5 min readMar 3, 2026 06:40 PM IST First published on: Mar 3, 2026 at 06:40 PM ISTWith the rollout of the human papillomavirus (HPV) vaccine, India has joined the group of 148 countries that have implemented HPV programmes, with nine of them starting as early as 2006. The current rollout, which began from Ajmer on February 28, will operate in campaign mode for three months to voluntarily vaccinate all adolescent girls aged 14, after which the vaccine will be available at all government centres free of cost.Cervical cancer remains the fourth-most common cancer among women globally and the second-most common in India. A new case of invasive cervical cancer surfaces every four months, and a death due to it occurs every seven minutes in India. While early age of sexual activity, multiple sexual partners, smoking, a weakened immune system, and poor hygiene are recognised risk factors for cervical cancer, infection with high-risk HPV is associated with nearly 70 percent of all cervical cancer cases. Nearly 80 per cent of sexually active individuals may acquire an HPV infection at some point in their lives. However, most infections are transient and cleared naturally by the immune system.AdvertisementHPV has over 100 known strains, with 14 being implicated in carcinogenesis. The vaccine now approved for rollout, Gardasil 4, protects against the two high-risk types 16 and 18, along with types 6 and 11, which are known to cause genital warts. Other vaccines include the bivalent Cervarix and Cervavac, and the nonavalent Gardasil-9, which offers protection against five additional strains.Experts remain divided about the HPV vaccine and its purported benefits. Sudeep Gupta, Director of TMC, in his conversation with the journal e-cancer in 2017, argued that rates of cervical cancer are already declining in the country. He argued that population-wide deployment of a vaccine would benefit a relatively small number of women and instead advocated strengthening basic facilities such as sanitation. Doctors also believe that the nine-strain vaccine should have been prioritised. This view is based on the hypothesis that while types 16 and 18 remain the most prevalent cancer-causing strains, vaccine-induced type replacement, where another strain fills the niche left vacant by an eliminated strain, could derail elimination efforts. Some studies, however, have negated this possibility, citing the genetic stability of the virus and the lack of natural competition between individual HPV types.Also Read | To check cervical cancer, vaccine and information must go togetherA frequent concern relates to the duration of protection. The vaccination is administered between 9 and 14 years of age, whereas the highest predisposition to cervical cancer lies between 50 and 59 years. This becomes particularly relevant as India has opted for a one-dose regimen, which studies suggest has comparable efficacy. However, doubts remain regarding the possible need for booster doses. Long-term follow-up and continued surveillance will be required to document protection beyond this period.India’s own experience with early HPV vaccination efforts has also influenced public perception. In 2009, state governments in Andhra Pradesh and Gujarat, in collaboration with the Indian Council of Medical Research and PATH, initiated HPV vaccination demonstration projects among adolescent girls. Following reports of seven deaths among participants and concerns regarding consent processes, these projects were suspended by the government in 2010.AdvertisementSocial and cultural myths present real challenges to vaccine uptake. KAP studies have consistently reported that knowledge among beneficiaries in rural areas and those belonging to lower socio-economic groups remains low. Even where awareness is relatively high, it does not necessarily translate into changes in attitude or practice. Even doctors, who may possess adequate knowledge about the vaccine, do not always opt for it themselves or suggest it to their patients.One of the most persistent myths about vaccination, seen earlier during the Covid-19 pandemic, is its alleged potential to cause sterility. HPV vaccination is often thought to imply prior sexual activity, to encourage premarital sexual behaviour among adolescents, or is even conflated with HIV within communities.you may likeSex education and community engagement must be integral to the vaccination strategy. School health initiatives can serve as a critical platform for delivering age-appropriate information about HPV, vaccination, and cancer, not only to adolescents but also to their guardians. Integrating awareness into existing adolescent health programmes such as RKSK (Rashtriya Kishor Swasthya Karyakram) can help ensure that education precedes misinformation. Many women who accompany family members to health facilities represent important opportunities for counselling and vaccination advocacy. Studies have shown that maternal education, perception of disease severity, and parental intention are strong predictors of adolescent vaccine uptake.Importantly, vaccination alone is not enough to eliminate cervical cancer. Screening strategies such as pap smear and Visual Inspection with Acetic Acid (VIA) have been introduced, but their uptake remains abysmally low, at less than 2 per cent. Self-sampling for HPV testing has emerged as a promising and patient-friendly alternative. However, high costs limit its widespread use.The HPV vaccine is only one piece of the puzzle in achieving the WHO’s 90-70-90 target by 2030. As India rolls out HPV vaccination more widely, it is important to move towards gender neutrality and include boys and members of the LGBTQ+ community. While the vaccine remains an important preventive tool, the ability to harness its full potential will depend on how thoughtfully it is complemented by screening, treatment, and education.Gupta is a doctor and writer