Last month, we caught up with Shikha Taneja Malik (Senior Manager, Scientific Affairs, Drugs for Neglected Diseases initiative (DNDi); formerly, Senior Program Manager, BIRAC, Ministry of Science and Technology, Government of India; Leadership Journey Alumna, India ’23) for World Immunization Week 2024 (April 24-30) to discuss the incidence of HPV in India, barriers to the uptake of HPV vaccines in the country, and details of her Leadership Project, which aimed to raise awareness about the virus among adolescent girls and their parents.
What is HPV, what are its risks, and how does the virus manifest among men and women?Â
Shikha Taneja Malik: Let’s take a step back and talk a bit about the virus first. The Human Papilloma Virus or HPV is the most common viral reproductive tract infection that causes a range of conditions among men and women, including precancerous lesions that may progress to cancer. It is a group of more than 200 related viruses and the infection spreads through contact with infected genital skin, mucous membranes or bodily fluids, and can be transmitted through sexual intercourse, including oral sex.
Sexually transmitted HPV types fall into two groups: low risk and high risk. High-risk HPVs can cause several types of cancer. Almost all sexually active people are exposed to this virus at some point in their lives, but the infection does not usually result in any symptoms. In most people, the body combats the infection on its own. But persistent infection of high-risk HPV types can lead to cervical cancer and/or other cancers of the vulva, vagina, mouth/throat, penis, and anus.
Why has HPV emerged as a growing concern in India in recent years?
Shikha Taneja Malik: Data shows global inequalities in the incidence of and death resulting from cervical cancer, with rates being much higher in low- and middle-income countries (LMICs). LMICs like India lag far behind the rest of the world in screening and other preventive measures which means that despite having effective vaccines available in the market to prevent cervical cancer, uptake is minimal. As a result, cervical cancer has been recorded as the second most common cancer among women in India. In 2020, about one-fourth of all cervical cancer deaths worldwide occurred in the country. It is time that, as a nation, we start taking the threat posed by this virus seriously and addressing the devastating effects it has on women, families, and the country.
What are the current barriers to the uptake of the HPV vaccine in India?
Shikha Taneja Malik: In India, the sociological factors at play when it comes to women’s health tend to involve a myriad of taboos. Anything related to sexual health is often stigmatised, resulting in a discriminatory divide becoming embedded in the fabric of society. In my opinion, a lack of knowledge about HPV and its prevention and socialcultural barriers towards discussing sexual health are the major barriers to the uptake of the HPV vaccine in the country.
In India, the government is actively pushing the HPV vaccine among girls between 9-14 years – what is the significance of boosting vaccines among this age group?
Shikha Taneja Malik: Ideally, the HPV vaccine should be administered before someone becomes sexually active, that is, before exposure to the virus. Cervical cancer accounts for more than 80 percent of all cancers related to HPV and the main purpose of HPV immunization is its prevention. In 2020, the World Health Organization (WHO) created a strategy to eliminate cervical cancer as a public health problem. WHO recommends that HPV vaccines should be included in all national immunization programmes. By 2030, the goal is to vaccinate 90 percent of all girls by the age of 15.
As a part of the 2023 India Leadership Journey, your Leadership Project focused on increasing awareness among adolescents and parents regarding the HPV vaccine and cervical cancer – could you share some insights/lessons that your study found?
Shikha Taneja Malik: The Project focused on raising awareness of HPV-related cancer and its prevention. To achieve this, I conducted focus group discussions with parents in an apartment complex in Pune, India and engaged in conversations with young girls at a school in Delhi. During these interactions, I emphasized the importance of understanding the virus, the diseases it causes (with a specific focus on cervical cancer), and preventive measures.
Before initiating discussions, I conducted a survey to assess overall knowledge and acceptance of vaccines as well as awareness of HPV and the acceptability of the HPV vaccine. The survey revealed that both parents and girls had intermediate to high levels of general vaccine knowledge and acceptance. They recognized vaccination as an effective measure against infectious diseases, with benefits outweighing risks. Parents demonstrated intermediate knowledge about HPV transmission and its association with cervical cancer, although awareness of HPV’s role in other diseases was limited. In contrast, young girls had minimal knowledge about the virus and the vaccine. Approximately 50 percent of them were unsure about taking the vaccine due to lack of information.
After addressing their queries during the discussions, I conducted a follow-up survey. When asked if they would like to vaccinate themselves, a majority of the participants expressed a desire to protect themselves or their children by getting vaccinated. This highlighted the positive impact of informed discussions on vaccine acceptance. By delivering credible information through a locally adapted approach, I was able to raise awareness and empower women and young girls to make informed health decisions.
How can we tackle the social stigma surrounding women and girls’ sexual and reproductive health while communicating the benefits of the HPV vaccine?
Shikha Taneja Malik: Clear and effective communication is essential for overcoming stigma related to sexual and reproductive health. Creating a safe space where girls can express themselves and ask questions is crucial. Encouraging open discussions within families empowers them with credible information, enabling informed decisions about their well-being. Peer-to-peer conversations also play a vital role; in my project too, young girls served as peer educators, sharing their knowledge. Women and girls who have received the vaccine can also share positive experiences to combat myths and misconceptions. Additionally, training teachers and dedicating time to sexual and reproductive health education are some of the key steps that would go a long way.
