ECCA Report: HPV Vaccination across Europe

A summary of HPV vaccination policies and practices across Europe is set-out in the ECCA’s Report on HPV Vaccination across Europe.

Download the report: HPV Vaccination across Europe

The data contained in this report show that of the 40 countries contributing data to this survey only 9 (Denmark, Germany, Greece, Italy, Luxembourg, Netherlands, Portugal, Spain and the UK) currently offer HPV vaccination free of charge to at least one age-cohort of females while an additional 3 countries (Belgium, France and Sweden) offer HPV vaccination on a co-payment basis. All of these countries are in Western Europe where healthcare budgets and existing infrastructure can more easily accommodate the introduction of the vaccines but where many countries also have organised cervical screening programmes or extensive opportunistic screening that have already greatly reduced cervical cancer rates.

The data also show that the UK is the only country that has implemented a national school-based vaccination programme, while in Spain only 9 of the 19 autonomous regions currently deliver HPV vaccination through this mechanism. School-based vaccination programmes are known to achieve high coverage of the target population for paediatric and adolescent vaccines(1) while on-demand provision through healthcare providers, even if supported by direct invitation and/or public education programmes, usually has suboptimal coverage rates and can miss lower socioeconomic groups and minorities(2).

This can be seen in the preliminary statistics obtained from some of the countries that have started HPV vaccination. Provisional figures for Scotland where HPV vaccination is delivered through a school-based programme show coverage at 92% for the first dose and 88% for the second(3) with similar rates (>90%) seen in the Spanish regions that are providing HPV vaccination through their schools(4). However, these high rates are not seen in the data available for countries or regions where HPV vaccination is given on-demand through healthcare professionals. Preliminary data from the Netherlands where on-demand vaccination is supported by invitation and public education puts coverage at approximately 50% although this likely reflects the impact of an anti-vaccination lobby in the country(5) and higher rates have been reported for the Spanish regions where on-demand vaccination is supported by invitation and/or public education(2). Then, coverage rates of <50% have been reported in the Spanish regions where on-demand vaccination is not supported by an organised effort to increase participation(2) as well as in Greece where coverage is currently estimated at only 9% of the target population(6).

These data show that HPV vaccination in Europe is currently being deployed by the countries with the lower cervical cancer rates while those with the higher rates have yet to implement it. Further, among the countries that have started HPV vaccination, we can see the majority are using on-demand provision rather than the school-based programmes that typically achieve the highest and most equitable coverage. Here it is important to remember that on-demand provision tends to the miss lower socioeconomic groups and minorities which are exactly the groups that are missed by the opportunistic cervical screening that still prevails in Europe(7,8). As such, these data show that HPV vaccination is being preferentially delivered to women who are at lower risk of cervical cancer while those who are at higher risk are again missing-out so the health inequalities we have seen with cervical cancer screening will be perpetuated. This is something that needs to be addressed as a matter of urgency along with the implementation of population-based organised cervical cancer screening programmes to ensure the benefits of these programmes are equitably realised by all European women.

  1. Fitzsimmons D, Orsters A, Hoppentrouwers and van Damme. Prevention and control of viral hepatitis through adolescent health programmes in Europe. Vaccine, 2007; 25;8651-8659
  2. Poethko-Muller C, Ellert U, Kuhnert R and Neuhauser H. Vaccination coverage against measles in German-born and foreign-born children and identification of unvaccinated subgroups in Germany. Vaccine (in press
  3. Information Services, NHS National Services Scotland. Provisional Human Papilloma Virus (HPV) Immunisation Uptake rates: as at 16 February 2009. http://www.isdscotland.org/isd/5921.html, accessed 02/04/09
  4. Dr Javier Cortes, Senior Consultant in Gynaecologic Oncology, Spanish Society of Obstetrics and Gynaecology, Spain (personal communication, March 2009)
  5. Dr Marina Conyn-van Spaendonck, National Immunisation Programme Manager, RIVM - Centre for Infectious Disease Control, Netherlands (personal communication, April 2009)
  6. Dr Theodoros Agorastos, Professor of Obstetrics and Gynecology, Papageorgiou General Hospital, Thessaloniki, Greece (personal communication, March 2009)
  7. IARC. Cervix Cancer Screening. IARC Handbooks of Cancer Prevention. Vol. 10. Lyon: IARCPress, 2005. pp. 1-302
  8. Arblaster L, Lambert M, Entwistle V et al. A systematic review of the effectiveness of health service interventions aimed at reducing inequalities in health. J. Health. Serv. Res. Policy. 1(2), 93-103 (1996)