Opinion New realities,new risks

The HPV vaccine should not be held hostage to middle-class fears and unease among medical professionals.

February 14, 2011 02:27 AM IST First published on: Feb 14, 2011 at 02:27 AM IST

Up to 80 per cent of women,once they become sexually active,are likely to be infected with the human papillomavirus (HPV) at least once in their lifetime,usually in their teens,20s and early 30s. These infections are generally asymptomatic and clear spontaneously within a few months. However,in some women the infection persists and is strongly correlated with the development of pre-cancerous cervical lesions,which unless detected and removed,can later develop into full-blown cancer.

Those at high risk are usually adolescents because the virus can more easily penetrate an immature cervical epithelium (cell lining of the cervix),a reason why perhaps cancer of the uterine cervix is today considered a disease of rural women who marry early and have multiple pregnancies. In urban India,on the other hand,it is argued that breast cancer is the greater danger to womens health. While this may be true to some extent,we would be foolhardy to give in entirely to such an argument. There is reason to believe that while adolescents in cities may not marry as early as their rural counterparts do,they are initiated into sex at an early age,albeit before marriage.

For these young women,the best protection is to be vaccinated while they are still children from the age of eight onwards. The current HPV vaccine targets strains that cause cancer of the uterine cervix over time and can therefore be considered a preventive measure. Remember also that it is highly unlikely that these young people will go for regular investigations such as Pap smear tests so that abnormal cell changes in the cervix can be picked up early and cancer can be nipped in the bud,so to speak. They surely will not want to be asked if they are married,and on answering in the negative,be judged as morally deficient people. Moreover,what if a high-minded doctor decides that he has an obligation to inform the parents,confidentiality be damned?

It is a matter of concern,therefore,as to why the HPV vaccine for preventing cancer of the uterine cervix is still a matter of dispute and unease among medical professionals in India. What I hear time and again from friends and colleagues is that they have been told by their doctors,mainly gynaecologists,that the vaccine is unsafe and that they should not vaccinate their young daughters with it. This is totally untrue and against the evidence to which they undoubtedly have access.

The data that is available from clinical trials worldwide makes it quite clear that no serious adverse reactions have been reported so far following immunisation with the HPV vaccine. A closer look at the facts surrounding the death of two women who were supposedly administered the HPV vaccine in India has also revealed that they died of unrelated causes (they committed suicide). And yet the scare persists among the informed. How else can one explain the halting of the HPV vaccination campaign in its tracks by the Indian Council of Medical Research (ICMR)?

The answer may well lie in the fact that middle-class society in India is,by and large,reluctant to face facts and talk openly about sexuality with anyone,especially children. They do not want to either educate themselves or their children on these matters,as they fear the repercussions. Parents have strenuously opposed sex education in schools even as evidence mounts that more and more young adolescents,including girls,are becoming sexually active. There is a reluctance to face this issue squarely and engage with it as it threatens the middle-class values with that they have grown up with,and which has defined their moral behaviour thus far. They would rather bury their heads in the sand and pretend that all is as usual rather than accept that they are entering territory,where new measures are needed to keep their children safe and that the HPV vaccination is one such measure.

A strategy which uses the HPV vaccine and current screening methods to prevent cervical cancer is a must in a country such as India. We should not only look at factors such as cost and access to facilities,but also discover a way of making people,especially the middle class,from where the majority of doctors come,feel at ease.

Advocating that young girls be administered the vaccine early may well be an unpalatable reminder for many that their daughters are likely to be more sexually active than they would like and that too,possibly before marriage.

Providing facts and information is not enough; our middle class norms too need to be handled.

The writer is president,CanSupport