In a district hospital in rural Maharashtra, the vaccination nurse keeps a handwritten list. It holds the names of roughly 200 nine-year-old girls whose parents brought them in for the human papillomavirus vaccine—only to be told the shots were gone. The list has been growing since early 2025, when India's catch-up campaign for girls aged nine to fourteen stalled due to persistent stockouts of the domestically produced Cervavac vaccine. For these families, the wait is not merely an inconvenience; it represents a missed window for protection against cervical cancer, a disease that kills an estimated 77,000 Indian women each year.

Vaccine Shortages Leave Girls Waiting

India's school-based HPV vaccination drives, launched in select districts in 2023, aimed to reach girls before they become sexually active. The two-dose schedule, recommended by India's immunisation panel, requires a gap of six to twelve months between shots. But as of late 2025, many districts have paused enrolment for nine-year-olds entirely, prioritising older girls who had already received their first dose. The result is a growing backlog of younger girls who may age out of the catch-up window before supply stabilises. State health officials in Maharashtra, Karnataka, and Uttar Pradesh have reported rationing doses. In some areas, only girls turning ten are eligible, leaving nine-year-olds on waitlists that stretch for months.

The World Health Organization has recommended a single-dose schedule since 2022, citing evidence that one shot provides sufficient protection. But India's National Technical Advisory Group on Immunisation has not yet adopted the change, citing the need for more domestic data. For parents like Sunita Devi, whose daughter is on the list in a Pune district, the confusion is palpable. “They told us to come back in three months. Then six. Now they say maybe next year,” she said. “I don’t understand why the vaccine is available in private clinics for double the price but not here for free.” Her frustration reflects a broader inequity: private-sector doses cost around ₹2,000 per shot, compared to roughly ₹800 in the public programme, putting them out of reach for many families.

The stockouts come at a time when global cervical cancer elimination goals depend on reaching 90% of girls by age fifteen. India, which accounts for about one-fifth of the world's cervical cancer cases, is far from that target. As of 2024, coverage among adolescent girls was estimated at under 10%, according to a study in The Lancet Global Health. The delays threaten to widen the gap between intention and reality.

Why India's HPV Rollout Stalled

The primary bottleneck is manufacturing capacity. The Serum Institute of India, the sole domestic producer of the quadrivalent HPV vaccine Cervavac, has faced production constraints amid surging global demand. Serum Institute supplies vaccines to more than thirty countries, many through Gavi, the Vaccine Alliance, which prioritises low-income nations in Africa and Asia. India's domestic orders, though substantial, have faced wait times of six to twelve months. Price negotiations between the central government and state procurement agencies have further slowed the process. While the Union health ministry negotiates bulk prices, individual states must place orders and manage distribution—a decentralised system that creates delays. Cold-chain gaps in rural districts, where electricity supply is erratic, also limit how many doses can be stored at any time. Health workers in some areas have reported discarding expired doses because they could not administer them in time.

The catch-up campaign, initially planned to cover 30 million girls aged nine to fourteen, was paused indefinitely in mid-2025 after only about 5 million had received at least one dose, according to estimates from the Ministry of Health and Family Welfare shared with journalists. The pause was not officially announced; instead, districts quietly stopped scheduling new appointments. Parents learned of the shortage only when they arrived at clinics.

Serum Institute has announced plans to expand manufacturing capacity, but the new facilities are not expected to come online until late 2026 or early 2027. In the interim, the company has prioritised fulfilling existing contracts with Gavi and other international buyers, leaving India's domestic programme to compete for remaining supply. The situation mirrors earlier stockouts of other vaccines, including BCG and tetanus toxoid, which also faced production hiccups.

Experts Split on Dose Strategy

The WHO's 2022 recommendation that a single dose of HPV vaccine provides adequate protection against cervical cancer was based on a growing body of evidence, including a large trial in India that showed high efficacy for one dose over at least ten years of follow-up. That trial, conducted by the International Agency for Research on Cancer and the Indian Council of Medical Research, enrolled more than 20,000 women and found that a single dose reduced persistent HPV infection by roughly 90%.

