IIt’s a Wednesday morning and Sneha Neurgaonkar is sitting on a stretcher in a private hospital in Pune, India. The 14-year-old is at Lalwani Mother and Child Care Hospital to receive the first Indian-made vaccine against human papillomavirus (HPV), which prevents cervical cancer.
Unlike the 10-year-old girl who got the vaccine before her, Sneha knows what cervical cancer is and the damage it causes to women in her country.
“I researched cervical cancer on Google and it’s bad,” she says. “Protection is very important because women are the leaders of the future generation and without them there is no world.”
Cervical cancer is the second leading cause of cancer deaths among women in India, killing an estimated 70,000 people a year – a quarter of the global burden of the disease. According to the World Health Organization (WHO), cervical cancer is the fourth most common cancer in women worldwide, with approximately 90% of deaths from the disease occurring in low- and middle-income countries.
Almost all cervical cancer is caused by an infection of certain types HPV. The disease takes 15 to 20 years to develop.
The HPV vaccine has been shown to significantly reduce the number of casesbut access to the vaccine in India is extremely limited as existing doses, sold by foreign pharmaceutical companies Merck and GSK, are expensive.
Developed as a joint initiative between the Indian government and the Serum Institute of India (SII) – the world’s largest vaccine manufacturer by dose – Cervavac is the first vaccine manufactured in the country that obtain approval from the Drugs Controller General.
Last month the government announced that this would happen including the vaccine included in the country’s vaccination program, meaning it will be distributed free of charge to girls between the ages of nine and 14.
Currently it is only available in private healthcare settings, at a price of 2,000 rupees (£19) per dose. SII CEO Adar Poonawalla says the vaccine will be available to the government in December at a price of Rs 300 to Rs 400 per dose.
The Pune-based SII can currently produce 70 million doses of the vaccine annually but aims to at least double that number by 2026. 25 million children are born in India every year.
Once demand in India is met, Poonawalla plans to export the vaccine. “We will start with African countries, the Indian subcontinent and perhaps South America,” he says. “Europe and the US will probably not see this vaccine because they are used to it the 9-valent (vaccine). Maybe in five or six years we will make the 9-valent and go to these countries.”
Umesh Shaligram, executive director at SII, says the new HPV vaccine “will have a huge impact.”
“I have always felt that women in low- and middle-income countries are not treated well,” he says. “It is a mother who gives you energy and strength. In Indian spirituality we have prayers, we have goddesses everywhere. If you ask me if we pass on that respect, probably not. I’ve always felt that loss. I was really happy that we could do something for that specific aspect of life.”
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This vaccine comes almost twenty years after the the first HPV vaccine was developed in 2006. Shaligram blames Covid for the delay in production, but some have criticized the delay.
“At some point it should no longer be an achievement if we get a cheap indigenous vaccine that we can afford 18 years after the one in the West,” said Achal Prabhala, coordinator of the AccessIBSA project, which campaigns for access to medicines in India, Brazil and South Africa. “Why can’t SII challenge the environment to produce vaccines at the same time as those in the West?”
Back in Lalwani, Sneha and her mother, Sonia, are happy that she has been vaccinated with a vaccine made in India. “If it is made in India, we have more confidence,” says Sonia.
Sneha says she told her friends about the vaccine. She thinks many of them don’t know about cervical cancer. “Right now there’s not a lot of awareness,” she says. “We didn’t learn anything about it at school. Period awareness is now being implemented, but previously it was taboo.”
Her doctor, Sunita Lalwani, a gynecologist and obstetrician, agrees: “I don’t think the government or families used to spend money on women’s health. Only when the lady gave birth or when she became really ill were women cared for. Vaccination was never considered. Women’s health was a big taboo.”
Despite that of the WHO recommendation that all women over the age of 30 undergo cervical cancer screening every five to ten years, less than 2% of women in India aged 30 to 49 have this screened.
Lalwani has trouble convincing women to go to appointments for a cervical smear, a procedure that uses a small brush to gently remove cells from the surface of the cervix and the area around it so they can be screened for cancer checked.
“Pap smears have always been available, but where are the takers? I have to call and text my patients. I can tell you: many don’t show up.”