Is human papillomavirus vaccination likely to be a useful strategy in India?

Abstract

Two vaccines that protect against infection by some of the oncogenic human papillomavirus (HPV) subtypes have recently been licensed for use in population-based vaccination strategies in many countries. However, these products are being promoted as ‘cervical cancer vaccines’ based on inadequate data. Specifically, there remain several concerns about the duration of immunogenicity, length of follow-up of trial subjects, endpoints chosen in vaccine trials, applicability of trial results to real populations, the safety of these products, and their cost-effectiveness as public health interventions. Furthermore, it is unlikely that vaccination will obviate the need for setting up robust and cost-effective screening programs in countries like India. This article will discuss various aspects of HPV vaccination from a public health perspective, especially from the point of view of its relevance to India and other South Asian countries.

Introduction

Introduction of the human papillomavirus (HPV) vaccines in India in recent years has led to considerable discussion in the medical and public health community. Arguments have been advanced for and against a population-based mass vaccination strategy. Suspension of field trials of one of the vaccines by the Indian regulators in April 2010 because of alleged irregularities has added grist to the mill. This article will pragmatically review the available evidence for HPV vaccination and assess whether it is relevant to a low-resource country like India. We will consider the end-of-study analyses of the large phase III prophylactic HPV-virus-like-particle (HPV-VLP) vaccines that have been published.

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