Ground report finds the free HPV vaccination programme stalling on consent and trust in Delhi government schools despite nearly 50 lakh girls covered nationally by June

Why in the News

India launched a free nationwide Human Papillomavirus (HPV) vaccination programme for adolescent girls on 28 February 2026, targeting about 1.15 crore girls annually, and nearly 50 lakh had been vaccinated by June. A spot check across Delhi government schools shows the binding constraint has shifted from vaccine availability to parental consent.

How does India’s free HPV vaccination programme work?

The programme runs as a school and dispensary linked drive layered onto routine immunisation, moving from enumeration to dose recording in a fixed sequence.

| Stage (lifecycle) | What happens | Primary actor |

| — | — | — |

| 1. Enumeration (input) | Lists of eligible adolescent girls in each neighbourhood are drawn up and carried door to door. | ASHA workers |

| 2. Awareness (demand generation) | Morning assemblies, doctor visits, counsellor sessions and poster campaigns explain HPV and cervical cancer. | School teachers and principals |

| 3. Consent (gatekeeping) | A parent or guardian signs a consent form routed through the U-WIN portal, declaring awareness of data collection and of the risks and benefits of the vaccine. | Parent or guardian |

| 4. Escort and verification (delivery) | Teachers walk batches of girls to the neighbourhood dispensary, where health workers verify identity. | Teachers and health workers |

| 5. Administration (dose) | The vaccine is injected in the upper arm at the dispensary. | Auxiliary Nurse Midwife and health staff |

| 6. Recording (tracking) | The dose is registered digitally so coverage against the annual target can be tracked. | U-WIN portal |

What is Human Papillomavirus (HPV)?

1. About: HPV is a sexually transmitted virus group of over 200 related types that infect the skin and mucous membranes. Most infections clear on their own.
2. Oncogenic types: Persistent infection by high risk types 16 and 18 causes roughly 70 percent of cervical cancers worldwide. The same virus family also causes anal, penile and oropharyngeal cancers.

What is cervical cancer?

1. About: Cervical cancer is a malignancy of the cervix, the lower narrow end of the uterus that opens into the vagina. Teachers in Delhi schools translated it as “bachchedani ke muh ka cancer”, cancer at the mouth of the womb, because the clinical term meant nothing to families.
2. Preventability: It is the only major cancer with both a vaccine against its causal agent and a screening test that detects precancerous lesions. Detection at the precancerous stage makes it almost fully treatable.

What is the U-WIN portal?

1. About: U-WIN is the Union Health Ministry’s digital immunisation registry, built on the CoWIN architecture, which registers beneficiaries and records every dose given under routine immunisation.
2. Function here: It routes the electronic consent declaration for the HPV dose and generates the coverage data against which the programme’s targets are measured.

What is CERVAVAC?

1. About: CERVAVAC is India’s first indigenously developed quadrivalent HPV vaccine, launched in 2022 and produced by the Serum Institute of India with Department of Biotechnology support.
2. Significance: It broke dependence on imported Gardasil and Cervarix, whose price had kept HPV vaccination confined to the private market since 2008.

Who are ASHA workers?

1. About: An Accredited Social Health Activist (ASHA) is a trained female community health volunteer introduced under the National Rural Health Mission in 2005, normally one for every 1,000 population.
2. Role here: ASHAs carry the eligibility lists, persuade parents at the doorstep and bring the girl to the dispensary. They call in the Auxiliary Nurse Midwife (ANM) when their own persuasion fails.

What is the National Technical Advisory Group on Immunisation?

1. About: The National Technical Advisory Group on Immunisation (NTAGI) is India’s apex advisory body on immunisation policy, which recommends which vaccines enter the Universal Immunisation Programme.
2. Role here: It recommended HPV vaccination for inclusion in the Universal Immunisation Programme in 2017, nine years before the national rollout began.

How did India arrive at a nationwide HPV programme?

