Call for rights-based HPV roll out: 'Screening, vaccination complimentary, not substitute'

By A Representative 

The Jan Swasthya Abhiyan (JSA), Indian chapter of the People’s Health Movement, has issued a revised approach paper on HPV vaccination in India, calling for “evidence-based, ethical, and people-centred policy and implementation.” The paper, re-drafted after consultations on March 25 and incorporating inputs from health activists and women’s groups, stresses that while HPV vaccination has strong scientific backing, its public health value will depend on how it is implemented.  

The document notes that “over 99% of squamous cell cervical cancers are associated with HPV infection,” and that persistent infection with high-risk strains such as HPV 16 and 18 causes around 70% of cervical cancers globally. India continues to face a heavy burden, with an incidence of 18.7 per 100,000 women and nearly 80,000 deaths annually, disproportionately affecting poorer and rural women.  

JSA acknowledges global evidence of vaccine efficacy, including herd immunity effects observed in Australia and the USA, and long-term reductions in cervical cancer incidence in Sweden and the UK. But it warns against projecting vaccination as a “complete solution” while screening programmes remain weak. “Vaccination and screening are complementary, not substitutes; women who receive the HPV vaccine still require screening later in life,” the paper states.  

The group raises serious ethical concerns, recalling the 2009 demonstration project where “consent forms were signed by hostel wardens or teachers rather than parents.” It insists that vaccination must be voluntary, with “written and verbal informed consent… in local languages,” and both parental consent and adolescent assent.  

JSA also criticises coercive implementation, noting reports of target-driven approaches that pressure frontline workers. “Any threats of disciplinary action against frontline functionaries violate fundamental ethical principles,” the paper warns, urging instead for training, support, and fair remuneration.  

Safety monitoring is another major concern. With over 500 million doses administered globally since 2006, rare anaphylaxis remains the only significant safety issue. Yet India’s weak adverse event monitoring systems risk undermining trust. JSA calls for autonomous review bodies, district-level hubs, transparent reporting, and a legally binding compensation framework to hold manufacturers accountable.  

Policy transparency is highlighted as a pressing issue. The paper questions the government’s choice of Gardasil, imported from Merck, over India’s indigenously developed Cervavac. “Recent Indian trials demonstrate that the indigenous Cervavac vaccine is non-inferior in immunogenicity and has an acceptable safety profile,” JSA notes, arguing that prioritising Cervavac would ensure affordability and self-reliance.  

The document concludes: “HPV vaccination in India has definite potential to reduce cervical cancer risk, but its public health value will depend on how it is implemented. Evidence supports its role as part of a broader prevention strategy; however, programmes which overlook ethical safeguards, transparency, and health system preparedness risk undermining both effectiveness and public trust.”  

JSA calls upon women’s groups, health worker unions, and civil society to demand informed consent, robust safety monitoring, equitable outreach, and expansion of screening and treatment services. It emphasises that cervical cancer prevention “cannot be reduced to a single vertical, technology-driven intervention” but must be embedded within strengthened reproductive health services and public health systems.