Comparison of HPV vaccination strategies for pilot implementation in North India

Abdul Basith K. M.; Nivedita Chakravarti; Tarundeep Singh

doi:10.18203/2394-6040.ijcmph20263651

Authors

Abdul Basith K. M. Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
Nivedita Chakravarti Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India
Tarundeep Singh Department of Community Medicine and School of Public Health, PGIMER, Chandigarh, India

DOI:

https://doi.org/10.18203/2394-6040.ijcmph20263651

Keywords:

Cervical cancer, Cervavac, Gardasil, HPV vaccination, India, Single-dose schedule

Abstract

Cervical cancer remains a leading cause of cancer mortality among women in India. India’s 2024 interim budget prioritization of HPV vaccination for girls aged 9-14 years provided a pivotal opportunity for state-led pilots to inform national policy. This paper compares three vaccination strategies (Single-dose Gardasil; Two-dose Cervavac; and Single-dose Cervavac) within the planning for a school-based HPV vaccination pilot targeting 6,300 girls in North India. A comparative analysis of programmatic feasibility, estimated financial cost, and scientific evidence was undertaken. Strategy 1 (single-dose Gardasil) and Strategy 2 (two-dose Cervavac) had comparable financial outlays (~23 million INR), but Strategy 2 imposes a 64% higher human resource burden (2,120 vs. 1,288 man-hours). While Strategy 1 is supported by the strongest longitudinal efficacy data, Strategy 2 aligns with the national interest of indigenous vaccine with minimal cost per dose. We recommend an approach that leverages single-dose Gardasil vaccination until further trial data on single-dose Cervavac is available, to optimize the coverage and improve programmatic efficiency.

References

Ferlay J, Ervik M, Lam F. Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available at: https://gco.iarc.who.int/today. Accessed on 21 March 2026.

World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. Geneva: WHO. 2020.

Chougule A, Joan M, Avasthi SK. Understanding of cervical cancer etiology, prevention, and early diagnosis by allied health professional students in India. Health Technol. 2026;16(1):145-53.

World Health Organization. Meeting of the Strategic Advisory Group of Experts on Immunization (SAGE), April 2022. Wkly Epidemiol Rec. 2022;97(29):329-48.

Kumar P, Ray A, Kumari A, Sultana A, Hora R, Singh K, et al. Chronicling the journey of pneumococcal conjugate vaccine introduction in India. Vaccines. 2025;13(4):432.

World Health Organization. Human papillomavirus vaccines: WHO position paper. Wkly Epidemiol Rec. 2022;50:645-72.

Ministry of Health & Family Welfare, Government of India. Operational guidelines for HPV vaccine introduction under universal immunization programme in India. 2023. Available at: https://nhmmizoram.org/upload/Draft%20Operational%20Guidelines%20-%20HPV%20Vaccine.pdf. Accessed on 21 March 2026.

Basu P, Malvi SG, Joshi S, Bhatla N, Muwonge R, Lucas E, et al. Vaccine efficacy against persistent human papillomavirus (HPV) 16/18 infection at 10 years after one, two, and three doses of quadrivalent HPV vaccine in girls in India: a multicentre, prospective, cohort study. Lancet Oncol. 2021;22:1518–29.

M de Carvalho T, Man I, Georges D, Saraswati LR, Bhandari P, Kataria I, et al. Health and economic effects of introducing single-dose or two-dose human papillomavirus vaccination in India. BMJ Glob Health. 2023;8:12580.

Sharma H, Parekh S, Pujari P, Shewale S, Desai S, Bhatla N, et al. Immunogenicity and safety of a new quadrivalent HPV vaccine in girls and boys aged 9–14 years versus an established quadrivalent HPV vaccine in women aged 15–26 years in India: a randomised, active-controlled, multicentre, phase 2/3 trial. Lancet Oncol. 2023;24:1321–33.

Tsu VD, LaMontagne DS, Atuhebwe P, Bloem PN, Ndiaye C. National implementation of HPV vaccination programs in low-resource countries: Lessons, challenges, and future prospects. Prev Med. 2021;144:106335.

Ahmed D, VanderEnde K, Harvey P, Bhatnagar P, Kaur N, Roy S, et al. Human papillomavirus (HPV) vaccine introduction in Sikkim state: Best practices from the first statewide multiple-age cohort HPV vaccine introduction in India-2018-2019. Vaccine. 2022;40(1):17–25.

Clinical Trials Registry - India. An RCT comparing antibody responses to single dose of Cervavac® and Gardasil® vaccines in healthy girls aged 9 to 14 years. Available at: https://ctri.nic.in/Clinicaltrials/pmaindet. Accessed on 21 February 2026.