India’s HPV rollout was delayed not by safety risks but by oversight and ethical challenges, which shaped public mistrust and slowed a vital health programme
India launched its nationwide HPV vaccination campaign on 28 February 2026, announced by Prime Minister (PM) Narendra Modi, with Union Health Minister Jagat Prakash Nadda joining virtually. Given India’s high burden of cervical cancer, the nationwide rollout carried significant public health importance. It was also quietly remarkable for another reason, particularly for those who have followed this story closely. Mr Nadda had been a member of the Parliamentary Standing Committee on Health that, in 2013, produced a damning report on the conduct of an HPV vaccine demonstration project in India. The report followed an investigation into the deaths of seven participants who received the vaccine under the project, mostly poor tribal girls living in government hostels, among the country’s most vulnerable and voiceless communities. The Chairman of the Parliamentary Standing Committee at the time, Mr Brajesh Pathak, now Deputy Chief Minister with additional charge of health in Uttar Pradesh, also launched the vaccination campaign in the state on 28 February.
The 2013 committee report focused on regulatory, ethical, and surveillance failures within the system. A separate committee appointed by the Government of India later examined the seven deaths of vaccinated girls. It concluded that they were most probably unrelated to the vaccine, noting the absence of any consistent clinical pattern preceding death or any temporal or spatial clustering. Despite the controversy, the HPV vaccines continued to be available in India’s private market. International scientific literature has not identified safety concerns, and the World Health Organization (WHO) has endorsed the vaccine now being rolled out in India.
The launch of the 2026 HPV vaccination campaign triggered a fresh wave of social media opposition, with the 2013 parliamentary committee report widely recirculated. The seven deaths associated with the 2009 PATH demonstration project were repeatedly invoked, and anti-vaccine accounts portrayed the rollout as a repetition of an experiment that had already claimed the lives of tribal girls. Missing from much of this discourse were the committee’s actual findings and, crucially, what it did not conclude. In response, medical associations and government agencies have mounted a coordinated outreach effort across traditional and social media to reassure the public of the vaccine’s safety.
The launch of the 2026 HPV vaccination campaign triggered a fresh wave of social media opposition, with the 2013 parliamentary committee report widely recirculated. The seven deaths associated with the 2009 PATH demonstration project were repeatedly invoked, and anti-vaccine accounts portrayed the rollout as a repetition of an experiment that had already claimed the lives of tribal girls. Missing from much of this discourse were the committee’s actual findings.
This divergence between perception and evidence reflects what occurs when a regulatory system lacks both the capacity and the credibility to settle a question authoritatively. India’s sixteen-year delay in adopting HPV vaccination stemmed from institutions' inability to communicate safety conclusions with sufficient clarity and conviction. That institutional fragility was evident earlier: in 2014, the Ministry of Health acknowledged “collective failure” three times in its formal response to the parliamentary committee’s report. The resulting controversy delayed national rollout for over a decade and a half, at the cost of tens of thousands of preventable deaths, until the recent decision to correct course and implement a nationwide campaign.
In mid-2009, PATH, a Seattle-based non-governmental organisation, partnered with India’s apex medical research body, the Indian Council of Medical Research (ICMR), to conduct what it termed a “demonstration project” for HPV vaccines in the districts of Khammam and Vadodara. Approximately 23,000 girls aged 10–14 — many from poor tribal communities residing in government hostels — received either Merck’s Gardasil or GlaxoSmithKline’s Cervarix, both supplied by the manufacturers. The project was funded by the Bill & Melinda Gates Foundation. At the same time, PATH was running similar demonstration projects in Uganda, Peru, and Vietnam. The 72nd Parliamentary Standing Committee later observed that the selection of countries — all high-burden, high-population markets with potential for rollouts of universal immunisation programmes suggested a commercial rationale alongside a public health objective.
When seven girls died during the course of the project, the programme was suspended. It is at this juncture that the episode has been most persistently misread — with lasting consequences. Investigations by a government-appointed inquiry committee concluded that none of the deaths was likely caused by the vaccine. The recorded causes included drowning, snakebite, two instances of pesticide ingestion classified as suicide, and a case of malaria; the remaining deaths were indeterminate but showed no clinical pattern consistent with vaccine-related harm. No post-mortem examination identified evidence of an adverse vaccine reaction.
India records over 120,000 new cases of cervical cancer and approximately 80,000 deaths each year — the majority preventable through vaccination.
What the investigations did identify was a research exercise conducted under conditions that would have been unacceptable in jurisdictions with robust clinical oversight. Consent procedures were deeply compromised: in many cases, hostel wardens or school principals signed on behalf of illiterate parents. In Andhra Pradesh alone, thousands of consent forms bore a warden’s signature rather than that of a parent or legal guardian. Immunisation cards were printed in English, a language neither the girls nor their families could read, and thousands of thumb impressions were recorded in place of signatures. Many participants believed they were receiving a routine government vaccination and were unaware that they were enrolled in a research study. No systematic mechanism to monitor adverse events was established. These findings pointed to grave ethical and procedural failures. They did not establish that the vaccine caused the deaths, a distinction that was largely erased in the public debate that followed.
