The birth of Savita (name changed) in Mandsaur district, Madhya Pradesh, 14 years ago was a moment of celebration for her family. The Banchhada community she was born into — a denotified tribe in Madhya Pradesh traditionally associated with sex work — welcomes the birth of girls, who are often viewed as future breadwinners. Yet, when a team of human papillomavirus (HPV) vaccinators recently approached Savita’s family, they were apprehensive. “Will she be able to work?” they asked candidly, worried about the vaccine’s future impact.
Their hesitation was neither unexpected nor isolated. Although cervical cancer is the second most common cancer among Indian women, preventive health-care initiatives often grapple with low levels of awareness and social stigma. Cervical cancer vaccination faces a distinct set of challenges — low cultural sensitivity around sexual health and gender bias, coupled with vaccine hesitancy — making it a pressing public health concern.
In light of this, the Government of India launched a nationwide cervical cancer campaign on February 28, 2026, providing free HPV vaccinations to 1.15 crore girls aged 14-15 years. India bears a quarter of the global cervical cancer burden, reporting over 1.2 lakh new cases and 80,000 deaths annually. Since nearly 95% of cases are caused by high-risk HPV strains, vaccination offers a significant preventive breakthrough.
From data to coverage
To implement the programme effectively and inclusively, the Mandsaur district administration adopted a data-driven, decentralised and adaptive strategy. For exhaustive coverage, the most vulnerable and often overlooked populations were targeted first.
Girls from difficult-to-reach communities — Banchhadas, nomadic tribes, urban slums, and school dropouts — became the starting point. These “missed populations” are at greater risk of falling off the radar of government service delivery.
Editorial | A jab well done: On India’s Human Papillomavirus vaccination programme
At the grassroots, the challenge is often not vaccine hesitancy but data invisibility. Leveraging multiple government databases — Rashtriya Bal Swasthya Karyakram (RBSK), SAMAGRA MP (a citizen-centric social security platform by the Government of Madhya Pradesh) and Ladli Laxmi Yojana hyper-localised target lists were created. Fragmented records were transformed into actionable intelligence. Door-to-door surveys and tracking through SAMAGRA IDs ensured that eligible girls did not fall through statistical gaps. School and anganwadi enrolment gaps over the years were meticulously analysed to prepare village-level Master Line Lists. Rapid identification of ‘low-coverage/high-resistance’ areas enabled coordinated micro-planning. Mapping vulnerable groups geographically also enabled customising communication strategies, tailored to cultural sensitivities.
Reducing barriers through ‘nudges’
Behavioural insights played a pivotal role in grassroots’ saturation. The district relied on the “Nudge Approach” that helped design an environment where vaccination became the default choice. This helped in effectively breaking down grassroots barriers such as reluctance, inertia, social discomfort. Health-care workers informed families that their daughters were ‘due for vaccination’, rather than asking them to choose to vaccinate. Families who refused vaccinations received repeated counselling visits by health-care teams. Schools and local bodies arranged transportation to eliminate logistical barriers, simplifying access.
Misinformation hoaxes and myths around vaccine-induced infertility resulted in initial resistance. To counter rumours, the administration launched targeted awareness campaigns involving Gen-Z influencers and youth icons. National-level athletes, young doctors, students, religious leaders and media personalities voluntarily joined the effort to promote vaccination and dispel misconceptions.
Social norms and peer networks served as powerful “behavioural nudges”. Local events publicly felicitated vaccinated families and recognised vaccinated girls as peer champions. Gram panchayat and ward-level data sharing sparked both collaboration and competition. Recognition was given to both top performers and the most improved. “Digital nudges” and red-flag reminders for frontline workers enhanced monitoring and accountability.
At the cutting-edge implementation level, resistance often manifests as delay, doubt, and discomfort rather than outright refusal. Vaccinations were conducted exclusively under medical supervision at visible health-care facilities, normalising the practice of adolescent girls’ vaccination. Experiences of women affected by cervical cancer were shared to create emotional resonance and encourage informed decision-making. Counselling sessions reduced stigma and replaced distrust with dialogue.
Strategy to impact
The HPV campaign was further integrated with on-going health-care programmes. Routine immunisation days, antenatal care clinics and the Pradhan Mantri Surakshit Matritva Abhiyan sessions were used to promote HPV awareness and conduct vaccination drives. When women accessed one service, they became more receptive to another, creating avenues for ‘bundling’ of health-care service delivery.
The results were significant. In less than 40 days, Mandsaur achieved 100% of its vaccination target — 493 vaccination sessions were conducted through 12 permanent and 27 temporary vaccination sites across the district. Girls who met the criteria, from 893 villages and 190 urban wards, were mobilised, moving from planning on paper to protecting the population.
The magnitude of India’s health-care challenge must be met with the measure of its grassroots’ actions. Policy design must bridge the yawning gap between intended outcomes and empirical ground realities. Behavioural and systemic “nudges” in implementation can leverage the human tendency to opt for preset choices. Dovetailing health-care data and grassroots innovations tailored to regional realities can bridge the last mile and deliver the final dose.
By moving from coverage to care, from data to impact, Mandsaur turned a formidable public health challenge into a collective mass movement. The district’s inclusive vaccination campaign demonstrated how a simple shot in the arm can truly become a fair shot at life.
Aditi Garg, IAS, is Collector and District Magistrate, Mandsaur, Madhya Pradesh
Published – July 03, 2026 12:08 am IST
