By Satyabrat Borah
India’s decision to push forward with a nationwide Human Papillomavirus vaccination programme marks one of those quiet but historic moments in public health that rarely grab screaming headlines yet shape the health of generations. Cervical cancer has haunted Indian families for decades, often striking women in the prime of their lives, silently advancing until it is too late. In this context, a vaccine that can prevent the majority of cases feels almost miraculous. But miracles in public health are never just about science. They are about trust, systems, follow up, and the humility to accept that even the best interventions need constant watching. A jab well done does not end with the prick of a needle. It continues long after, in how we listen to people’s bodies, fears, and experiences.
Cervical cancer remains one of the leading causes of cancer deaths among Indian women. Unlike many other cancers, its cause is largely known. Persistent infection with certain high risk strains of HPV is the main culprit. This knowledge has been around for years, and vaccines targeting these strains have been used globally for more than a decade. Countries that introduced HPV vaccination early are already seeing dramatic drops in cervical cancer rates and precancerous lesions. India, with its huge population and diverse healthcare landscape, arrived later to this effort, but its arrival still matters immensely. When a country of India’s size moves, the global health needle shifts.
The promise of the HPV vaccine is straightforward and powerful. Vaccinate girls before they are exposed to the virus, ideally in early adolescence, and you can prevent most cervical cancers before they ever begin. It is prevention at its purest form. No chemotherapy wards. No late night hospital vigils. No mothers leaving children behind. Just protection built quietly into the immune system. For a public health worker who has watched women arrive at hospitals with advanced cervical cancer, the vaccine feels like a long overdue relief.
Yet vaccination programmes do not operate in laboratories. They operate in real communities, shaped by rumours, past experiences, cultural beliefs, and the fragile relationship many people have with the healthcare system. India knows this well. Memories of past controversies around vaccines have not faded. There were times when poor communication, lack of consent, or inadequate monitoring created mistrust. Those lessons must sit at the centre of the HPV vaccination programme, not at its margins.
One of the most important pillars of any vaccination effort is the monitoring of adverse events following immunisation. This phrase sounds technical, but at its heart it is deeply human. It means paying attention when someone says they felt unwell after a shot. It means recording symptoms carefully. It means investigating seriously, even when the event turns out to be unrelated. It means never brushing aside concerns with arrogance or impatience. For parents, especially when it involves their daughters, reassurance does not come from statistics alone. It comes from being heard.
HPV vaccines have been studied extensively across the world. Large scale trials and years of real world use show that they are safe, with side effects that are mostly mild and temporary, like pain at the injection site, fever, dizziness, or nausea. Severe adverse events are rare and, when examined closely, often not causally linked to the vaccine. This scientific consensus is strong. But science does not eliminate fear. A single story of a child fainting after a shot can travel faster than a hundred research papers. In the age of social media, misinformation moves at frightening speed, often wearing the costume of concern.
This is why follow up after immunisation is not optional. It is essential. When health workers actively check on vaccinated children, when systems exist to report and investigate adverse events transparently, trust grows. When people see that the government is not defensive but
responsive, scepticism softens. A vaccination programme that ignores post vaccination experiences risks undoing its own good work.
India already has systems in place for monitoring adverse events following immunisation through its Universal Immunisation Programme. These systems need to be strengthened and adapted for the scale and sensitivity of the HPV rollout. HPV vaccination often targets adolescents, a group that traditionally interacts less with routine immunisation services compared to infants. Schools become important sites of vaccination, which introduces new dynamics. Teachers, parents, school administrators, and health workers all become stakeholders. Clear protocols for observation after vaccination, immediate care for fainting or anxiety related reactions, and proper referral pathways matter more than ever.
Adolescents are particularly prone to vasovagal syncope, a fancy term for fainting triggered by fear, pain, or anxiety. This is not unique to HPV vaccines and happens with many injections in this age group. But without proper explanation, such events can be misinterpreted as severe vaccine reactions. If a girl faints in a school classroom after vaccination and rumours spread that the vaccine caused serious harm, the damage to public confidence can be swift and deep. Proper preparation, including having children seated during vaccination, observing them afterward, and calmly explaining what happened, can prevent panic.
Communication is as important as surveillance. Parents deserve honest conversations about benefits and risks, without exaggeration or dismissal. Overpromising absolute safety is a mistake, because no medical intervention is entirely free of risk. What matters is proportionality and preparedness. When health authorities say, yes, mild side effects can occur, yes, we are watching closely, and yes, we will investigate any serious event, they invite people into a partnership rather than a lecture.
