This document discusses HPV vaccination in the WHO European Region. It provides data on which countries have introduced the HPV vaccine as of 2011, the criteria used by countries in their decision making, details on routine and catch-up vaccination programs in various countries, and HPV vaccine coverage rates. It also discusses components of successful HPV vaccination programs and the importance of continuing cervical cancer screening programs alongside vaccination.

1. Comprehensive Cervical Cancer Prevention and Control Meeting
18-20 May 2011
HPV vaccination in WHO
European Region
Liudmila Mosina
Vaccine Preventable Diseases & Immunization Programme, WHO Regional Office for Europe

2. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 2
Introduction of HPV vaccine, WHO
European Region, Jan 2011
HPV
Introduced (20)
Not introduced
2007: BEL, FRA, DEU, ITA
2008: DEN, GRE, LUX, ROM, SPA, SWI, UNK
2009: NET, NOR, POR, SMR, SVN, MKD
2010: IRE, LVA SWE

3. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 3
Decision Making (16 countries)
 National Immunization Technical Advisory
Groups provided recommendations on HPV
vaccination
 Main criteria used (67% of countries):
– Disease burden;
– Safety and efficacy of vaccine;
– Cost effectiveness (9 countries economic
evaluations)
 Additional criteria:
– Political will
– WHO/ECCA recommendations
– Acceptance by target group and parents
– Insufficiency of opportunistic cervical cancer
screening programme to prevent cervical cancer
in young women

4. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 4
Routine and catch up vaccination
(15 countries)
Routine vaccination of target group: 6 countries
Routine and catch up vaccination: 9 countries
Age of routine:
– Range: 10 – 18 years old
– The most frequent: 12-14 years old (69%)
Age of catch up:
– Range: 13 – 26 years old
– The most frequent: 13-18 years old (70%);

5. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 5
Delivery systems
(15 countries)
 School vaccination: Norway,
Romania, The former Yugoslav
Republic of Macedonia,
Sweden, UNK
 Health facilities (GP,
paediatricians, immunization
centres) – Denmark, Greece,
Italy, Luxemburg, Portugal
 Regional strategies (school
vaccination and health
facilities): Spain, Switzerland
 Health facilities (GP,
paediatricians,
gynaecologists): Belgium,
France, Germany
 Mass immunization campaigns:
The Netherlands
Existing systems
(11 countries)
Alternative systems
(4 countries)

6. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 6
HPV vaccine coverage, 2009
83 81
76
73
59
55
47
44
34
30 30
11
0
10
20
30
40
50
60
70
80
90
POR UNK SPA DEN ITA SWI NET BEL MKD FRA DEU ROM
%
Sources: WHO/UNICEF JRF, WHO survey, VENICE survey

7. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 7
Components of success from countries
achieving high coverage (1)
 Decision making:
– Evidence based decision based on NITAG
recommendations
– Open and honest decision making process
 Delivery system:
– Adding HPV vaccine into existing immunization
delivery system
– Implementation of HPV vaccination within National
Immunization Programme
– Developing strategies for timely administration of
subsequent doses

8. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 8
Components of success from countries
achieving high coverage (2)
 Effective advocacy and communication prior to introduction:
– Development and implementation of advocacy and communication
plans
– Assessment of perceptions of HPV vaccine among target audiences to
develop effective communication strategies. Strategies defined as
important by many countries:
• Sending letters to families
• Education of vaccine providers and health care professionals
 Timely response to AEFI and negative publicity:
– Preparedness and anticipation
– Assessment of baseline levels of diseases which might be linked with
vaccination
– Provision of single communication message to public
 Monitoring of HPV coverage

9. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 9
Cervical cancer screening
programmes
 All countries recommended to continue cervical
cancer screening programmes
 Six countries planned to strengthen their
programmes through introduction of organized
screening or adding HPV genotyping: Austria,
Belgium, Denmark, France, Portugal, and
Romania.
 Some countries (France, Switzerland, and UNK)
conducted surveys to study impact of HPV
vaccination on women’s behavior, including
participation in cervical cancer screening
programme.

10. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 10
WHO European Region, WB income
group classification
High income (32)
Upper middle income (13)
Lower middle income (6)
Low income (2)

11. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 11
Age-standardized cervical cancer mortality rates, WHO
European Region, 2008
<=1.9
<=3.7
<=5.9
<=11.8
No data
Source: IARC, Globocan 2008

12. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 12
GAVI eligible countries in WHO
European Region
GAVI eligible
GAVI graduating
Non GAVI eligible

13. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 13
WHO Meeting on Cervical Cancer
Prevention
 Date: 12-13 October 2011
 Venue: Istanbul, Turkey
 Participants: representatives of national
immunization and cervical cancer
screening programmes from 53 Member
States
 Partners

14. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 14
Objectives (1)
 Review the region’s progress in primarily
and secondary cervical cancer
prevention; define priorities for future
 Review national policies and programmes
for introducing HPV vaccines and
organized screening within the broader
context of cancer control and
reproductive health

15. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 15
Objectives (2)
 Share experiences, best practices and
lessons learnt among countries in the
Region
 Create synergy between WHO EURO
programmes; coordinate support between
partners

16. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 16
Expected outcomes (1)
 Summarize and distribute the
experiences and lessons learnt on HPV
vaccination form early adopting
countries
 Define future regional priorities for
cervical cancer prevention

17. 18-20 May 2011Comprehensive Cervical Cancer Prevention and Control Meeting 17
Expected outcomes (2)
 Achieve a common understanding and
commitment for implementation of
comprehensive approach in cervical
cancer prevention
 Facilitate implementation and adoption
of best practices among the countries in
the region