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A promising vaccine

The outstanding results produced by a newly approved vaccine against cervical cancer raises hopes of sharply reducing the high levels of mortality and morbidity from this disease. The World Health Organisation views the availability of the vaccine as an unprecedented opportunity to save lives in developing countries, which account for 80 per cent of cervical cancer cases. A second vaccine awaits regulatory approval and is also expected to get a licence soon. Sound national protocols for prevention, early detection, and treatment of cervical cancer can protect the lives and welfare of thousands of women in resource-poor countries. JAMA, the Journal of the American Medical Association, reports that more than 200,000 women die from cervical cancer annually and that almost half a million new cases are reported. India accounts for a quarter of the world's affliction with this form of cancer and a third of the deaths. The medical community has been pointing out that it is possible to bring about a significant reduction in the incidence of cervical cancer through policy intervention, as developed countries have shown. This is a rare instance where the cause (particular types of human papillomavirus transmitted by skin contact), the risk factors (mainly deprived socio-economic settings), an identifiable pre-cancerous condition, and treatment possibilities are well described. If women are developing cervical cancer despite such comprehensive knowledge, it is a clear pointer to serious deficiencies in health policy.

Under the circumstances, Health Minister Anbumani Ramadoss has done well to emphasise the Government's intention to make available a vaccine against cervical cancer as soon as possible. The expectation is that, with active Government support, the joint efforts of Merck, the vaccine developer, and the Institute of Cytology and Preventive Oncology, Noida will yield a population-level vaccination programme early in 2007. It is vital that official policy recognises the imperative of expanding and universalising the screening and treatment programme for women who may be infected by the papillomavirus. There is evidence that simple and low cost tests to identify viral infection and tissue level effects are as useful as the well-established Papanicolaou smear test. However, the value of testing programmes can be realised only if there is immediate treatment and follow-up. By adopting a policy that provides for vaccination, screening, and timely and effective treatment of cervical cancer, India can significantly improve its poor record on women's health.

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