1. 2008: Gardasil and Cervarix entered the Indian private market. Price kept them inaccessible to most families.
2. 2009 to 2010: A vaccine demonstration project in Andhra Pradesh and Gujarat was suspended after seven girls died. A government probe found no link to the vaccine.
3. 2016: Punjab launched a pilot in Mansa and Bathinda, and Delhi ran a hospital based programme.
4. 2017: NTAGI recommended inclusion in the Universal Immunisation Programme. Global vaccine shortages delayed the rollout.
5. 2018: Sikkim became the first State to offer free school based vaccination statewide, reporting over 95 percent coverage.
6. 2022: CERVAVAC was launched, giving India its first indigenous HPV vaccine.
7. 2026: The nationwide free programme was launched on 28 February, targeting about 1.15 crore girls annually, with nearly 50 lakh vaccinated by June.

What does the cervical cancer burden data establish about the urgency?

| Year | India, estimated cases | India, deaths | Delhi, estimated incidence | Delhi, estimated mortality |

| — | — | — | — | — |

| 2020 | Not available | 33,095 | Not available | Not available |

| 2021 | 77,000 | 33,938 | 793 | 428 |

| 2022 | 77,426 | 34,806 | 767 | 414 |

| 2023 | 77,959 | 35,691 | 741 | 400 |

| 2024 | 78,499 | Not available | 716 | 387 |

| 2025 | 79,239 | Not available | 692 | 374 |

1. Rising national caseload: Estimated cases climbed from 77,000 in 2021 to 79,239 in 2025, a steady annual increase across every year in the series.
2. Deaths rising faster than cases: Deaths moved from 33,095 in 2020 to 35,691 in 2023, so mortality grew even as incidence rose only marginally.
3. Delhi moving the other way: Delhi’s estimated incidence fell from 793 in 2021 to 692 in 2025 and mortality from 428 to 374, which makes the capital’s low school uptake harder to explain by burden alone.
4. Source: The figures are Ministry of Health and Family Welfare estimates.

What does the Delhi school evidence reveal about the gap between eligibility and uptake?

1. State level volume: Delhi has administered over 14,000 doses. A renewed school push in July set a target of 1.49 lakh girls over 100 days.
2. The Fatehpur Beri school: The first girl to take the dose was made class monitor as a reward, and ten other girls aged 14 to 15 walked with two teachers to the neighbourhood dispensary the same day.
3. A CM Shri school in North Delhi: Of about 20 to 25 eligible girls, 14 parents signed consent forms and not a single girl has been vaccinated so far.
4. A Yamuna Vihar government school: Of roughly 259 eligible girls, only close to 60 took the shot despite doctor visits, dedicated assemblies and counsellor sessions.
5. The doorstep conversion rate: One ASHA worker in Nangloi has spoken to nearly 100 families and counts about 12 girls vaccinated, and estimates that of every eight to ten families she explains it to, one or two go.
6. The contrast in Kailash Nagar: Almost all eligible girls in the area of an ASHA worker with seven years in the same neighbourhood have been vaccinated.

Why are parents withholding consent?

1. Fertility fear: Parents ask whether the vaccine will affect their daughter’s ability to have children later. This is the single most repeated objection in both government and private schools.
2. Safety and illness fear: Families ask whether the injection will cause fever or illness, and relatives advise waiting to see what happens to other girls first.
3. Suspicion of motive: Parents believe developed countries conduct research in India because of its large population, and that private companies are driving the programme.
4. Rumour networks: Persuasion collapses at the neighbour’s doorstep, since a family that has understood the explanation reverses after one conversation on the street.
5. Unfamiliarity with the disease: Neither Human Papillomavirus nor cervical cancer registered with families, so the vaccine had no problem attached to it.
6. First generation learner households: Principals report that children from labour class families with no prior schooling in the household are the hardest to reach with the idea of a preventive vaccine.

Why does a signed consent form not produce a vaccinated girl?

