Why Your Little Girl Needs Vaccine for Sexually Transmitted HPV

From the age of 9 and above, every girl should get the HPV vaccine to protect against cervical cancer, say doctors.

To be most effective, the vaccine is recommended to be given between the ages of nine and 13.

(Photo: iStock/Altered by The Quint)

(This story has been republished from FIT's archives following the DCGI authorizing the manufacture of India's first indigenous vaccine to treat HPV and cervical cancer.)

(Last week of April is observed as World Immunisation Week by World Health Organisation. The theme this year is #VaccinesWork. FIT is republishing this article to create awareness about the importance of vaccinations)

What happens when it’s recommended that 9-year-old girls get vaccinated against a sexually-transmitted virus? We get squeamish.

Doctors are asking for all girls after the age of nine to be given vaccine for HPV (human papillomavirus), which causes cervical cancer. The reason is that kids one day will grow up and have sex and therefore, it’s important to protect them from this harmful virus. There has been some push to include the HPV vaccine as part of the country’s universal immunisation programme.

However, there still are a lot of questions that people have in mind and not everyone is convinced. Why now? Our pre-teens aren’t having sex right now. Can we get the vaccine later in life? Does it have side effects? What is HPV and how harmful is it? Our explainer as we observe Cervical Cancer Prevention Week.

What Is The Need for HPV Vaccine?

Cervical cancer, mainly caused by HPV, is the leading cancer in Indian women, the second most common cancer in women worldwide, and the fifth most common cancer in humans.

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In India, there are 74,000 deaths caused by cervical cancer and 1.32 lakh new cases diagnosed every year. Nearly 366 million Indian girls and women aged 15 years and above are at risk from cervical cancer.

Gynaecologists we spoke with vouch for the vaccine and several studies have been published which call it an effective option.

There is a vaccine that promises to prevent this deadly cancer, then why will you not take it? What is the hesitation? We vaccinate our children without even a second thought because they’ll protect them from some deadly infection. So why not this?

Dr Ranjana Sharma, Senior Consultant, Gynaecology, Apollo Hospital

HPV is the most common sexually-transmitted infection (STD) globally.

(Photo: iStock)

HPV is the most common sexually-transmitted infection (STD) globally. Most people are infected at some point in their lives.

HPV is a group of more than 150 related viruses. Most HPV infections are usually harmless and go away by themselves, but some types can lead to cancer or genital warts. Nearly all cervical cancer is due to HPV of two types, HPV16 and HPV18.

Why Give the Vaccine to Pre-Teens? Why Not Later?

To be most effective, the vaccine is recommended to be given between the ages of nine and 13. One obvious factor is to immunise before they get sexually active. But also, younger girls will develop immunity better.

The reason to vaccinate young girls is not just that they aren’t sexual activity yet so they are a better lot. Otherwise also their age favours better immunity; younger the kid, better the immunity.

Dr Ranjana Sharma, Senior Consultant, Gynaecology, Apollo Hospital

To be most effective, the vaccine is recommended to be given between the ages of nine and 13.

(Photo: iStock)

If an adult who is not sexually active and is getting a shot, and a child is getting a shot, the vaccine is more effective in the latter, she adds.

The dose is also lesser for children between ages 9 and 11, they get two shots. From year 11 and above, three shots within 6 months are given.

Dr Chitra Setya, a senior gynaecologist, says that school-going children are also more accessible.

The parents are more aware and used to giving vaccines to their children and it comes under the general pediatric immunisation programme. Once you get older, people aren’t used to getting vaccines at that age and it gets difficult to follow.

Dr Chitra Setya, Senior Gynaecologist

Can Sexually Active Women Also Get Vaccinated?

The vaccine can be given to women up to the age of 45. And you can get it whether or not you’re sexually active.

It’s not a single virus, it’s a family of viruses. Even if you are sexually active and have or haven’t contracted an infection, it’s still recommended, since you may have contracted one strain of the virus, but there multiple. So, everyone should get it.

Dr Ranjana Sharma, Senior Consultant, Gynaecology, Apollo Hospital

You can continue with normal activities, sexual or otherwise, during the course of your vaccination.