The 72nd Parliamentary Standing Committee report, presented to the Rajya Sabha on 30 August 2013 and endorsed by members across major political parties, recognised this distinction, even if its language was unsparing. Its criticism was directed primarily at process failures: the misclassification of a clinical study as a “demonstration project”, the exploitation of regulatory grey areas, and the use of state machinery to administer a research exercise as though it were a routine public health intervention. The committee observed that the Drugs Controller General of India (DCGI) had “remained a silent spectator … even when its own rules and regulations were being so flagrantly violated.” The failure was identified as institutional and systemic, shared across multiple agencies. It was not an indictment of a harmful vaccine.
These systemic lacunae were not unique to the HPV vaccine project. For years, India’s clinical research ecosystem functioned amid uneven regulatory enforcement, under-resourced ethics committees, and weak institutional accountability. Concerns regarding consent procedures and adverse-event reporting resurfaced during the COVID-19 vaccine trials. The HPV episode was therefore not an aberration, but a particularly visible manifestation of a structural weakness, one that predated PATH’s entry into India and endured well beyond it.
A comparison with the other countries where PATH conducted HPV demonstration projects highlights the difference in timelines. Uganda incorporated the HPV vaccine into its national immunisation programme in 2015. Peru moved even earlier, introducing it nationwide in 2011 without significant political controversy. Vietnam, the slowest of the three, has scheduled national inclusion for 2026 — the same year India is finally proceeding with rollout.
Weak regulatory systems do not merely fail in the moment of oversight. They create informational vacuums that allow mistrust to harden, fuelling vaccine hesitancy long after the original events have passed.
India records over 120,000 new cases of cervical cancer and approximately 80,000 deaths each year — the majority preventable through vaccination. Peru and Uganda, both participants in the earlier PATH demonstration project, have protected adolescent girls against the HPV strains responsible for most of these cancers since 2011 and 2015, respectively. India and Vietnam began only in 2026. The social media backlash accompanying the 2026 rollout draws on the same recycled narrative that contributed to that delay.
In the absence of a credible and widely accepted official account, a simpler story took hold: that foreign organisations had experimented on tribal girls, that seven had died, and that the episode had gone unaddressed. The narrative carries emotional force and persistence, resurfacing with each subsequent vaccine initiative. Weak regulatory systems do not merely fail in the moment of oversight. They create informational vacuums that allow mistrust to harden, fuelling vaccine hesitancy long after the original events have passed.
India is now administering single-dose Gardasil, procured through Gavi, as the indigenously developed Cervavac by Serum Institute of India awaits WHO approval for single-dose use. The vaccine is being delivered to millions of girls through a public programme whose credibility will depend on the strength of the institutions behind it. At this scale, adverse events will occur. Each will be viewed through the memory of 2009. Public trust will turn on how transparently and consistently those events are investigated and communicated.
Union Health Minister Jagat Prakash Nadda’s movement from the 2013 committee room to the 2026 ministry podium reflects, in miniature, India’s own path. The country moved from a legitimate grievance about research conduct through years of conflation and mistrust before recognising that the science itself was not at fault.
That requires independent adverse-event surveillance with findings reported publicly, regardless of convenience; consent processes designed for the communities they serve rather than for bureaucratic compliance; and ethics review mechanisms with genuine autonomy. A programme of this magnitude, serving a population that has waited this long and borne this cost, demands institutional foundations capable of sustaining it through the next wave of opposition — and the one after that.
The girls in Khammam and Vadodara received vaccines that were, and remain, among the most effective cancer-prevention tools in modern medicine. The failure lay not in the science, but in procedure and oversight: serious enough to warrant reform, yet categorically different from the narrative that has circulated for over fifteen years. Union Health Minister Jagat Prakash Nadda’s movement from the 2013 committee room to the 2026 ministry podium reflects, in miniature, India’s own path. The country moved from a legitimate grievance about research conduct through years of conflation and mistrust before recognising that the science itself was not at fault. Trust in a health system is not restored by announcement. It is built gradually, through institutions that act with credibility and consistency.
Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Observer Research Foundation.
Disclosure: The Observer Research Foundation has received funding from the Bill & Melinda Gates Foundation, which also funded the PATH demonstration project described in this article. This piece was written without direction from any funder, and the views expressed are those of the author alone.
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Oommen C. Kurian is Senior Fellow and Head of the Health Initiative at the Inclusive Growth and SDGs Programme, Observer Research Foundation. Trained in economics and ...
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