Turning the Tide on Cervical Cancer in India

The Government of India’s decision to launch a free nationwide single-dose human papillomavirus (HPV) vaccination campaign for girls aged 14 is a major milestone in the fight against cervical cancer. ¹ Despite being largely preventable, cervical cancer continues to impose a heavy mortality burden in India, with 127,526 incident cases and 79,906 deaths reported in 2022. ² Persistent infection with high-risk HPV types 16 and 18 accounts for most cervical cancers. ² WHO now endorses a single-dose schedule for girls aged 9–14 years, recognising that one dose provides durable protection and facilitates broader and faster vaccine coverage. ³ Furthermore, a meta-analysis of more than 902,368 vaccinated women found that one-dose schedules offer protection comparable to two- and three-dose regimens, with effectiveness sustained for at least eight years. ⁴

HPV vaccination in India has historically been constrained by cost, with market prices placing the vaccine beyond the reach of most families and contributing to extremely low coverage. ² The Government of India’s decision to provide the free vaccine through a national campaign therefore represents an important step toward correcting long-standing inequities in access to cervical cancer prevention. ¹ By removing financial barriers, the programme has the potential to reach girls in rural and socioeconomically disadvantaged communities, where cervical cancer mortality remains disproportionately high. ² To ensure sustained impact, however, incorporation into the Universal Immunisation Programme (UIP) would be preferable to a time-limited campaign model. ⁵ Routine integration protects successive birth cohorts, strengthens accountability, and supports long-term coverage stability. ⁵ Economic evaluations from Australia have demonstrated that HPV vaccination is highly cost-effective when delivered through national immunisation programmes, particularly when high coverage and long-term reductions in cervical cancer burden are considered. ⁶ These findings support sustained public investment in HPV vaccination as a high-value cancer prevention strategy.

Countries within the WHO South-East Asia Region, including Nepal, Bhutan, Sri Lanka, and Thailand have successfully introduced HPV vaccination into their national immunisation schedules, achieving high uptake through school-based and routine delivery platforms. ⁷ International experience suggests that hybrid delivery models combining school-based vaccination with facility-based catch-up services may be particularly effective in achieving high coverage.^8,9 Australia’s nationally funded HPV programme integrates school-based vaccination with primary healthcare and community-based delivery mechanisms, contributing to some of the highest HPV vaccine uptake rates globally and positioning the country on a trajectory toward cervical cancer elimination. ⁹ Similarly, Rwanda achieved vaccination coverage exceeding 90% through a school-based strategy supported by strong community engagement, health facility participation, and intersectoral collaboration between health and education sectors. ⁹ These experiences indicate that a hybrid approach may be especially relevant for India, where substantial proportions of adolescent girls may be missed by either school-based or facility-based delivery alone. A phased implementation framework incorporating school vaccination, outreach for out-of-school girls, digital monitoring systems, community mobilisation, and integration with routine immunisation services could maximise both equity and coverage while supporting long-term programme sustainability. Achieving durable impact will depend on high adolescent uptake, informed parental consent, and sustained public engagement to address misinformation and sociocultural hesitancy. ² Given India’s population scale, sustained and equitable implementation of HPV vaccination could markedly accelerate progress toward the WHO 90–70–90 cervical cancer elimination targets.^10,11

In conclusion, India stands at a critical juncture in cervical cancer prevention. The success of this initiative will depend on sustained political commitment, community trust, and its translation into measurable gains in vaccination coverage and early cancer control.

ORCID iD

Tarun Kumar Suvvari https://orcid.org/0000-0003-0063-0339