The story of cervical cancer and HPV vaccine in India is one of lack of accountability of individuals and agencies in power; the nexus exploits vulnerable women
Poonam Pandey, a young and little-known model and actress, dies of cervical cancer.
On February 2, news platforms and social media went berserk with the 'news' of model-starlet Poonam Pandey’s 'death' due to cervical cancer. People were understandably shocked by her death by a serious, yet preventable, disease, which had gained fresh attention in the nation’s consciousness just a day earlier, with Union Finance Minister Nirmala Sitharaman announcing in the Interim Budget speech that the Centre would encourage vaccination against cervical cancer for girls aged nine to 14 years.
As it turned out, on February 3Pandey’s 'death' turned out to be fake. The resurrected starlet, who announced the news of her being alive on Instagram, claimed that the death hoax was designed to create awareness about cervical cancer among women in India.
Poonam’s spotlight
It may seem ironic but Pandey’s ill-advised and tone-deaf campaign brought the spotlight, once again, not only on cervical cancer but also on a more sordid aspect of the disease. This concerns its vaccination and the greed of pharmaceutical companies to capture one of the largest markets for the HPV (Human Papilloma Virus) vaccine at any cost, including, sacrificing the lives of young girls.
The story about cervical cancer and the HPV vaccine in India is one of lack of accountability of individuals and agencies in power. From government regulatory bodies to Big Pharma, unethical media agencies to publicity-hungry celebrities – it is difficult to dismiss the existence of a nexus that has led to the exploitation of vulnerable and desperate Indian women carrying the risk of a deadly disease.
The beginning
It all started in 2007, when a healthcare charity called Program for Appropriate Technology in Health (PATH) – funded by the US-based Bill and Melinda Gates Foundation – received approval from the Indian Council for Medical Research (ICMR) and the Drug Controller General of India (DCGI) to conduct human clinical trial for the HPV vaccines, Gardasil and Cervarix, manufactured by Merck, the parent company of MSD Pharmaceuticals, and GlaxoSmithKline, respectively.
The ICMR, the apex body on clinical trials in India, gave its nod to the project in 2007, nearly a year before the two vaccines were approved by the Indian government for inclusion in the universal immunisation programme – a job normally handled by the National Technical Advisory Group on Immunisation.
Blatantly illegal
The clinical trial, masked as a ‘demonstration project’ by PATH, provided HPV vaccines to 24,000 girls in Andhra Pradesh and Gujarat. The project faced intense scrutiny and criticism for major disparities in execution, lack of patient consent, inclusion of vulnerable and tribal population groups in the study cohort and safety concerns following the deaths of seven girls after vaccination.
It was later found that serious adverse events were not monitored, and the consent of trial subjects was not obtained properly. There were several reported instances of missing signatures or thumbprints on the patient consent forms. Additionally, the Merck vaccine was not tested for safe use in children or adults, making its use in this trial blatantly illegal.
A parliamentary panel accused PATH of violating local regulations during the trial on Indian girls and questioned the approval of the project by the ICMR. PATH's activities were deemed as commercially driven promotional campaigns for the vaccine manufacturers in an effort to capture the Indian market. Similar campaigns by PATH were also noted in Peru, Uganda and Vietnam.
Battle in SC
A public interest litigation alleging human rights violations was filed before the Supreme Court in 2012 by women’s health activists Kalpana Mehta, Nalini Bhanot and V Rukmini Rao, representing the Gramya Resource Centre for Women from Andhra Pradesh, against PATH, Merck, GSK and the Indian regulatory bodies. Since the patient cohort consisted of underage tribal girls, the petitioners claimed violations of a slew of patient rights, including the right to informed consent as well as various global conventions.
Fast forward to February 2024. MSD Pharmaceuticals Pvt. Ltd, the Indian subsidiary of Merck & promoter of Gardasil in India, revived its efforts to capture the Indian market. In order to gain maximum traction, the PR campaign around Gardasil was timed closely with the Union finance minister and the Union Health Ministry’s announcements on the push for the HPV vaccine for n-14-year-old adolescent girls.
