A Quinquennial Review of the WHO’s Global Call for Action to Eliminate Cervical Cancer - an Indian Perspective

OBJECTIVES: In 2018, the WHO made a global call for action to eliminate cervical cancer (CCE), the fourth most common cancer globally. Over 80% of all cervical cancer (CC) cases were recorded in lower-middle-income countries (LMICs), with 21% occurring in India. Bivalent and quadrivalent (4vHPV) vaccines were introduced in India in 2008, (around ₹3000/dose) with nonavalent introduced in 2018 (₹8500/dose). In 2022, an indigenous 4vHPV (₹200-400/dose) was approved. We aimed to assess the disease burden of CC in India and the role of HPV vaccination in CCE.

METHODS: A targeted review, with searches in Embase and MEDLINE, was conducted to identify economic, clinical, epidemiology, and observational studies from 2021-2023.

RESULTS: In total, 58 articles were included. Results from the included articles show that CC currently accounts for 29.9% of all cancers in India, making it the second most common cancer in women. Vaccinating 9 to 12-year-old girls in India is considered a cost-effective strategy, assuming a high coverage rate and lifelong protection. Gender-neutral vaccination is considered a costly strategy, although is recommended for CCE. Efficacy of a single-dose 4vHPV was similar to 2-dose/3-dose as reported in the IARC study conducted in India. Based on this, in 2023, WHO made an updated recommendation on choosing a single-dose policy. Surveys showed the main challenges of CCE were lack of awareness among the general population regarding CC and HPV vaccines, inadequate screening programs, high vaccine costs, and shortages of vaccine supply.

CONCLUSIONS: Despite the WHO global call for CCE, disease burden of CC in India remains high. This may improve in the coming years given the recent approval of the indigenous 4vHPV, which is expected to be significantly cheaper and readily available. Educational programs, single-dose vaccination, and introduction of the new vaccine might play an accelerated role in CCE in India paving the way for other LMICs.