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European Immunization Week 2023

On the European Immunization Week #EIW2023, the #ReThinkHPVaccination Consortium reiterates its commitment to contribute to the reduction of HPV vaccination inequalities in Europe.

Although HPV-generated cancers are some of the most preventable forms of cancer, the vaccine uptake in most of Central Eastern Europe and Southern Europe (EU-widening Countries and Associated Countries) is low or very low. HPV infection is responsible for 99.7% of cervical cancers and there is also evidence linking HPV with cancers of the anus, vulva, vagina, penis, and oropharynx. The now-available HPV vaccine covers 90% of the circulating strains of the virus.

In this context, vaccination of the female and male populations should be one of the public health priorities. Theoretically, it is, but practically the results are missing in many countries – #Romania, Bulgaria, Greece, Poland, Republic of Moldova, Ukraine, Belarus, Georgia, Albania, etc. (identified by the European Cancer Organisation in the Report Viral Protection: Achieving the Possible. A Four-Step Plan for Eliminating HPV Cancers in Europe) are the best example of how lack of access to the right information, misinformation / fake-news, unrealistic communication strategies, and the infodemic related to vaccination in general (including COVID-19 vaccination) can generate thousands of avoidable deaths.

The World Health Organization's (#WHO) strategy for the global elimination of cervical cancer, together with Europe's Beating Cancer Plan, the European Cancer Mission, and the EU4Health Program, create a unique opportunity for European Union to be a leader in eliminating an endemic virus.
One of the major problems, identified during the Consortium years of acting in Romania, when it comes to preventing a disease by vaccination is the inadequate communication that derives from a low level of understanding the particularities of the population you are addressing. By adding the low level of health literacy and the fake news and conspiracy theories that arise from it to the low capacity of the authorities to communicate with the citizens, a major gap in HPV vaccination rates and cancer survival rates was created between countries in Europe.

For example, at the EU level, Romania ranks first in terms of incidence and mortality for cervical cancer: the incidence is 2.5 times higher than the European average, and the mortality rate is over 4 times higher. When referring to HPV, this information can be explained partly by the following data, according to the national survey organized by the Centre for Innovation in Medicine, Renasterea Foundation, and National Institute for Public Health:

  • (2018) 48% of women respondents said that in the last 3 years they were not tested for HPV;
  • (2018-2020) no less than 67% of women and girls from rural areas, aged 15-65, have genital infections;
  • (2020) Only 36% of Romanian women have heard of the HPV virus and only 31% associate this infection with cervical cancer.

Currently, after the 2008’s HPV vaccination failure (less than 2% of the target population was vaccinated at that time), Romania started implementing a new HPV vaccination program for girls aged 11-18 and a Regional Screening Program for Cervical Cancer, but these need to be strengthened by sustainable and highly personalized communication, and training courses for the people involved in the process (from family doctors to school teachers).

In 2020, the Romanian Ministry of Health announced its intention to introduce free HPV vaccination also for boys. But as HPV infection is perceived as a women's health issue exclusively in countries with a profile resembling Romania, the mere fact that there are free vaccines available for boys does not guarantee their vaccination.

Inequalities in vaccination in general and HPV vaccination rates exist not only between countries, but also within countries, communities, and groups. For example, a total of 41 counties, along with the municipality of Bucharest, constitute the official administrative divisions of Romania, but based on Renasterea Foundation’s experience with their cancer screening projects, in the Northern and North-Eastern part of the country, the level of cervical cancer, and HPV vaccination literacy is very low, being hard to get access to the people through classical methods. Different communication vectors and messages are needed.

There is no better time to reinforce the communication efforts around HPV vaccination than the COVID-19 pandemic context. The rate of COVID-19 vaccination in Romania is one of the lowest in the EU, but this is the highest level for any vaccination campaign covering adults, together with children. In this context, based on the COVID-19 vaccination campaign and learnings, the vaccination against HPV could be restarted in a different manner.

The #ReThinkHPVaccination Project aims at changing this narrative and reducing inequalities in HPV vaccination between and within countries through personalized communication & training, based on social innovation and assessment, as well as targeted interventions on the behavioral determinants of health.

Building a model of success, the main objective of this project is to support Romania and other CEE countries to rethink, restart or begin their HPV vaccination campaigns and so take a step closer to achieving the WHO objective and Europe's Beating Cancer Plan and Cancer Mission objectives with regards to HPV vaccination and cancer prevention.

Views and opinions expressed are however those of the author(s) only and do not necessarily reflect those of the European Union or European Health and Digital Executive Agency (HaDEA). Neither the European Union nor the granting authority can be held responsible for them.
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