Comparison of HPV vaccination strategies for pilot implementation in North India

Abstract

Cervical cancer remains a leading cause of cancer mortality among women in India. India’s 2024 interim budget prioritization of HPV vaccination for girls aged 9-14 years provided a pivotal opportunity for state-led pilots to inform national policy. This paper compares three vaccination strategies (Single-dose Gardasil; Two-dose Cervavac; and Single-dose Cervavac) within the planning for a school-based HPV vaccination pilot targeting 6,300 girls in North India. A comparative analysis of programmatic feasibility, estimated financial cost, and scientific evidence was undertaken. Strategy 1 (single-dose Gardasil) and Strategy 2 (two-dose Cervavac) had comparable financial outlays (~23 million INR), but Strategy 2 imposes a 64% higher human resource burden (2,120 vs. 1,288 man-hours). While Strategy 1 is supported by the strongest longitudinal efficacy data, Strategy 2 aligns with the national interest of indigenous vaccine with minimal cost per dose. We recommend an approach that leverages single-dose Gardasil vaccination until further trial data on single-dose Cervavac is available, to optimize the coverage and improve programmatic efficiency.