1. Consent is procedural, trust is not: Fourteen signed forms in one North Delhi school produced zero vaccinations, which shows the signature records permission rather than conviction.
2. The programme is treated as paperwork: Teachers prepared lists and sent data, and when students did not turn up for vaccination there was no follow up and nobody took them to the dispensary.
3. No staff bandwidth: Schools do not have the teachers for sustained individual follow up, so the drive becomes an administrative exercise completed because it is required.
4. No mass communication anchor: Unlike the pulse polio campaign, the HPV drive has no jingle or slogan carrying it into every home, so the message depends entirely on individual persuasion.
5. What actually converts: Uptake rose where a teacher disclosed her own sister’s HPV diagnosis, where vaccinated girls stood before hesitant parents in the school library and answered questions, and where an ASHA worker said she had vaccinated her own daughter.
6. Familiarity built earlier: In the neighbourhood with near full coverage, the health worker had already worked with the same families on family planning, malaria, leprosy, pregnancy and polio, so trust predated the vaccine.

How does the private school response differ?

1. Programme predates the campaign: In a Dwarka private school, HPV awareness has been part of the annual adolescent health programme for several years rather than beginning with the government drive.
2. Scheduling for parents: Doctors, alumni and parents are brought into the auditorium on a Saturday so working parents can attend, instead of hurried classroom announcements.
3. Peer messengers: Former students who are now medical graduates return to answer the same two questions on safety and fertility, and parents connect with them because they studied in the same classrooms.
4. The delivery difference: The private school does not escort students to the dispensary, leaving the decision and the trip entirely to the family.

Challenges to the HPV vaccination programme

1. Consent architecture as a single point of failure: One guardian’s refusal blocks the dose even where the girl and the school are willing. e.g. the North Delhi CM Shri school where 14 signed forms produced no vaccinations at all.
2. The shadow of the 2009 demonstration project: A suspended trial with deaths that a probe later delinked from the vaccine still supplies the template for rumour. e.g. the Andhra Pradesh and Gujarat demonstration halted after seven girls died.
3. Absence of a mass communication asset: No jingle, mascot or slogan carries the message to households that no health worker reaches. e.g. pulse polio’s “do boond zindagi ki” campaign, which has no HPV equivalent.
4. Boys excluded from the target group: A girls only schedule leaves male transmission and male HPV linked cancers untouched. e.g. Australia extended free HPV vaccination to boys in 2013 and now reports elimination level cervical cancer incidence.
5. Vaccination without screening cover: Vaccination protects the next cohort and does nothing for women already exposed. e.g. National Family Health Survey 5 found under 2 percent of women aged 30 to 49 had ever been screened for cervical cancer.
6. Supply dependence and price: Rollout timing has repeatedly turned on vaccine availability rather than policy intent. e.g. global vaccine shortages delayed implementation of the 2017 NTAGI recommendation by years.
7. School as the sole delivery channel: Out of school and married adolescent girls fall outside the drive entirely. e.g. girls who drop out after Class 8 in urban resettlement colonies never appear on a school eligibility list.

Conclusion

The national HPV programme has solved the two problems it was designed to solve, price and supply, through an indigenous vaccine and free public delivery. The constraint has moved to a place the programme was not designed for, which is the household’s willingness to consent. Uptake now tracks the length of the relationship between the health worker and the family, not the strength of the medical case. Closing the gap requires a communication campaign at the scale of pulse polio and follow up staff who are not the same overburdened teachers already filling in the lists.

Immunisation and Cervical Cancer Control in India

1. About: India runs the Universal Immunisation Programme (UIP), one of the largest public health programmes in the world, providing free vaccines against 12 vaccine preventable diseases, nine nationally and three in selected States.
2. Scale: UIP targets roughly 2.67 crore newborns and 2.9 crore pregnant women every year.
3. Cervical cancer burden: Cervical cancer is the second most common cancer among Indian women after breast cancer, and India accounts for close to a fifth of global cervical cancer deaths.
4. Elimination framework: The World Health Organization’s 90 to 70 to 90 targets for 2030 require 90 percent of girls vaccinated by age 15, 70 percent of women screened with a high performance test by 35 and again by 45, and 90 percent of those with disease treated.
5. Vaccine platform: India manufactures a large share of the world’s vaccines, which is why an indigenous HPV vaccine changed the price structure of the programme immediately.