It doesn’t have side effects. Depending on the individual, even if it does, they are mild and temporary like any other vaccine.

Should It Be Part of the Universal Immunisation Programme?

Many doctors and public health experts are in favour of the vaccine being introduced as part of the Universal Immunisation Programme. The Indian Council of Medical Research (ICMR) has been the driving force behind the vaccination programme.

The Delhi and Punjab governments have already started vaccinating girls aged 11-13 from November 2016.

(Photo: iStock)

Speaking to Fit, Dr Soumya Swaminathan, Director-General of ICMR, and now WHO Deputy Director General for Programmes, said that they have been pushing for it to become part of the policy.

However, some oncologists from Mumbai’s Tata Memorial Centre feel that HPV vaccine is not needed. They cite the sharp fall in the number of cervical cancer cases without medical intervention, attributing it to increased awareness, particularly of personal hygiene. They also questioned the efficacy and safety of the vaccine.

As a counter to this, the WHO and ICMR say that evidence suggests that there is no safety concern.

Yes, the rates have gone down. But it’s still a lot. HPV is very easy to eliminate. So, why not speed it up instead of waiting 2000 years for it to die naturally.

Dr Soumya Swaminathan

Is Cost a Concern?

There are two brands of the vaccine available. A single shot of Gardasil costs approximately Rs 3,000 and Cervarix, about Rs 2,000. So yes, it is a costly intervention.

Recently, RSS’s economic wing, the Swadeshi Jagran Manch, asked Prime Minister Narendra Modi to not include the vaccine, saying it would “divert scarce resources from more worthwhile health initiatives to (a) vaccine of doubtful utility”.

A single shot of Gardasil costs approximately Rs 3,000 and Cervarix, about Rs 2,000.

(Photo: iStock)

For people who are against the vaccine, the high cost is their strongest argument. But experts in favour argue that it’s an effective tool to combat a dangerous cancer.

“When it comes to protecting the whole country, the government has to prioritise. But see this cancer affects women when they are young. We lose one mother every eight minutes, usually in their 30s or 40s, often just at the time when families need them the most,” Dr Ranjana Sharma puts it into perspective.

The government doesn’t have a proper screening programme. We cannot do HPV testing and treatment and 80-90 percent of your population goes uncovered. So, at least invest in vaccinating girls, and in the end you may actually save money.

Dr Ranjana Sharma

Is Rural Population Affected More Than the Urban?

Gynaecologists don’t think so. They believe that access to healthcare is a bigger problem than hygiene in rural areas.

Cervical cancer has a high mortality rate, if the vaccine isn’t made widely available, in rural areas people won’t even know about cervical screening.

The deaths are more in rural areas because people don’t get checked and it is diagnosed late. The urban population is aware and they get tests and screening done early.

Dr Chitra Setya

In urban areas, people are accessing the vaccine in private healthcare, but for rural areas a programme is needed since the costs are high.

(Photo: iStock)

Cervical cancer screening, such as a pap smear, can detect early cancer or abnormal cells that may develop into cancer.

If someone has had an HPV test or a pap smear even once in her lifetime it has a huge protective effect.

Dr Ranjana Sharma

In urban areas, people are accessing the vaccine in private healthcare, but for rural areas a programme is needed since the costs are high.

She adds that hygiene plays a role but there are more important risk factors including sex at an early age, multiple partners, and poor immune function and urban areas have all these factors too.

Should Boys Get the Vaccine Too?

HPV is a virus that any sexually active human can contract, male or female. Men run the risk of penile cancer and other problems like warts because of HPV and that can have implications in the mouth and lungs as well.

If you have enough vaccines, you start giving it to the boys as well, so ultimately it will reduce the risk of cancer drastically. But since we don’t have so many vaccines, we want to first give it to the population that is affected the most.

Dr Ranjana Sharma

If you are a parent of a pre-teen, educate yourself, weigh your options and make a balanced decision based not on morality but facts.

(FIT is reproducing the story first published on 22nd December 2017 for Cervical Cancer Prevention Week. Cervical cancer is the second most common cancer among women in India.)