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UPSC EDITORIAL ANALYSIS : The Jab In Time

       

                   

Source: Indian Express

  • Prelims: Current events of national importance, cervical cancer, Government policies, universal immunization programme, Human Papillomavirus (HPV) etc
  • Mains GS Paper II: Government policies and interventions for development in various sectors and issues arising out of their design and implementations etc

 

ARTICLE HIGHLIGHTS

  • The government is planning to include cervical cancer vaccine in the universal immunization programme; an inoculation campaign targeted at girls in the nine to 14 age group is likely to commence this year.

         

INSIGHTS ON THE ISSUE

Context

Cervical cancer:

  • It is the second-most common cancer among women in India, mostly affecting the middle-aged.
  • With 1,23,907 new cases and 77,348 deaths in the year 2022, India contributed to one-fifth of the global
  • Main cause: Presence of persistent high-risk type of Human Papilloma Virus (HPV) infection
    • co-factors like low socioeconomic conditions, low immunity status, other genital infections, smoking etc, that facilitate initiation and progression to cancer.
  • Cervical cancer is preventable and curable if detected early.
  • Most cervical cancer and precancer cases can be detected in the reproductive age group.
  • Cervical cancer has a long pre-invasive phase that lasts for 10–15 years.
    • This provides a window of opportunity to detect and treat the neoplasia in pre-invasive stages
  • Cervical cancer is detected and managed at an early stage, it is found to have over 93 percent cure rate.
  • Cervical cancer can be prevented through HPV vaccination of girls.

Reasons for high mortality:

  • Lack of awareness
  • Fear of cancer
  • Early symptoms of disease not being evident
  • Women not being screened

Population-based cross-sectional study(conducted by the Indian Institute of Public Health-IIPH Hyderabad in 2021):

Andhra Pradesh:

  • It showed that for 68 percent of patients, the first point of contact after having cancer symptoms was traditional healers and only 3 percent had received HPV vaccination.

Steps taken for Cervical Cancer:

  • Cervical cancer is the only non-communicable disease that can be eliminated
  • It has potential to make significant contributions to Sustainable Development Goal 3.4 of reducing premature deaths by one third by 2030.
  • WHO’s global strategy incorporates clear targets and means of accountability, along three strategic pillars:
    • Widespread HPV vaccination
    • Screening and early diagnosis
    • Treatment of cervical pre-cancer and cancer.
  • The proposed targets are:
    • 90 percent girls fully vaccinated by 15 years of age with two doses of HPV vaccine;
    • 70 percent women screened with a high-performance test at 35 and 45 years of age
    • 90 percent of women with cervical pre-cancer and cancer receive treatment, including palliative care, to achieve a goal of less than four cases per 1,00,000 women.

Steps by India:

  • It has implemented cancer screening by trained nurses even in primary health centers under the:
    • National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke — the NPCDCS programme.
  • Screening tools like visual screening tests and HPV tests are simple and easily available.
  • Painless outpatient treatment
  • Evidence-based management algorithms are in place for guidance.
  • Increased uptake of the HPV vaccine by eligible girls will prevent the disease.

What steps need to be taken?

  • Indigenous HPV test kits and HPV vaccines can be a boon for resource-scarce settings, enabling scaling up of activities further.
  • The promising new developments like:
    • Single dose HPV vaccination,
    • self-sampling for HPV testing
    • artificial intelligence technologies for easy and accurate diagnosis
  • Treatment will further accelerate the future potential in elimination of cervical cancer even in LMICs.
  • There is an urgent need to strengthen population-level awareness on causes as well as prevention methods for cervical cancer
  • Encourage the uptake of HPV vaccine
  • Devise strategies to overcome vaccine hesitancy
  • Encourage age-appropriate screening, especially using HPV testing.
  • Capacity building for scaling up pre-cancer treatment processes
    • smooth referral linkages
    • ensuring quality cancer treatment
    • palliative care services as required
  • Strengthening the health systems to be prepared to cater the entire gamut of services for cervical cancer.
  • Efforts will have to be consistent to ensure screening programmes, integrating latest technology for accurate and early diagnosis.
    • This should be coupled with strengthening cancer registries both at the population level and hospital based, with improved referral linkages.
  • Mechanisms to reduce the financial burden for care should be strengthened.
  • Build and strengthen partnerships at the primary, secondary, tertiary hospital level with NGOs working in communities
    • Innovators striving to develop tests at individual level, and public health professionals.

Way Forward.

  • It is vital to connect all the dots in patients’ care pathways — swiftness in diagnosis and referral for treatment, improving quality of care, while incorporating digital technologies and easy communication.
  • It will be useful to issue followup reminders and linking palliative care early on, which is essential to strengthen the efforts towards elimination.
  • Collaborations and partnerships in latest research and adopting successful models in community outreach and care pathways are equally crucial to enable us to march towards eliminating cervical cancer..

 

QUESTION FOR PRACTICE

Critically examine the role of WHO in providing global health security during the COVID-19 Pandemic.(UPSC 2020) (200 WORDS, 10 MARKS)