Constitutional Framework Governing Public Health in India

1. Article 21: The right to life has been read by the Supreme Court to include the right to health and to emergency medical care.
2. Article 47: Directs the State to raise the level of nutrition and the standard of living and to improve public health as a primary duty.
3. Seventh Schedule, State List Entry 6: Places public health, sanitation, hospitals and dispensaries with the States.
4. Seventh Schedule, Concurrent List Entry 29: Covers prevention of the extension of infectious or contagious diseases between States.
5. Article 243G and the Eleventh Schedule: Devolve health and family welfare functions to Panchayats.
6. Article 243W and the Twelfth Schedule: Devolve public health and sanitation functions to urban local bodies.

Laws and Rules Governing Vaccines and Immunisation

1. Drugs and Cosmetics Act, 1940: Governs the import, manufacture, distribution and quality of drugs and vaccines in India.
2. Vaccines are regulated as new drugs and biologicals, with the Central Drugs Standard Control Organisation as the licensing authority.
3. New Drugs and Clinical Trials Rules, 2019: Set the approval pathway, ethics committee requirements and compensation rules for clinical trials.
4. Introduced timelines for trial approval and a defined regime for compensation in case of trial related injury or death.
5. Epidemic Diseases Act, 1897: Empowers governments to take special measures during the outbreak of a dangerous epidemic disease.
6. Digital Personal Data Protection Act, 2023: Governs the personal data of beneficiaries collected on digital health platforms.
7. Requires verifiable consent of a parent or lawful guardian for processing a child’s personal data, which is what the U-WIN consent declaration operationalises.
8. Clinical Establishments (Registration and Regulation) Act, 2010: Provides for registration and minimum standards for clinical establishments, including those administering vaccines.

Back2Basics: Universal Immunisation Programme (UIP)

1. Ministry: Ministry of Health and Family Welfare, delivered through the National Health Mission.
2. Launch: Began as the Expanded Programme on Immunisation in 1978 and was renamed and expanded as the Universal Immunisation Programme in 1985.
3. Objective: Provide free vaccination against vaccine preventable diseases to all infants, children and pregnant women.
4. Beneficiaries: Newborns, children up to the relevant age schedule, adolescents for specific vaccines, and pregnant women for tetanus and adult diphtheria.
5. Coverage: Vaccines against tuberculosis, diphtheria, pertussis, tetanus, polio, hepatitis B, measles and rubella, Haemophilus influenzae type b, rotavirus and pneumococcal disease, with Japanese encephalitis in endemic districts.
6. Delivery design: Fixed session sites at health facilities, outreach sessions in villages and urban slums, and a cold chain network down to the sub centre.
7. Digital backbone: U-WIN registers beneficiaries and records every dose, and eVIN tracks vaccine stock and cold chain temperature in real time.

Government Initiatives for Immunisation and Cancer Control

1. Mission Indradhanush: Launched in 2014 to reach children and pregnant women left out or partially covered by routine immunisation, with Intensified Mission Indradhanush targeting low coverage districts.
2. U-WIN: A national digital immunisation registry that issues a digital vaccination certificate and enables vaccination anywhere in the country.
3. National Programme for Prevention and Control of Non Communicable Diseases (NP-NCD): Runs population level screening for oral, breast and cervical cancer for those above 30 through health and wellness centres.
4. Ayushman Bharat Pradhan Mantri Jan Arogya Yojana: Provides secondary and tertiary hospitalisation cover, including cancer treatment packages, for eligible families.
5. Rashtriya Kishor Swasthya Karyakram: Adolescent health programme covering nutrition, sexual and reproductive health, mental health and substance misuse, with peer educators and adolescent friendly health clinics.
6. Rashtriya Bal Swasthya Karyakram: Screens children for defects at birth, deficiencies, diseases and developmental delays, with school based screening teams.
7. School Health and Wellness Programme: Places trained health and wellness ambassadors in government schools to deliver health messaging.
8. National Cancer Grid: A network of cancer centres and charitable institutions that standardises cancer treatment protocols across India.

