV is said to spread via “skin-to-skin” and “skin-to-mucosa” contact. This means the more direct your contact with another person, the higher the odds of you being exposed to the virus.

HPV may also be transmitted through clothing or linens, razors, toilet seats, or rarely, via sterilised medical equipment as was seen in a 1986 study on vaginal speculums. (OBP Medical) To add to the mystery of HPV, not every case looks the same.

Some people may be asymptomatic, others may have warts or precancerous lesions of the mouth, tonsils, throat, penis, vagina, vulva, cervix or anus.

HPV can also be treated before it escalates to oral or genital cancers, but the extent to which medication can eliminate the virus from our bodies is still widely debated.

Takeaway #1: HPV is a widespread virus that nearly all of us are likely to encounter in our everyday lives, even if we are engaging in sexual acts at low frequencies or do not engage in it at all. 

Early diagnosis and treatment may relieve the symptoms but does not break the cycle of transmission, making HPV one of the most common STIs across the globe. 

It is also unclear whether HPV truly is more likely to spread through ‘sexual contact’ or whether non-sexual modes of HPV transmission simply haven’t been studied in as much depth.

Which brings us to the vaccine.

HPV vaccines are available in three forms- bivalent (targetting 2 strains), quadrivalent (targeting 4 strains) and nonavalent (9 strains).

While the former two vaccines have been licensed in India since 2008, the nonavalent option was only licensed in 2018. So why haven’t we been hearing more about it?

Questionable ethics of clinical trials

In 2009, human trials were conducted on 23,500 participants from Andhra Pradesh and Gujarat, with most recruits being girls between the ages of 9 to 14 from tribal areas of the states.

Seven deaths were reported during this study and an investigative report by SAMA, a women’s health group, alleged that participants received “consent forms…in English which even the health care provider administering the vaccine to them may not be able to read, let alone the participants.”

Of these reported deaths, five were allegedly unrelated to the study. One was the result of a drowning incident in a quarry. One was the result of a snakebite. Two were the result of pesticide inhalation. One was due to complications from malaria.

Of the remaining deaths, one of the girls suffered a high fever and the other experienced a suspected cerebral haemorrhage.

News of these deaths was then followed by a letter to the PM from Swadeshi Jagran Manch (a branch of the RSS) that recommended “the strongest action against groups that pervert science, which brings ignominy to the scientific community in the country and sells the country to vested interests.”

And just like that, an unnamed health ministry official was quoted saying to Indian Express, “we are not going ahead with the vaccine now”.

Takeaway #2: Should the future of healthcare in India really be so heavily reliant on political agendas? 

When governments refuse to roll out vaccines that are approved in clinical trials, it affects the population disproportionately. Because people who must rely on government programs to access vaccinations continue to suffer while a small percentage of people are able to pay obscene prices to access vaccines from private clinics.

If this conversation really was about outrage at seven children having died during a clinical trial, why weren’t they provided complete knowledge on the project before being asked to sign?

Why must the tribal populace be targeted as suitable guinea pigs for these trials while city dwellers get to rest and merely wait to access approved vaccines? What is the point of outrage after the damage is already done?

And if the rest of the world is accelerating their efforts to fight HPV and HPV-related cancers, shouldn’t we be on that list too?

Especially when we account for 25% of the world’s cervical cancer-related deaths and have over 1 lakh individuals diagnosed with cervical cancer every year?

HPV vaccines can be administered to individuals above 9 years of age and is said to be most effective before the age of 26 (with new research also examining the possibility of efficient vaccination before the age of 45).

For people below the age of 15, the vaccine is administered in two sittings while people above that age group must receive the vaccine in three sittings. Due to the required gap between doses, the overall process can take between 6 to 12 months.

The shots cost roughly 3000INR per injection, with Cervarix offering immunity against two strains of HPV and Gardasil offering immunity against 4 or 9 strains. If you are able to afford the vaccines, please look into the Gardasil vaccines as they are also slightly cheaper and might be more effective than the Cervarix.

Takeaway #3: In highlighting the limited accessibility of this vaccine along with the lack of clarity on the ease at which it can spread, it’s important to understand the true gravity of India’s resistance to the vaccine.

Preventing the use of public toilets will not guarantee your safety against HPV, but it does get better. 

Limiting sexual contact to one partner and getting regularly tested with them them only makes your chances of preventing HPV better but not absolute. 

Getting vaccinated to slow down the spread of a virus whose transmission modes we don’t even fully understand yet, may be exactly what our scientific community and epidemiologists need to buy more time and study the virus in more depth. 

But you can’t study what you won’t even acknowledge.