Himanshu Aneja and Jacob Puliyel

Dr Panna Choudhury has dedicated his President’s Page to advocacy for preventing cervical cancer(1). He makes a passing reference to the prohibitive costs of the vaccine but he reiterates the Indian Academy of Pediatrics (IAP) recommendation to offer HPV vaccine to ‘all appropriate females who can afford the vaccine’. The vaccine costs Rs 18750 per person (Conversion rate $1 = Rs 50)(2). According to the article, although there are no recommendations about the need for booster doses and efficacy for 5 years is all that is known.

The answer to the question of how to decide who can afford the vaccine is not explicit. For example, can we assume that parents, who have only one girl child and earn Rs 20,000 per month, will afford the vaccine? Intuitively one feels that the question of affordability will relate to costs and benefits, besides earnings every month. Persons may afford heavy costs if the benefits are commensurate.

We have done a quick calculation of the cost of preventing cancer by this vaccine. In a recent study from India published in the NEJM, 31,488 women (30 to 59 years old), were followed up over 8 years with no intervention (in the control group)(3). 64 died of cervical cancer. The absolute risk of cervical cancer was 2.5/10,000/year. If we optimistically assume that every case of cervical cancer will be prevented by the vaccine, the absolute risk reduction is 0.00025 and the numbers needed to vaccinate to prevent one death is 4000. The cost per life saved is Rs 75 million. We wonder how many members of the IAP work in areas where the people can afford this vaccine.

The article suggests that the vaccine should be introduced to parents as a cervical cancer preventing vaccine and not as a vaccine against sexually transmitted infections. In this and numerous other subtle ways, we as doctors and trusted advisors can sell the vaccine. The question we need to ask is – should we? Individual doctors will need to wrestle with this, as the IAP has left the choice of whom to advise, to individual judgment.

1. Choudhury P. Preventing cervical cancer: Pediatrician’s role. Indian Pediatr 2009; 46: 201-203.

2. Centers for Disease Control and Prevention. HPV vaccine information for young women. Available from: http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm#hpvvac4. Accessed on April 4, 2009.