Proponents of adopting the single-dose schedule argue it could stretch existing supplies, allowing the programme to reach more girls with fewer shots. “If we switch to one dose, we could vaccinate twice as many girls with the same number of vials,” said Dr. Rajeshwari Rao, a public-health researcher at the Public Health Foundation of India. “Given the stockouts, it seems like a pragmatic choice.” But India's immunisation panel has been cautious. Some experts worry that waning immunity over decades—the vaccine is designed to protect for life—might leave women vulnerable later if they receive only one dose. “The trial data are promising, but we don't have long-term follow-up beyond ten to fifteen years,” said Dr. Anil K. Sharma, a paediatrician and member of the Indian Academy of Pediatrics' immunization committee. “A booster may still be needed, and we don't want to create a false sense of security.”

The debate over immediate coverage versus long-term certainty is one that reasonable experts disagree on, with no easy resolution in sight. If India adopts the single-dose schedule, it could free up millions of doses for the catch-up campaign. But changing policy takes time: the National Technical Advisory Group on Immunisation meets quarterly, and a formal recommendation would require approval from the Ministry of Health. Meanwhile, girls continue to wait.

Economic Burden of Missed Prevention

Cervical cancer treatment in India can cost between ₹1.5 lakh and ₹5 lakh per patient, depending on the stage and regimen—roughly three to five times the annual income of a rural household. Most cases are diagnosed at advanced stages because screening coverage remains low; only about 2% of women have ever been screened for cervical cancer, according to the National Family Health Survey. Late-stage treatment is more expensive and less effective, with five-year survival rates below 50%.

The government spends an estimated ₹500 crore annually on cervical cancer treatment through public hospitals and insurance schemes, compared to roughly ₹200 crore on prevention—including vaccination and screening. A modelling study published in 2024 in The Lancet Oncology by researchers at the Public Health Foundation of India and Harvard T.H. Chan School of Public Health suggested that a one-year delay in achieving high vaccination coverage could lead to a 20% increase in future cancer cases, adding thousands of avoidable deaths and billions of rupees in treatment costs over the next two decades.

For families already struggling with out-of-pocket health expenses, a cervical cancer diagnosis can be catastrophic. “I sold my buffalo to pay for my wife's chemotherapy,” said Ramesh, a farmer from the Kolar district of Karnataka, who spoke to a health worker in March 2025. “If the vaccine had been available for my daughter, maybe she wouldn't have to go through this.” His story is not unique: many families in rural India face a choice between treatment and other necessities.

The economic argument for prevention is clear, but translating that into sustained political will has been challenging. Vaccine stockouts erode trust in public health programmes, making it harder to achieve high coverage when supply eventually stabilises. Some parents, after being turned away multiple times, may decide the vaccine is not worth the effort. Others may turn to private clinics, widening the gap between rich and poor.

Global Supply Chain Squeeze Hits India

India's HPV vaccine shortage is not an isolated problem. Globally, demand for the vaccine has surged since the WHO's cervical cancer elimination initiative was launched in 2020, and manufacturing capacity has struggled to keep pace. Gavi-funded shipments have prioritised low-income African nations, where cervical cancer incidence is highest and vaccination coverage is often below 30%. India, despite its large disease burden, is classified as a lower-middle-income country and does not qualify for Gavi's free vaccines for the poorest nations.

The Serum Institute's Cervavac is one of only a handful of HPV vaccines prequalified by the WHO, alongside Merck's Gardasil and GlaxoSmithKline's Cervarix. But Gardasil is expensive and in limited supply, and Cervarix has been discontinued in many markets. The Quadrivalent vaccine donation pledge from the United States, announced in 2023 to supply 1.2 million doses to India, remains partially unfilled as of early 2026, with only about 400,000 doses delivered, according to US government records reviewed by journalists.

Manufacturing expansion is a slow process. Building new bioreactors, validating production lines, and obtaining regulatory approvals can take eighteen to twenty-four months. Serum Institute has announced a ₹1,000 crore investment to boost Cervavac production, but the new capacity is unlikely to ease shortages before 2027. In the interim, India must compete with other countries for limited global supply, a situation that has led to diplomatic tensions.

