NEW DELHI: A major controversy has erupted over the Punjab government’s recent decision to launch HPV vaccination against cervical cancer government-run hospitals as the health economic evaluation, based on which the initiative has been started, is now being challenged as “misleading and fallacious”.
The row, though limited to Punjab at present, assumes national significance as most private gynaecologists across the country prescribe the vaccination for all adolescent girls before they get sexually active.
Punjab government recently had launched the vaccination with the support of the World Health Organisation based on an evaluation carried out by nine researchers from the Post Graduate Institute, Chandigarh.
Jacob Puliyel, a senior member of the National Technical Advisory Council, in an article published in the prestigious journal Cancer, however, has said that the PGI authors’ evaluation was grossly erroneous, as it wrongly assumed that mortality in cervical cancer was 98 to 99%. “This falsely exaggerated the benefit of vaccination,” the paper says.
The paper points out that the authors not only present a faulty model – “they also distort the science published by others”.
The PGI authors, in their evaluation, had said that a paper by the Harvard School of Public Health has reported that, “Only if the price of the vaccine is considered as high as US$100 (Rs 6,440) per dose, the cost per DALY averted generally exceeds the cost-effectiveness threshold of the respective countries.” The Harvard article, on the other hand, reports that the vaccine is not cost-effective if it costs more than US$ $3.30 (Rs 212.5) per child, the paper by Puliyel says.
This is the vaccine that was associated with deaths of tribal girls in Andhra Pradesh in 2010, in a clinical trial performed without their consent by PATH of the Bill and Melinda Gates Foundation.
The PGI paper was also carried out in Cancer and had claimed that the HPV vaccine was cost-effective in India even if it were to cost the US $ 14 (Rs 900) per girl child vaccinated.
“The article published by PGI authors is misleading and fallacious and grossly misrepresents the facts as it falsely exaggerated the benefit of vaccination,” Puliyel, a paediatrician and head of paediatric department at St Stephen’s hospital in Delhi told this newspaper.
“From the facts and studies available worldwide, there is no evidence that vaccinating preadolescent girls will protect them from cervical cancer although it may provide temporary protection against some strains of HPV,” he added. “Neither is it cost-effective. Several adverse effects have been reported so much so that Japan no longer recommends it.” Shankar Prinja, lead author from the PGI who had done the evaluation did not respond to an email sent by this newspaper.