Another layer of complexity in India is gender and social norms. HPV is sexually transmitted, and this fact, though biologically relevant, can make people uncomfortable. Some parents worry that vaccinating girls implies early sexual activity or encourages promiscuity, fears that have been repeatedly disproven but still persist. Others ask why boys are not included, a valid question since HPV affects them too and they play a role in transmission. These concerns
intersect with vaccine safety anxieties. When people are already uneasy, any reported adverse event can feel like confirmation of their doubts.
Here again, robust follow up systems help. When data on adverse events is collected, analysed, and shared openly, myths lose some of their power. Transparency does not weaken a programme. It strengthens it. Publishing regular reports, even when they show minor issues, signals confidence and accountability. It tells the public that nothing is being hidden.
Healthcare workers sit at the frontline of this effort. Their training, confidence, and empathy determine how the programme is experienced on the ground. If a nurse dismisses a parent’s worry with a shrug, mistrust grows. If a health worker takes time to explain what a side effect means and what to watch for, reassurance follows. Supporting these workers with clear guidelines, adequate staffing, and institutional backing is part of ethical vaccination practice. Monitoring adverse events is not just a bureaucratic exercise. It is emotional labour.
There is also a scientific reason why follow up matters even when vaccines are known to be safe. Large populations can reveal rare events that smaller trials cannot detect. India’s demographic diversity, nutritional variations, and burden of other infections mean that real world data from Indian settings is valuable. Post marketing surveillance allows scientists to continually refine their understanding. It is how medicine stays honest with itself.
Critics of vaccination programmes sometimes accuse governments of being obsessed with numbers, targets, and coverage percentages, while ignoring individual suffering. The answer to this criticism is not to abandon vaccination, but to humanise it. Counting doses administered is important, but counting how people feel afterward is just as important. A programme that measures success only by coverage risks losing its soul.
The HPV vaccination programme also raises questions about long term follow up. The vaccine’s benefit unfolds over decades. Cervical cancer prevention today means fewer cases twenty or thirty years from now. Adverse events, in contrast, are immediate. This imbalance can skew public perception. People see the immediate discomfort but not the distant prevention. Thoughtful communication and continued engagement with vaccinated cohorts over time can bridge this gap. It reminds society that public health often asks for patience in exchange for protection.
India’s move toward locally produced HPV vaccines has added another dimension to the conversation. Indigenous production promises lower costs and wider access, which is crucial for sustainability. At the same time, it puts additional responsibility on regulators and manufacturers to ensure rigorous quality control and surveillance. Public confidence in domestically produced vaccines depends on strong oversight and openness. National pride should go hand in hand with scientific rigour.
The history of public health is full of examples where good interventions stumbled because follow up was weak. Conversely, there are examples where initial setbacks were managed well
through transparency and responsiveness, ultimately strengthening programmes. India’s polio eradication effort, once plagued by scepticism and resistance, succeeded not just because of vaccines, but because of relentless engagement, monitoring, and trust building. The HPV vaccination programme can draw inspiration from this legacy.
There is also an ethical dimension to adverse event monitoring. When the state asks individuals to accept a medical intervention for the collective good, it assumes a moral responsibility to care for those individuals if something goes wrong. Even if an adverse event is not caused by the vaccine, the experience of harm is real to the person affected. Providing medical care, support, and clear explanations is part of the social contract of public health.
In many ways, the HPV vaccination programme is a test of maturity for India’s health system. Can it move beyond the old model of top down directives and embrace a more dialogic approach. Can it handle criticism without becoming defensive. Can it acknowledge uncertainty without fuelling fear. These questions matter as much as cold chain logistics or supply numbers.
A jab well done is one that is given with skill, followed with care, and remembered with trust. The needle is only the beginning. What follows is observation, listening, recording, analysing, and responding. It is the quiet work that does not make posters or slogans, but determines whether parents recommend the vaccine to neighbours or warn them away.
If India gets this right, the rewards are immense. Fewer women dying of preventable cancer. Less suffering for families. A generation that grows up protected without ever having to think about the disease they avoided. And perhaps just as importantly, a public that feels respected and involved rather than coerced or ignored.
The HPV vaccination programme deserves applause for its ambition and intent. It is a step toward a future where prevention is valued as much as cure. But applause should not drown out vigilance. Following up on adverse events after immunisation is not a footnote. It is the spine of credibility. In the long run, trust is the most powerful vaccine of all.