Key Facts about HPV and Cervical Cancer

1. World Cancer Day is observed on 4 February.
2. January is observed as Cervical Cancer Awareness Month.
3. World Immunisation Week is observed in the last week of April.
4. HPV types 16 and 18 cause about 70 percent of cervical cancer cases globally.
5. Sikkim (2018) was the first Indian State to run a free statewide school based HPV vaccination programme.
6. CERVAVAC (2022) was India’s first indigenous HPV vaccine, developed by the Serum Institute of India.
7. The World Health Organization recommends a single dose schedule as sufficient for girls aged 9 to 14 in most settings.
8. Cervical cancer is the only cancer for which the World Health Organization has adopted a global elimination strategy.

Challenges in India’s Immunisation and Cancer Control System

1. Zero dose and partially immunised children: Large absolute numbers of children receive no vaccine at all, concentrated in migrant and urban slum pockets. e.g. World Health Organization and UNICEF estimates repeatedly place India among the countries with the highest number of zero dose children.
2. Cold chain and last mile logistics: Temperature excursions destroy vaccine potency before it reaches the beneficiary. e.g. the electronic Vaccine Intelligence Network was rolled out precisely because vial temperature breaches at primary health centre level were routine.
3. Human resource shortfall at the delivery point: Auxiliary nurse midwives and specialists are unavailable in the numbers the sessions need. e.g. Rural Health Statistics reports persistent shortfalls of specialists at Community Health Centres running above 70 percent.
4. Screening coverage far below elimination targets: Vaccination is expanding while screening remains negligible. e.g. National Family Health Survey 5 recorded under 2 percent of women aged 30 to 49 as ever screened for cervical cancer.
5. Weak cancer surveillance: Population based cancer registries cover only a fraction of the population, so burden numbers remain estimates. e.g. the National Cancer Registry Programme’s registries cover a small share of India’s districts.
6. Out of pocket expenditure on cancer care: Late stage diagnosis pushes families into catastrophic health spending. e.g. tertiary oncology capacity remains concentrated in a few institutions such as Tata Memorial Hospital in Mumbai, forcing long distance travel and lodging costs.
7. Vaccine hesitancy and organised misinformation: School based campaigns face coordinated resistance that spreads faster than official communication. e.g. the 2017 measles rubella campaign faced organised parental resistance in schools in Tamil Nadu and Karnataka.

Way Forward

1. Run a national communication campaign at pulse polio scale: Commission a jingle, mascot and mass media schedule for HPV so the message reaches households that no health worker visits.
2. Fund dedicated follow up staff: Attach mobilisers to the drive rather than adding it to the workload of teachers who already carry full teaching loads.
3. Use vaccinated girls and local clinicians as messengers: Institutionalise the parent meeting format where vaccinated students and returning medical graduates answer safety and fertility questions directly.
4. Extend delivery beyond schools: Cover out of school adolescent girls through Anganwadi centres, health and wellness centres and camp mode sessions.
5. Pair vaccination with screening: Scale HPV DNA based screening for women above 30 under NP-NCD so the programme protects both cohorts at once.
6. Publish transparent adverse event data: Report and explain adverse events following immunisation publicly so rumour has a factual counterweight.
7. Extend the schedule to boys once supply allows: Move towards gender neutral vaccination to cut transmission and prevent HPV linked cancers in men.

PYQ:

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[2024] With reference to the ‘Pradhan Mantri Surakshit Matritva Abhiyan’, consider the following statements:

1. This scheme guarantees a minimum package of antenatal care services to women in their second and third trimesters of pregnancy and six months post-delivery health care service in any government health facility.
2. Under this scheme, private sector health care providers of certain specialities can volunteer to provide services at nearby government health facilities.

Which of the statements given above is/are correct?

(a) 1 only

(b) 2 only

(c) Both 1 and 2

(d) Neither 1 nor 2

Answer: (b)

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