The global squeeze has also affected other vaccines, including those for polio and measles, but the impact on HPV is particularly acute because the vaccine is relatively new to India's public programme. Unlike older vaccines, which have established production lines and multiple suppliers, HPV vaccine manufacturing is concentrated in a few facilities. Diversifying the supply base—through technology transfer or licensing to other Indian manufacturers—has been discussed but not implemented. For instance, the government has held talks with Biological E. and Bharat Biotech about producing HPV vaccines, but no agreements have been finalised as of late 2025.

What Catch-Up Looks Like Now

In the districts where school-based campaigns are still running, only ten-year-old girls are being vaccinated, and only in schools that have been selected for the pilot. Nine-year-olds are excluded entirely until supply stabilises. Health workers have improvised: some maintain waitlists and call parents when doses become available, but the calls are rare. “We have maybe ten doses a month for a population of 2,000 eligible girls,” said a nurse in a rural Uttar Pradesh clinic. “It's like trying to fill a bucket with a teaspoon.”

Communication with parents has been poor. Many families were not told about the shortage when they first brought their daughters for vaccination; they learned only when they arrived for the second dose. Some assumed the programme had been cancelled. Others heard rumours that the vaccine caused infertility—a false claim that has circulated on social media and that health workers struggle to counter without a consistent supply to demonstrate trustworthiness.

Private clinics have stepped in to fill some of the gap, but at a cost that many families cannot afford. The price of a single dose in the private sector ranges from ₹1,500 to ₹2,500, depending on the brand and location. For a family earning ₹10,000 a month, that represents a significant expense. Some private practitioners have offered discounts for siblings, but the overall reach remains limited to urban and peri-urban areas.

Community health workers, known as ASHAs, are often the first point of contact for families. But they have not been trained to counsel parents about HPV vaccination, and many are unaware of the stockouts themselves. “I tell mothers to bring their daughters to the clinic, but when they go, there's no vaccine,” said an ASHA worker in Bihar. “They get angry at me. I don't know what to say.” The breakdown in trust could have long-term consequences for other immunisation programmes.

Bridging the Gap: Policy Fixes Under Debate

Several policy options are under discussion to address the shortage and prevent future disruptions. The most immediate is adopting the WHO single-dose recommendation. A switch would roughly double the number of girls who could be vaccinated with existing stock, potentially allowing the catch-up campaign to resume within months. A coalition of public-health experts has urged the government to act, citing the ethical imperative to protect girls now rather than wait for an uncertain future supply.

A second option is centralising vaccine procurement. Currently, states negotiate separately with manufacturers, leading to delays and price variation. A national procurement hub could consolidate orders, negotiate better terms, and allocate doses based on need. The model has worked for other vaccines, such as the pentavalent vaccine, which is procured centrally and distributed to states. Expanding this to HPV could streamline the process and reduce inequities.

Longer-term investments include building domestic capacity for mRNA vaccine production, which could allow India to manufacture its own HPV vaccines using newer technology. The government has funded research into mRNA platforms for influenza and COVID-19, but HPV has not been a priority. Some experts argue that the technology could be adapted relatively quickly, given the existing infrastructure. For example, the Pune-based Gennova Biopharmaceuticals has developed an mRNA vaccine candidate for COVID-19 and could potentially repurpose its platform for HPV.

Integrating HPV vaccination with routine adolescent health visits—such as those for tetanus boosters or menstrual health education—could also improve coverage. Currently, the vaccine is offered only through school-based campaigns and a few fixed clinics. By embedding it in existing health services, the programme could reach out-of-school girls, who are often the most vulnerable. Community health worker outreach, using mobile teams, has been piloted in a few districts with promising results, but scaling up requires funding and political will.

The debate over these options reflects deeper tensions in India's health system: between centralisation and state autonomy, between short-term fixes and long-term investments, and between the urgency of preventing cancer and the caution of maintaining scientific rigour. There is no single answer that satisfies all stakeholders. What is clear is that the status quo—leaving nine-year-old girls on waitlists—is untenable, and that any solution will require coordinated action from the central government, state governments, manufacturers, and international partners. As the waitlists grow, the window for effective catch-up narrows, and the cost of inaction—measured in lives and rupees—continues to mount.

This article is for informational purposes only and does not constitute medical advice. Readers are encouraged to consult healthcare professionals for personalised guidance.