Agnita Mohanty | Team TrickyScribe: Human papillomavirus (HPV) is a virus responsible for cancers in various body parts, notably cervical cancer. While a strong immune system can often clear HPV infections naturally within one to two years, persistent infections with high-risk HPV strains can lead to cancer. HPV-related cancers often affect squamous cells, the thin, flat cells lining inner organ surfaces, resulting in cancers called squamous cell carcinomas.
HPV-related cancers include:
• Anal cancer
• Cervical cancer
• Oropharyngeal cancer
• Penile cancer
• Vaginal cancer
• Vulvar cancerCervical cancer, the most common HPV-related cancer, particularly affects women who are rarely or never screened. Routine screening with an HPV or Pap test can detect and remove abnormal cells before they turn cancerous, helping prevent cervical cancer. Most cervical cancers stem from high-risk HPV types, specifically HPV16 and HPV18.
How Does HPV Affect the Body?
HPV infections can manifest as genital warts (from low-risk HPV) or, in high-risk cases, may remain symptomless, progressing over time to more severe symptoms such as lumps, bleeding, and pain as cancer develops. Persistent infections can cause cellular changes, including hyperplasia and dysplasia, which may lead to cancer if untreated.
Availability and Cost of HPV Vaccine
Currently, the HPV vaccine is available in private hospitals/clinics at approximately Rs. 4000 per dose. However, in a promising move, the Indian government announced plans to include the HPV vaccine in the national immunization program, making it more accessible and affordable. Once implemented, this vaccine will be part of the routine immunization schedule for girls aged 9 to 14, alongside vaccines like BCG, polio, and hepatitis.
Bihar’s Initiative: Free HPV Vaccination Program
The Bihar Cabinet has approved an initial Rs. 150 crore for free HPV vaccination for about 9.5 million girls aged 9 to 14 years, with potential funding increasing up to Rs. 200 crore. Bihar is the first state to incorporate the HPV vaccine into its universal immunization program, following pilot projects in Sikkim and Punjab (2016-2018).
Cervical Cancer: A Growing Concern in Bihar
Bihar, among the top five states in India with the highest cervical cancer rates, has limited population-based cancer data. Estimates from cancer registries predict an incidence of around 10 cases per 100,000 people, with approximately 60,000 new cervical cancer cases annually.
High-risk factors in Bihar include:
• Low socioeconomic status
• Limited healthcare access
• Early marriage and pregnancy
• Poor genital hygiene
• Inadequate nutritionA study conducted by various medical departments in Bihar revealed an HPV infection prevalence of 37.3% among participants, with HPV16 identified as a primary cause of cervical cancer in the state (National Medical Journal of India, August 3, 2024).
Challenges and Need for Awareness
While the free HPV vaccination program is a significant step, addressing other health infrastructure issues is crucial for its success.
Key challenges in Bihar’s healthcare system include:
• Lack of organized screening programs
• Insufficient treatment facilities
• Limited awareness about early symptoms
• Shortage of trained oncologists and specialized equipmentAccording to the WHO, there should be one radiotherapy machine per 1 million people. Bihar, with a population of over 130 million, currently has only around 15 radiotherapy machines across eight centers, far below the recommended ratio.
Moving Forward: A Holistic Approach
Providing free HPV vaccines alone is not enough. Awareness programs, training for healthcare providers, and community engagement are essential to ensure the effectiveness of this initiative. Parental education on the importance of nutrition, hygiene, and the risks associated with early marriage is also critical. By focusing on prevention and early detection, Bihar can potentially reduce cervical cancer cases by up to 90%.
The HPV vaccine is highly effective, reducing the risk of high-risk HPV infections and HPV-related cancers by up to 99%. The vaccine’s side effects are generally mild and include temporary soreness, dizziness, fever, and headaches. Continuous research indicates the vaccine remains effective over time, making it a valuable addition to public health initiatives in India and a model for other states to follow.
With concerted efforts, Bihar’s free HPV vaccination initiative has the potential to become a groundbreaking step in public health, significantly lowering cervical cancer rates and protecting the health of future generations.
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