This piece was co-written by Margaret Stanley, Daniel Kelly and Peter Baker (full biographies at the bottom of this piece).
HPV, cancer cases and gender-neutral HPV vaccination: the current situation
Vaccinating both boys and girls against the human papilloma virus (HPV) is a flagship policy in Europe’s Beating Cancer Plan. If implemented throughout the European Union, gender-neutral vaccination has the potential to eliminate all cervical, anal, vaginal, penile, head and neck cancers caused by HPV.
HPV causes approximately 5% of all cancers worldwide. It is responsible for approximately 67,500 new cancer cases each year across the 27 EU Member States. Up to 30% of these cancers are in men, with rates of male head and neck cancer increasing with worrying rapidity. Men who have sex with men are at particular risk, especially from anal cancer, as they are unprotected by female-only vaccination programmes.
Gender-neutral HPV vaccination programmes
Currently, about half of all EU Member States deliver gender-neutral vaccination programmes. In addition to providing gender-wide protection, gender-neutral programmes are more likely to remain resilient in the face of anti-vaccination campaigns (as have been seen in Ireland and Denmark, for example) or shocks like the COVID-19 pandemic. In turn, gender-neutral vaccination programmes have been shown to be cost-effective, even in countries with high (>80%) vaccination rates in girls.
But gender-neutral programmes cannot make the difference needed if vaccination uptake is too low to achieve ‘herd immunity‘. Europe’s Beating Cancer Plan has an uptake target of 90% for girls, with an accompanying objective of achieving a ‘significant’ increase for boys. (The European Cancer Organisation has argued for a universal 90% uptake target, across all sexes). However, current uptake targets are not being met, in Europe or globally. In order to meet these targets, and in more than just one or two countries, a new approach is needed.
Credit: Journal of Internal Medicine
The PROTECT-EUROPE programme
This is where the PROTECT-EUROPE programme comes in. Led by the European Cancer Organisation, PROTECT-EUROPE: Vaccinating Europe to protect against the cancers caused by HPV is a two-year, EU-funded programme. It brings together more than 30 organisations, from across 16 countries, to encourage and advocate for increased vaccination uptake.
The project consortium’s stakeholders include clinicians from oncology, general practice, pharmacy and nursing, together with public health professionals, patient groups, young people’s organisations and sporting organisations. Members are working together through six inter-related ‘Work Packages,’ with each focusing on a different aspect of the project.
a. Information and training for healthcare professionals
The first key objective for PROTECT-EUROPE is to provide healthcare professionals with information and training.
Health practitioners often act as a key point of contact, and a trusted source, for young people and caregivers seeking information about HPV vaccination. However, there is evidence that many practitioners lack the confidence (and underpinning knowledge) to provide appropriate guidance. It is therefore important to optimise one-on-one communication, to leverage patients’ trust in clinicians to help increase vaccine uptake.
Many healthcare practitioners remain without sufficient knowledge and training on HPV vaccination. In Bulgaria, for example, GPs are known to tell patients that HPV vaccination causes infertility in females. Without adequate knowledge, many wrongly advise against vaccination. It is therefore important to fill this gap through robust educational training.
The PROTECT-EUROPE training programmes will first be delivered digitally. These will then be scaled up to Member States, using a ‘training-of-trainers’ model. A series of masterclasses on HPV vaccination will also be delivered to relevant health professionals, via conferences, symposia and workshops.
b. Tackling online misinformation
The project’s second main objective is to design and provide guidance and campaign tools for tackling online misinformation around HPV vaccination. These will be provided to Member States and relevant civil society organisations.
Online misinformation about HPV vaccination is known to be a key factor contributing to vaccine hesitancy. By making appropriate guidance and campaign tools available, Member States and relevant organisations will be in a better position to address flawed online information.
The campaign tools will be designed in a range of different formats, to enable circulation as widely as possible. These will include social-media-appropriate content, online website material, physical posters, and community-site leaflets.
c. Reaching marginalised groups
There are known health inequalities (including in HPV-related cancer outcomes) within and across multiple EU nations. These are linked to a wide array of health determinants, including geographical location, socioeconomic background and ethnic minority status.
PROTECT-EUROPE will pay particular attention to issues of equality and diversity, to ensure that vaccination programmes reach marginalised and higher-risk groups.
