by Mandy Van Deven
– India –
Taking the lives of 75,000 women each year, cervical cancer is the leading cause of death for women in India. This number accounts for a third of all cancers that affect women in India and a fifth of the total cervical cancer related deaths worldwide. With 132,000 new reported cases in India annually, this disease is having catastrophic effects on the developing world.
The cause of cervical cancer is particular strains of the human papillomavirus (HPV), which at least half of sexually active men and women worldwide contract during the course of their life. Although having fewer sexual partners decreases one’s risk of contracting HPV, the pervasiveness of the virus makes it difficult to avoid. HPV is transmitted by skin-on-skin contact, and thus renders condom use ineffective for complete prevention. However, the recent development of a vaccine has given many people hope.
The government of Gujarat, India’s westernmost state, has responded to the cervical cancer crisis in the country by launching its first ever vaccination project. “The demonstration project in Gujarat will be aimed at vaccinating 16,000 girls between 10 to 14 years of age, which will help to examine the possibility to introduce the vaccination project across the country,” said state Health and Family Welfare Minister Jaynarayan Vyas in an interview with The Hindu. “Vaccines will be provided free of cost by the government to school-going as well as non-school going girls.”
While the effort is to be lauded, 16,000 girls is a small drop in the bucket given the country’s 1.15 billion population, half of which is female and over 100 million are adolescent girls. At the current price of $360 per girl, the three-dose shot is also cost prohibitive to the average citizen. A national vaccination program would require a multi-billion dollar government expenditure, as well as the creation of a national immunization public health program to ensure the use of safe, disposable needles and completion of the full dose. To make matters more complicated, the current vaccination only lasts for six years, and requires a booster shot to uphold its effectiveness. Unfortunately, the Indian government is not currently able to tackle a project of this magnitude alone.
The World Health Organization Initiative for Vaccine Research’s Dr. Linda Eckert believes this widespread effort might be viable with the help of foreign aid. She suggests the Global Alliance on Vaccines and Immunization could subsidize the cost while Unicef negotiates the price with the pharmaceutical companies who sell the vaccine. The Indian Council of Medical Research has come up with another option: allow its citizens to be used as test subjects for the pharmaceutical companies’ research.
A long-term study on the viability of Gardasil in India will begin next month with 600 patients soon to be recruited. Naveen A Rao, managing director of Merck Sharp & Dohme Pharmaceuticals in India says, “The study will take six months to complete and a follow-up for two and a half years will be conducted. At the completion, we will supply the drug at a very affordable cost for the Indian population.” Gardasil currently occupies 79% of the cervical cancer treatment market in India, and the results of this study could expand the company’s reach even further.
For older women, vaccination is not an option, though cervical cancer in this population can be prevented by a routine test well known to American women: the pap smear. Pap exams are the least complicated and most effective way to prevent cervical cancer and have contributed to the significantly reduced death rate in women over the past 40 years. Regular pap smears take a swab of cervical cells and then examine them under a microscope.
Although this process sounds easy enough, this screening requires trained personnel to complete the swab and accurately interpret the results. If abnormal lesions are identified, the lesions need to be removed before they progress into cancer, a simple and non-invasive procedure that requires the skill of a qualified physician. A lack of quality care, inadequate local infrastructure such as electricity and clean water, insufficient public awareness, and lack of affordability are all major hindrances for India’s most vulnerable patients. Many women living in slums and villages fail to receive a diagnosis until it is too late to treat.
In a place where eight women die every hour from this preventable disease, more steps should be taken to ensure women’s health is a higher national priority. The World Health Organization has said cancer will be the most dangerous and fastest growing disease in just five years time, but this growing peril can be decreased through awareness raising efforts, vaccination, and screenings that detect problems at their earliest stages.
About the Author
Mandy Van Deven is a freelance writer and the founder of the Feminist Review blog. Focusing on gender, politics, and popular culture, her work has appeared in various online and print media, including AlterNet, Bitch, In These Times, and make/shift. Mandy worked for over ten years as a grassroots organizer in New York and Atlanta. She is an avid and enthusiastic world traveler who has collected friends in countries all over the globe. Mandy currently lives in Kolkata, India.
Preventable and yet not prevented. What a dreadful shame. I hope this article will lead to greater awareness of the problem and the facilitation of relieving the problems of delivering good health care to all of the people of India, especially that of preventable diseases.
It verges on a crime agaist humanity for there to be ways to prevent diseases that are only available to the few. This issue everywhere in the world is one the human race could do something about. We must.
Very nice and informative article, our problem in the middle east particularly Gulf region isn’t financial resources, but social acceptance as conservatives who represent the majority of population think that such vaccinations would promote women to have multiple sexual relationships, while the fact that most women got such infection because of their husbands’ unfaithfulness.
There seems to be hope but as you have also mentioned, in a country that suffers from so many shortcomings, it looks like impossible that a vaccine will actually be effective enough to make a difference. There is utter ignorance and awareness levels are nil for majority of women, both literate and otherwise. However, the fact that the Gujarat government has recognized this disease and has in mind to find a solution, in itself is a positive step we hope to see come up with positive results.
Great Article. As a mother with 3 daughters, I am happy this vaccine is out there. I think that girls in the USA may have this vaccination up to age 23. I also agree with the reader that posted her comments on the middle east. Since this vaccine is for the prevention of a sexually transmitted disease then it is disregarded because the expectations of culture and society in the middle east would think this an unnecessary step in disease prevention. Due to the fact that the girl is to remain virtuous till marriage, they most likely will not want to get them vaccinated, so it does not protect the woman from what she may encounter during her marriage. Very sad reality, but hopeful outlook on a new vaccine.
Excellent article which addressed the hurldes in the implementataion of cervical cancer vaccination in developing country such as India. The availability of vaccine at an afforadable cost after the clinical trials involving Indian population seems to be promising to curtail the prevalence of preventable cervical cancer among Indian women.
Need for a booster dose after 6 years to preserve the efficacy of vaccine and other financial constraints for Indian Governement in the implemention of National Immunization Programme with cervical vaccine in India remains a challenge now.
Dr.S.Gunasakaran,MBBS,MD
Excellent article which addressed the hurdles in the implementation of cervical cancer vaccination in the developing country such as India. The availability of vaccine at an affordable cost after the clinical trials involving Indian population raise the hope in curtailment of high prevalence rates of Cervical Cancer among Indian women.
Need for a booster dose after 6 years of vaccination to preserve the efficacy of vaccine and the financial constraints for Indian Government in the implementation of National Immunization Programme with cervical cancer vaccine remains a challenge now.
Dr.S.Gunasakaran,MBBS,MD