On February 28, 2026, Prime Minister Narendra Modi launched a national campaign to vaccinate every 14-year-old girl in India with a single dose of the HPV (Human Papillomavirus) vaccine Gardasil-4. The stated goal is to prevent cervical cancer — the second most common cancer in Indian women, claiming nearly 80,000 lives every year. The intention is good. The urgency is real. But between a good intention and a well-executed programme lies a distance that, in this case, every parent of a teenage daughter deserves to understand.
This is an article about five questions that should have been answered before this campaign was launched at this speed — and that families and citizens have every right to ask now.
Question 1: Does this vaccine actually cover the virus strains circulating in India?
Gardasil-4 protects against four types of Human Papillomavirus: types 6, 11, 16, and 18. The cancer-prevention claim rests on types 16 and 18, which cause roughly 70% of cervical cancer cases globally. So far, so good. But India is not a single epidemiological unit — and when researchers have looked closely at which HPV types actually circulate in Indian communities, the picture is more complicated.
A study of the healthy general population in Karnataka found that 75% of HPV infections were caused by types other than 16 and 18 — the very types this vaccine does not cover. A study in Uttar Pradesh found 26 distinct HPV genotypes in clinically asymptomatic women. Across multiple Indian studies, types 31, 33, 45, 52, and 58 appear consistently – all high-risk, cancer-causing types, none covered by Gardasil-4.
A broader vaccine — Gardasil-9 — covers all nine of the most dangerous types and is estimated to prevent 91% of Indian cervical cancer cases, compared to 76% for Gardasil-4. India also has its own domestically produced HPV vaccine, Cervavac, made by the Serum Institute of Pune, which covers the same four types as Gardasil-4 at a fraction of the cost. The government has chosen neither the broader vaccine nor the Indian-made one. Gardasil-4 by Merck — an American pharmaceutical company — is what your daughter will receive. No public explanation has been offered for this choice.
Question 2: Is the health system actually ready to handle this?
The government's guidelines for this campaign describe an impressive system: cold chain storage at every health centre, a dedicated doctor for managing adverse reactions, digital consent on the U-WIN app, a 24-hour helpline, and anaphylaxis kits at every vaccination site. On paper, this is reassuring. In practice, anyone who has visited a rural primary health centre or a government sub-centre knows that this description does not match most of these facilities.
The guidelines also say that health officials in all states have been trained. But there is a crucial difference between training state headquarters officials and training the ASHA workers and ANMs who will actually give the injections in your village or mohalla. An ASHA worker who attended one orientation session is not a trained adverse event manager. A health centre without reliable electricity is not a functional cold chain facility, regardless of what the government database may say.
After vaccination, the guidelines recommend that girls wait and be observed for 30 minutes. This is medically sound advice — fainting and anxiety responses are common in adolescent girls receiving injections, and a small number of girls can have serious allergic reactions. But a PHC running a mass vaccination camp for hundreds of girls in a single day, with one doctor, cannot realistically provide this level of individual attention. When something goes wrong in these conditions, the family are on their own.
Question 3: What happens if my daughter has a reaction — and who is responsible?
This is the question the campaign documentation answers least satisfactorily. The vaccination certificate your daughter receives will tell you the name of the vaccine and the address of the nearest 24-hour facility for adverse reactions. It will tell you nothing about who specifically is accountable if she develops symptoms days or weeks later, what the investigation process is, what your rights as a family are, or how to formally report what happened.
There is no named officer at the district level with a published phone number whose specific job is to investigate adverse events from this campaign and respond to affected families within a defined number of days. In areas without mobile internet — where a very large number of India's 14-year-olds live — the digital reporting system simply does not function. Adverse events in these areas will not be counted. And if they are not counted, they officially did not happen.
Question 4: Is my daughter actually the patient who needs this most urgently?
Here is a number that should stop every reader: India's cervical cancer screening rate for women aged 30 to 49 — the age group at highest immediate risk — is approximately 2%. Not 20%. Two per cent. Fewer than one woman in fifty who should be screened for this disease is actually being screened for it.
Cervical cancer is not like most cancers. It develops slowly, over years, and it can be detected at a pre-cancerous stage by a simple test called VIA — Visual Inspection with Acetic Acid — that costs almost nothing, requires no laboratory, and can be performed by a trained ANM at any primary health centre. If detected early, it is almost entirely curable. Women are dying in India today not because we lack a cure, but because we are not looking. The government has chosen to spend approximately Rs 1,300 crore every year vaccinating 14-year-olds against a disease they may encounter in their thirties, rather than spending a fraction of that sum finding and treating the women who have the disease right now.
Your 14-year-old daughter is also, statistically, likely to be anaemic. More than half of Indian adolescent girls are. She may be malnourished. She certainly has not received any reproductive health education at school. Her mental health needs are almost certainly unaddressed by the public system. Each of these problems is immediate, common, and treatable. The government has not launched a national campaign for any of them.
Question 5: Was my daughter's consent — and yours — actually meaningful?
The campaign is voluntary, and parental consent is required before vaccination. This is correct and important. But consent is only meaningful if the person giving it has received real, understandable information about what they are consenting to. The government's information materials for this campaign have been produced in Hindi and English. If you are a parent in Telangana, Tamil Nadu, West Bengal, or any of the dozen other states where Hindi is not the everyday language, the materials prepared for you are in a language you may not read fluently. The government asked states to adapt these materials locally, but states that have not yet published basic pre-campaign health data have not demonstrated the capacity to also develop high-quality local-language consent materials under campaign-launch pressure.
Consent obtained through a leaflet that a parent cannot read is not consent. It is a signature on a form.
What should you do?
If your daughter is being called for this vaccination, you have every right to ask the vaccinating facility the following before she receives the injection: Is there a doctor on site today? What should I watch for after vaccination, and for how long? What is the helpline number if she has a reaction tonight or next week? Is her name and health status being recorded — not just her vaccination?
You also have every right to wait. The vaccination is voluntary. The campaign runs for three months, and the vaccine will remain available after that on routine immunisation days. There is no medical reason to rush on Day One of a campaign whose infrastructure has not been independently verified.
Cervical cancer is real. The HPV vaccination programme that vaccinates millions of girls without knowing which virus strains are actually circulating in their communities, without a system to track harm, and without first addressing the immediate health crises those girls are living with today – anaemia, malnutrition, and absent health education – is not putting their interests first. It is putting a number on a chart first.
Your daughter is not a number on a chart.
Dr Narasimha Reddy Donthi is a public policy expert based in Hyderabad. Views expressed here are the author’s own.
References:
• GLOBOCAN 2022 data on India's cervical cancer burden (1.2 lakh new cases, 80,000 deaths annually).
• Kulkarni S.S. et al. (2011), Asian Pacific Journal of Cancer Prevention — HPV type distribution in Karnataka's general population.
• Mudhigeti N. et al. (2022), ScienceDirect — comparative prevention rates of quadrivalent vs. nonavalent HPV vaccine in India.
• Singh N. et al. (2012) — 26 HPV genotypes in asymptomatic women, eastern Uttar Pradesh.
• National Family Health Survey (NFHS-5) — anaemia prevalence in Indian adolescent girls.
• D.O.No.Z.33014/15/2026-IMM, Ministry of Health and Family Welfare, dated February 25, 2026.