The whole project will be independently evaluated, by University College Cork.
All the project’s outputs will be made available via an accessible online hub, and disseminated via a final project report and a large-scale event.
The broader landscape of EU HPV vaccination projects
PROTECT-EUROPE, which will conclude in January 2025, complements two other EU-funded projects with similar goals.
The first, PERCH (PartnERship to Contrast HPV), is led by EU Member States. PERCH aims to:
- Improve the capacity of Member States to plan and implement HPV vaccination campaigns, through sharing knowledge and experience
- Improve data and monitoring systems on HPV vaccination and screening
- Improve knowledge and awareness of HPV-related disease and prevention among target groups
- Improve knowledge and abilities for healthcare professionals working in HPV vaccine promotion
The second project, ReThink, focuses on reducing HPV vaccination inequalities. It is working on improving vaccination uptake in countries with low vaccination rates, with a specific work package focus on Romania.
Professor Margaret Stanley OBE
Margaret Stanley is Professor Emerita of Epithelial Biology, Director of Research in the Department of Pathology, University of Cambridge, Honorary Fellow of Christ’s College, Fellow of the Academy of Medical Sciences, Honorary Fellow of the UK Royal College of Obstetricians and Gynaecologists.
She has lifetime awards from the American Society for Colposcopy and Cytopathology (ASCCP) and International Papillomavirus Society (IPVS), was a member of the UK Biology and Biotechnology Science Research Council (BBSRC), and is a member of the Spongiform Encephalopathies Advisory Committee (SEAC) that advised the UK government on prion diseases. In 2004 she was awarded an OBE for services to Virology.
She is a member of the Expert Groups advising on HPV vaccines for WHO SAGE, acted as the invited HPV expert for the HPV subcommittee of the UK Joint Committee on Vaccines and Immunisation (JCVI), is an invited expert on HPV vaccines for the European Centre for Disease Control (ECDC), is a member of the HPV vaccines advisory group for the Bill and Melinda Gates Foundation, and is co-chair of the HPV Action Network of the European Cancer Organisation.
She was the President of the International Papillomavirus Society from 2018- to 2021, and was awarded the Hilleman Award for outstanding contribution to HPV vaccine development, implementation and advocacy.
Professor Daniel Kelly OBE
Daniel Kelly is a graduate of the integrated Social Science and Nursing degree programme at Edinburgh University. On qualifying he gained clinical experience in intensive care, hospice and acute oncology settings. This included specialist oncology training at the Royal Marsden Hospital, London.
He then spent five years in two Charge Nurse roles. The first, at Edinburgh Royal Infirmary, was in the Sexual Health service at the height of the HIV crisis in the late 1980s. He then returned to Oncology at the Western General Hospital in Edinburgh, to manage a chemotherapy unit specialising in high-dose/trial treatments, including the treatment of young adults. He completed an MSc in Advanced Practice: Cancer Nursing at the University of Surrey during this time.
He then moved into education as a Lecturer in Cancer Nursing, at the Royal Marsden Hospital/Institute of Cancer Research. Here he contributed to the development of innovative cancer and palliative care degree programmes for several years. In 1998, he was appointed Senior Nurse (Research & Development) at University College Hospitals. He also completed a part-time PhD in Sociology at Goldsmiths, University of London, awarded in 2002. This was an ethnographic study of men undergoing treatment for prostate cancer.
For three years he was Senior Research Fellow, working jointly at UCL Hospitals and City University, London. He was then appointed Reader in Cancer Nursing at Middlesex University in 2005, with subsequent promotion to Professor of Nursing and Cancer Care. He has been based at Cardiff University since 2011, as The Royal College of Nursing Chair of Nursing Research.
Peter Baker MA FRSPH FRSA works as a consultant on HPV for the European Cancer Organisation.
Until 2020, he was Campaign Director of HPV Action, a UK coalition of around 50 patient and professional organisations which succesfully campaigned to a achieve gender-neutral HPV vaccination programme.
Peter is also Director of Global Action on Men’s Health, an international charity. In turn, he sits on the editorial boards of: the International Journal of Men’s Social and Community Health, and Trends in Urology and Men’s Health.
The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorses those views or opinions.