Vaccination alone cannot eliminate cervical cancer. Critically evaluate India's screening and treatment infrastructure vis-à-vis WHO's 90-70-90 framework.

WHO's global strategy to eliminate cervical cancer rests on three pillars — vaccinate, screen, treat — codified as the 90-70-90 targets for 2030 [3]. India's National HPV Vaccination Campaign, launched in February 2026, has addressed the first pillar with impressive speed [1], but elimination will be decided by the two pillars that remain structurally weak.

Vaccination (90%): a credible start

• Single-dose Gardasil-4 given free to 14-year-old girls across all 36 States/UTs, targeting ~1.2 crore beneficiaries [1].
• Over 80 lakh doses delivered within months through the Ayushman Arogya Mandir–PHC–CHC chain, linked to 24x7 AEFI centres [1][2].
• Limit: the vaccine cannot protect the crores of already-exposed adult women, who will constitute India's cancer burden for the next two decades.

Screening (70%): the weakest link

• Scale exists — over 10.18 crore women aged 30+ screened under NHM/AAMs [4], with 8.15 crore cervical screenings recorded on the NP-NCD portal till 31.10.2025 [5].
• But WHO specifies a high-performance test; India relies largely on VIA by trained frontline workers at sub-centres [3][5] — operator-dependent and less sensitive than HPV-DNA testing.
• Screening remains largely opportunistic rather than the structured twice-in-a-lifetime cycle (ages 35 and 45) WHO prescribes [3].

Treatment (90%): thin and uneven

• Only 19 State Cancer Institutes and 20 Tertiary Care Cancer Centres approved under the tertiary-care scheme [6] — radiotherapy and oncology capacity concentrated in larger cities.
• The referral link is the real bottleneck: VIA-positive women must travel to higher centres for diagnostic evaluation [5], where loss-to-follow-up is high.

India has turned the vaccination pillar into a demonstrable success, but 90-70-90 works as a product, not a menu — weakness in screening or treatment erodes vaccination gains. The way forward is migrating population screening to HPV-DNA testing, decentralising precancer treatment to CHC level, and strengthening cancer registries. Delivered through Ayushman Bharat's existing network, this would make the 2030 elimination pledge substantively real.