Ramping up the fight against cervical cancer

Recently, India launched vaccination against cervical cancer by including it in the national immunisation programme, Mission Indradhanush. Beginning March, all 14-year-old girls in the country will receive a single dose of the HPV vaccine Gardasil-4, produced by the American pharma giant MSD.

The decision marks a significant public-health intervention aimed at reducing the burden of cervical cancer, one of the leading causes of cancer deaths among Indian women. India reports 1,20,000 cervical cancer cases a year and close to 80,000 deaths. The country accounts for a substantial share of global cervical cancer deaths, though questions remain about the accuracy of incidence reporting.

The introduction of the vaccination has revived a debate that had remained largely quiet in recent years. Two questions dominate the discussion: whether the vaccine provides meaningful, long enough protection or it could increase cancer risk rather than prevent it. Supreme Court lawyer Prashant Bhushan cited arguments from the 2018 book HPV Vaccine on Trial by Mary Holland and co-authors to challenge the vaccine.

The book describes the HPV vaccine as a pharmaceutical juggernaut generating more than $2.5 billion in annual sales for pharma companies, and argues that commercial incentives played a major role in its global promotion. It claims that manufacturer data reviewed by the U.S. Food and Drug Administration (FDA) at the time of approval showed higher reported deaths among vaccine recipients than deaths from cervical cancer itself. More concerning are rumours, such as claims that the vaccine causes infertility, spreading from anti-vaccine circles to the wider public through social media and fuelling public apprehension.

Part of the difficulty in assessing HPV vaccines lies in the long natural history of cervical cancer, which typically develops decades after infection with HPV. Cervical cancer often appears around the age of 50, which means a vaccine given to adolescents can be fully evaluated only three or four decades later. When Gardasil was first approved by the FDA in June 2006, clinical trials had followed participants for only about three to five years, though the development programme ran from 1998 to 2006. This limited follow-up was absolutely insufficient to judge the vaccine and has been a source of criticism.

But now, nearly three decades after the earliest vaccinations began, a growing body of real-world evidence has emerged. A large nationwide cohort study in Sweden, published in February 2026 in the British Medical Journal (BMJ), followed close to a million women for up to 18 years. The study documented 930 cases of invasive cervical cancer, including 97 among about 4,00,000 vaccinated women and 833 among the roughly 6,00,000 unvaccinated women. Women vaccinated before the age of 17 had about a 79% lower risk of cervical cancer, with protection lasting at least 13-15 years. Those vaccinated at 17 years or older had about a 37% lower risk.

Other studies report similar findings. One recent review counted 54 studies conducted across different countries and vaccine types, most reporting significant reductions in HPV infections, precancerous lesions, and cervical cancer risk following vaccination.

Winning trust

However, scientific evidence alone does not determine public acceptance. Vaccination programmes depend heavily on public trust. Unfortunately, HPV vaccination has had a contentious history in India. In 2009, a Phase 4 trial in the then undivided Andhra Pradesh and Gujarat triggered intense debate after several deaths among participants. Expert probes could not establish any causal link between the vaccine and the deaths, but the episode left a lasting imprint on public perception.

Concerns about vaccine safety often arise from the belief that regulatory approval may precede long-term safety data. Monitoring systems attempt to address this gap. Globally, vaccine safety surveillance relies on reporting platforms such as the Vaccine Adverse Event Reporting System in the United States and the Adverse Events Following Immunization (AEFI) system in India. At least in India, the system undercounts adverse events because it depends on voluntary reporting. Vaccine companies argue that multiple layers of pharmacovigilance and epidemiological studies continue to evaluate safety long after vaccines are introduced.

Another reason for raised eyebrows is that despite India having an indigenous vaccine comparable to MSD’s Gardasil-4, which protects against four HPV types, the national programme has opted for a foreign vaccine. However, the Indian Council of Medical Research is still evaluating whether a single dose of the Indian-made vaccine Cervavac, developed by the Serum Institute of India, produces antibody responses comparable to those of Gardasil. The results of this study will determine whether the domestic vaccine too becomes part of the national programme.

The policy push also reflects international health priorities. In 2023, GAVI, the Vaccine Alliance approved a $250-million grant to India to support the introduction of the HPV vaccine and the typhoid conjugate vaccine. Global health agencies consider HPV vaccination a central strategy for reducing cervical cancer globally. India’s decision to introduce HPV vaccination, therefore, sits at the intersection of science, policy and public trust. Preventing cervical cancer on a national scale will require more than a vaccination drive.

The success of HPV vaccination programme ultimately will depend not only on the science behind the vaccine but also on how transparently the programme is implemented. Clear communication of evidence, transparent safety monitoring and openness to scrutiny will determine whether the programme earns the confidence it needs to succeed.

Cervical cancer is largely preventable, but preventing it at scale requires something more than a vaccine in a vial. It requires sustained public trust.

Ameer Shahul is the author of Vaccine Nation: How Immunisation Shaped India; views expressed are personal

Published – March 26, 2026 12:19 am IST