Human papillomavirus is responsible for 95% of cervical tumours. Since 2006, several vaccines have been licensed that can prevent most cases.
In Spain, the autonomous communities first introduced the vaccine for girls, and from the end of 2023, boys will also be vaccinated throughout the country.
More than 30,000 European women are diagnosed with cervical cancer every year and some 13,500 die from it. These figures, however, may become history in the not too distant future: vaccines against human papillomavirus (HPV) can prevent the vast majority of cases, as reminded every 26 March on World Cervical Cancer Prevention Day.
The introduction of these vaccines in Europe in 2006 marked a paradigm shift and experts have now been able to corroborate their efficacy. A study published in The Lancet using data from the UK found that women who had been vaccinated at 12 and 13 years of age had 87% fewer cervical tumours than those who had not received the vaccine. Another study in The New England Journal of Medicine showed similar results in Sweden, with cancer rates 88% lower in women vaccinated in adolescence than in those not vaccinated.
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In Spain, HPV vaccines were authorised in October 2007 and incorporated into the vaccination schedules of the autonomous communities during 2008, as explained in an article by the Spanish Association of Paediatrics. At that time it was indicated for girls, and in recent years it has been progressively added to boys, as the deadline for including them dictated by the Ministry of Health expired this year.
Human papillomavirus, which causes 95% of cervical cancer cases, is the most common sexually transmitted infection and is estimated to affect 10% of the population at some point in their lives. Although some HPV types (there are more than 100) are considered low risk, others are high risk and can cause cancer of the cervix, vulva, penis, vagina, anus, rectum and oropharynx. That is why, although women are the most frequent sufferers, it is important to vaccinate men as well, both because they may suffer from some of these tumours themselves and because they can transmit the infection to women.
It should be remembered, however, that having an HPV infection does not necessarily indicate cancer. Some are cleared spontaneously, but a small percentage may persist and develop into precancerous lesions and eventually cancer.
The Ministry of Health’s vaccination schedule approved for 2024 recommends HPV vaccination in the total population at 12 years of age, between 12 and 18 years of age in unvaccinated or incompletely vaccinated females and in males from the time of inclusion in the schedule, and in adults of any age in situations of risk (men who have sex with men and people in prostitution up to 25 years of age). In addition, vaccination is recommended in immunocompromised children under 18 years of age (including HIV), in adults up to 45 years of age in immunosuppressed conditions (WHIM syndrome, HIV and solid organ or haematopoietic progenitor transplantation), and in women of any age who have been treated for high-grade intraepithelial lesions of the cervix. Routine vaccination, as well as rescue vaccination, is basically carried out in primary care centres or in specialised care centres in the case of at-risk groups.
In Spain, HPV vaccination rates reached 90% for the first dose and 83.2% for the second dose in 2022, according to data from the Ministry of Health. Experts agree on the importance of maintaining high rates – over 80% – in both girls and boys to maintain herd immunity.
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Our country is on the right track, but this is not the case across Europe. According to a report by the European Federation of the Pharmaceutical Industry (Efpia), vaccination rates in Europe differ from 30 to 70% depending on the country, creating a territorial inequality that has an impact on overall health, well-being and also on the economy.
In this context, the European Commission presented this January a Recommendation to support Member States in their efforts to prevent cancer through vaccination. Europe is focusing on the HPV vaccine – together with the hepatitis B vaccine – as key to preventing viral infections that can lead to cancer. Europe points out that while an estimated 40% of cancer cases in the EU are preventable, only around 5% of total health spending was spent on prevention in Member States in 2021.
The European Commission’s recommendations include the objective that all countries should achieve vaccination rates among girls of 90% and increase vaccination rates among boys, and proposes that immunisation should be financed, communication should be strengthened and the vaccine should be made available to all sectors of the population, as well as improving the monitoring and registration of vaccination, among other things.
According to the Efpia report, HPV vaccines in Europe can prevent 27,000 cases of cervical cancer and 12,000 deaths. The cost of cervical cancer treatment costs around 26,000 euros, according to data from Italy, which means that Italy alone could save 74 million euros. In addition, the use of the vaccine, without the need to treat the cancer, would also save almost 500,000 nursing hours, which could be spent on other patients.
In terms of value to society, vaccinating all women in the 27 EU states would increase productivity with 5.7 million working hours not lost, as well as 387 million euros.
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The global situation is no more encouraging and between 2019 and 2021 saw a drop from 25% to 15% in global HPV vaccination coverage. A ratio that implies that, in that period, 3.5 million more girls did not receive the vaccine. These are worrying figures, which led the World Health Organisation to publish a new position paper in December 2022, indicating the possibility of vaccinating with a single dose (as opposed to the recommended two doses) with the aim of speeding up immunisation and reversing the drop in coverage.
This is very important as the highest prevalence of cervical HPV infections has been identified among women in sub-Saharan Africa (24%), followed by Latin America and the Caribbean (16%), Eastern Europe (14%) and Southeast Asia (14%). Vaccination that prevents infectious diseases is important from the point of view of the individual but also from a public health point of view and is therefore a global issue where the commitment of the whole society is needed. The Covid vaccines were a great example of how such engagement impacts on the health of all.
Eradicating HPV cancer is in everyone’s hands.