Cancer vaccine: how European countries can save more lives

A widely-available cancer vaccine is driving down rates of cervical cancer across Europe. Human papillomavirus (HPV) vaccines have been given to millions of people since they were first approved twenty years ago. 

However, some countries are protecting more people than others: Sweden, Portugal, Malta are on course to eliminate cervical cancer within a generation, but vaccine coverage in central and eastern European countries is generally lower than in their western and northern neighbours.  

Read more: 

• HPV vaccine: cervical cancer deaths plummet among young women in England
• Swedish study: HPV vaccines protect against cervical cancer after 18 years 
• Could dentists help Europe beat cervical cancer? 

To meet EU and WHO vaccine goals, countries need to vaccinate 90% of girls and increase vaccination rates among boys. The European Cancer Organisation (ECO) has developed a detailed ‘good practice’ guide to help countries meet their targets. It includes concrete policy steps, scientific evidence, and case studies from around the world to support countries in improving vaccination rates.

‘Over time, we’ve seen greater awareness of the importance of HPV vaccination, but coverage across Europe is uneven,’ says Professor Daniel Kelly, Emeritus Professor of Healthcare Sciences at Cardiff University. ‘We wanted to bring together the evidence and tools countries need to improve uptake of screening and vaccination to help them move forward.’  

The guide breaks down the key challenge into six categories: policy & governance, vaccination delivery, data systems and monitoring, communication, access & equity, catchup vaccination and extended programmes.

Juliana de Sá, Policy Officer at ECO, says that because each country faces unique challenges, there is no one-size-fits-all template. ‘All 27 EU countries are committed to gender neutral vaccination but there are a range of approaches for achieving HPV vaccination goals,’ she explains. ‘For example, some countries may be doing well on delivery but need to improve communication. For others, the challenge is data monitoring or access issues.’

The case studies featured in the guide feature high-achieving countries such as Sweden, but also highlight good practices from Slovakia, Bulgaria and Rwanda. When it comes to advocating for the optimal approach to vaccine delivery, the guide is not prescriptive. For example, it highlights the school-based programmes which have helped Sweden and others achieve high vaccination rates, but also celebrates Portugal’s success which is built around primary care.  

Preventing cervical cancers and more

The impact of HPV vaccination programmes can take time to emerge. That’s because HPV infections can cause cancer decades after an individual is exposed to the virus. The data on cervical cancer are beginning to mount, but ECO believes there is scope to prevent other cancers too.

Prof Kelly, who is Co-chair of the ECO HPV & Hep B Action Network, says rates of oropharyngeal cancers are alarming, with much lower levels of awareness and poorer data collection. There is also a lingering – and inaccurate – perception that the vaccine benefits only women. This is because the vaccine was initially offered to adolescent girls to prevent cervical cancer, before being extended to boys.

‘This is not a gendered virus, it affects tissues across the body regardless of sex or gender,’ he says. ‘We know HPV vaccines are helping to control cervical cancer in countries where uptake is high, but head and neck cancer is now overtaking cervical cancer. Clinicians are seeing men in their forties, fifties and sixties who were not included in prevention programmes. We need to change that for the next generation.’

ECO says the HPV vaccine should be viewed as a success story not just for health, but for health systems and national finances. There is political momentum building behind the vaccine as evidence of its impact mounts. Health ministers are celebrating but Ministries of Finance are also playing close attention to the savings that arise from not having to treat invasive cancer. 

‘I’m optimistic about awareness now, but challenges remain,’ Prof Kelly says. ‘The dangers include complacency – with some highly successful countries reporting a decline in screening and vaccination – as well as politicisation of this vital public health tool. The guide aims to ensure policy is evidence based across Europe.’