As India dithers, funding agency waits, says cervical cancer vaccine effective

The Indian Express
Jan 24, 2018

Amid an in-principle decision by the government against introduction of a cervical cancer vaccine in the national immunisation programme, the international organisation that was to have funded the initial rollout has stressed the safety and efficacy of the vaccine while being in no position to influence the government decision-making process.
Even as the National Technical Advisory Group on Immunisation is in the process of deliberating on the recommendation of a subcommittee in favour of Human Papilloma Virus (HPV) vaccine, the health ministry has made it clear that HPV is not among its immediate priorities. The revelation by a top ministry functionary came days after the Swadeshi Jagran Manch, economic wing of the RSS, wrote to Prime Minister Narendra Modi against HPV in the national programme citing cost and safety concerns.
The initial rollout was to have been funded by GAVI, the international vaccine alliance. “We know that immunisation is a top priority for the government,” GAVI deputy CEO Anuradha Gupta told The Indian Express from Geneva. “Right now, the focus is on raising coverage to over 90%, for which the Prime Minister has set out his vision, and continuing the nationwide rollout of measles, rubella, pneumococcal and rotavirus vaccines. We understand the decision on introducing HPV into the national programme is currently going through the due governance processes.”
Gupta said from GAVI’s perspective, HPV vaccines are safe, effective and have the potential to save millions of women worldwide, that provide 100% protection against cervical pre-cancers and genital warts. “All three HPV vaccines – Cervarix, Gardasil, and Gardasil 9 – went through years of extensive safety testing before they were licensed by FDA. FDA only licences a vaccine if it is safe, effective, and the benefits outweigh the risks. The Global Advisory Committee on Vaccine Safety has to date not found any safety issue that would alter its recommendations for the use of the HPV vaccines,” Gupta said from Geneva.
In December 2015, GAVI announced a $500 million grant for India, a quarter of which was to be spent for health system strengthening. The rest was for the introduction of four new vaccines – measles rubella, rotavirus, pneumonia and cervical cancer. Since the approval of this additional support by the GAVI Board, India has introduced vaccines against UIP rotavirus (February 2016) — the leading cause of diarrhoea in children — and measles-rubella (February 2017) and pneumococcal (May 2017) — the leading cause of pneumonia — in various parts of the country, all in the space of 15 months..
While seeking that the vaccine not be introduced, the Swadeshi Jagran Manch has cited cost concerns. Gupta said the intervention of GAVI – which is an international PPP comprising UN agencies, governments, the vaccine industry, private sector and civil society – has significantly brought down the costs of the vaccine.
“GAVI secures vaccine prices that are just a fraction of the price of those in developed country markets. For example, for each dose of HPV vaccine, which prevents cervical cancer, GAVI pays $4.50 compared to more than $100 in the US. The GAVI price for Rotavirus vaccine is $2.50 per dose. I paid $120 per dose in Geneva for the same vaccines for my grandchild. Vaccine manufacturers in India have played an important part in making this happen and are a key source of supply for GAVI,” said Gupta who, before her international assignment, had overseen India’s drive against polio as additional secretary and mission director, National Rural Health Mission, in the Union health ministry.
India with its birth cohort of 27 million children is a priority area for GAVI. “ The current political commitment to universal and free immunisation is fantastic, and GAVI has supported them every step of the way,” Gupta said.

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