Merck in game
Merck management reportedly gave the job of designing the campaign to a digital advertising agency, Schbang, which has a track record of creating healthcare campaigns around small-time celebrities and on social media, including one in 2023 for MSD called #DontGetCaughtByHPV. Schbang’s self-proclaimed success metrics were YouTube views, impressions and increased traffic to their corporate website. Schbang created a startling campaign for Merck’s HPV vaccine centred around Pandey’s fake death.
When Pandey’s death was announced on her Instagram account, people expressed doubts about the veracity of the news. The very next day, the actor announced that she was alive and that she simply wanted to “create awareness about cervical cancer”. There was expected and justified public uproar against the crass publicity stunt. Several independent agencies and individuals have, since, called for legal action against Pandey, forcing Schbang to switch into ‘0damage control mode’.
Schbang tactics
Schbang released a statement on LinkedIn which, unfortunately, serves as a justification of their actions, disguised as an apology. As is their method of measuring the success of a campaign, Schbang proudly published the increased Google search hits for the campaign and website traffic, including a graph visualizing the same. They even went as far as posting screenshots of comments by the general public boasting of the resounding success of their campaign. The cherry on the cake is the now defunct website poonampandeyisalive.com, created ostensibly to spread awareness about cervical cancer.
Cervical cancer is a complex disease affected by multiple factors. It leads to the formation of malignant tumours in the cervix, the lower narrow end of the uterus that connects the uterus to the vagina. There are two types of the cancer, named after the type of cervical cells they affect: adenocarcinoma and the more common squamous cell carcinoma (SCC).
Indian concerns
The most common cause of cervical cancer is chronic infection caused by the sexually transmitted human papilloma virus, with two high-risk variants, HPV 16 and HPV 18, causing 70 percent of cervical cancers worldwide. A four-fold higher prevalence of cervical cancer has been observed in low- and middle-income countries such as South Africa, India, China and Brazil, perhaps implying that socio economic factors have a direct correlation with the incidence of cervical cancer.
Cervical cancer has shown alarmingly high rates in girls in low-income areas, where access to healthcare and vaccines is limited. As the latest figures from year 2022 show, cervical cancer continued to be the second most common cancer in Indian women, with an incident rate of 127,526 (17.7 per cent) cases and a mortality rate of 79,906 deaths (11.2 per cent).
Disease burden
With no national or state levels programmes to vaccinate or screen for cervical cancer, India continues to carry a disproportionately high disease burden despite the cancer being highly preventable, and curable when caught early. This is so because before the cancer appears in the cervix, the cells of the cervix go through changes known as dysplasia, in which abnormal cells begin to appear in the cervical tissue. These cells can be easily detected through Pap smear screening.
Nearly all cervical cancers can be prevented by HPV vaccination of young girls and routine cervical cancer screening for adult women using the HPV, Pap smear and HPV/pap co-tests. The screening methods are very effective in detecting HPV infection through changes in cellular morphology. Hence, all one needs is a comprehensive cervical cancer prevention strategy that includes vaccination and screening.
Go for serum
The two most widely available vaccines, Cervarix and Gardasil, are expensive and due to their controversial history, induce a sense of dread in the general population. A locally developed alternative by the Serum Institute, CERVAVAC, holds the potential to overcome this financial barrier and increase affordability.
Additionally, due to its association with sexual transmission and HIV, social and cultural reasons have prevented the uptake of the vaccine. Just like with the polio vaccine, the need of the hour is a mandatory inclusion of the HPV vaccine in the universal immunization programme and incentives that would encourage parents to vaccinate their girl child.
Pandey, an ‘influencer’ with little influence, is just a pawn in a much bigger game and she, by no means, belongs to nor represents the women from low- and middle-income communities who lack access to healthcare and are primarily affected by cervical cancer.
Dubious campaign
As for the campaign itself, no amount of website traffic, increased views or viral tweets can be attributed to the implementation of healthcare policies by regulatory bodies or a decrease in incidence rates.
It’s 2024, and we possess enough scientific and operational expertise to be able to predict, prevent, detect and eliminate the disease without having to resort to poor publicity stunts.
(The Federal seeks to present views and opinions from all sides of the spectrum. The information, ideas or opinions in the article are of the author and do not necessarily reflect the views of The Federal.)
