C Mougin (April 2024). The Bourgogne-Franche-Comté HPV Consortium: a local network to increase HPV awareness and vaccine coverage. www.HPVWorld.com, 263.

Vaccination against HPV in France has been recommended since 2007 for girls and since 2019 for boys aged 11 to 14  years (with catch-up vaccination possible up to 19  years of age). At the end of 2022, coverage for the full HPV vaccination schedule in France was around 48% among girls aged 16 years, well below the goal of 80% stipulated in the French national cancer plan for the period 2021 to 2025. The introduction of an HPV vaccination program in schools was requested in February 2023 by the President of France, and launched by the Ministry of Health in October 2023. The program will introduce HPV vaccination for girls and boys at the age of 12-13 in French secondary schools, and is based on successful models implemented in several other European countries.

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L Galeridis et al. (February 2024). Bridging Gaps in HPV Prevention: The HPV Prevention Policy Atlas as a Vital Communication Tool. www.HPVWorld.com, 244

On June 22, 2023, the second edition of the HPV Prevention Policy Atlas was launched at the Romanian Parliament. This innovative visual communication tool, led by the European Parliamentary Forum for Sexual and Reproductive Rights (EPF) and supported by the European Cancer Organisation (ECO), provides invaluable insights into the state of HPV prevention policies across the European region. It not only benchmarks and evaluates countries' performance in three critical areas - primary prevention (vaccination), secondary prevention (screening), and online information dissemination - but also serves as a crucial means of communication, calling for action where needed.

Full publication available here.

K Canfell (January 2024). Interview with Karen Canfell (Part I). www.HPVWorld.com, 259

Simulation models are essential to understand the future impact of cancer control interventions, especially when primary data are limited or long-term follow-up is lacking. Models are still perceived by some as too speculative to inform clinical decisions, but there is emerging understanding of the important role of comprehensive models.

Full publication available here.

K Canfell (January 2024). Interview with Karen Canfell (Part II). www.HPVWorld.com, 260

In the context of the WHO cervical cancer elimination campaign (90% vaccination, 70% HPV screening, 90% treatment), which are important proposals related to HPV vaccination: required levels of female vaccine coverage? Added value of including routine vaccination of boys? Predictions on the protection afforded by one-dose vaccination?

Full publication available here.

U Ivanus et al. (January 2024). Strengthening HPV vaccination coverage, data quality, and communication in Europe with project PERCH. www.HPVWorld.com, 258

Although highly preventable through HPV vaccination and screening, cervical cancer remains a significant public health concern in Europe. In 2020, according to data from the Global Cancer Observatory, it was the 9th most common female cancer in Europe, with approximately 58,169 new cases and 25,989 deaths. Although HPV vaccines have been available since 2006, both introduction and coverage still do not reach optimal levels. These disparities highlight the urgent need to address the prevention and management of cervical cancer in Europe.

In an effort to address preventable cervical cancers and other HPV-related cancers and health-disparities, the European PartnERship to Contrast HPV (PERCH) was funded as a Joint Action project by the European Health and Digital Executive Agency (HaDEA) in November 2022.

Full publication available here.

D Edwards et al. (January 2024). Interventions that improve HPV vaccination uptake and intention: an umbrella review summary. www.HPVWorld.com, 255.

When looking at studies about vaccination uptake, we found that various methods were used to encourage people to be vaccinated. These methods included things like educational programmes, using technology to provide information, sending reminders, and offering rewards or incentives to individuals. In the educational programmes, some of the important things that affected their impact were the timing of the intervention, how information was given and who gave it. Other ways of encouraging people to get vaccinated involved a combination of approaches, with strategies involving healthcare providers (professional education, using electronic health record reminders, vaccination coordinators, making home visits, using health information technology systems, nurse directives or protocols regarding HPV and having pre-written consent forms ready), public health initiatives and radio broadcasts which looked to effect change at both organisational and community level.

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H Fisher et al. (December 2023). Supporting adolescents in providing consent within the English HPV vaccination programme. www.HPVWorld.com, 250

Three vaccines are available that protect against the high-risk HPV types that are responsible for the majority of HPV-related cancers. In England, adolescents are usually offered the HPV vaccine when they are aged 12-13 years old, as it is most effective if administered before sexual debut. Until recently, uptake of the schools-based HPV vaccination programme exceeded the 80% level required to have a significant impact on cervical cancer deaths.

The COVID-19 pandemic has caused disruptions to delivery of the vaccination programme, and national uptake figures remain below 70%. Supporting more adolescents to provide consent could help restore uptake of the HPV vaccination programme to pre-pandemic levels.

Full publication available here.

I Man & I Baussano (September 2023). Building resilient cancer prevention through gender-neutral HPV vaccination. www.HPVWorld.com, 245

Recently, the World Health Organization (WHO) has called for global action towards the elimination of cervical cancer as a public health problem with the overarching target of reducing the age-standardized incidence rate of cervical cancer to fewer than four cases per 100,000 women-years. To reach this target, it is recommended, among other measures, to vaccinate 90% of all girls by age 15 years. However, available data show an average 67% coverage among countries that have introduced HPV vaccination. High-income countries could more easily afford the high price of HPV vaccines and although initially targeting their vaccine programs to young girls, they are now increasingly moving towards gender-neutral vaccination to directly protect males from HPV-related cancers and to improve the population-level impact of HPV vaccination despite suboptimal coverage of girls.

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CL Hathaway et al. (August 2023). Understanding HPV prevention and control in women living with HIV. www.HPVWorld.com, 240

In November 2020, the World Health Organization (WHO) launched its cervical cancer elimination strategy, aiming to reduce incidence to less than 4 per 100,000 women through three interventions: 1) vaccinating 90% of girls by age 15 years, 2) screening 70% of women twice in their lifetime, and 3) treating 90% of women with precancers or invasive cervical cancer. Key to elimination are interventions that are tailored to women with HIV, a population at higher risk of HPV acquisition and persistence and invasive cervical cancer. Modeling studies that explicitly include HPV and HIV synergies can evaluate the long-term impact of interventions on women with HIV, particularly HPV vaccination, cervical screening, and pre-cancer treatment.

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C Davies & SR Skinner (August 2023). School-based vaccination is key to reducing HPV-related diseases. www.HPVWorld.com, 238.

Schools are ideal settings for administering vaccines: they enable access to large numbers of adolescents, are convenient for families, promote peer support and social norms, assist in reducing inequitable access to vaccination and promote high coverage. School-based vaccination is considered the most effective and efficient means of ensuring high vaccine coverage for adolescents especially given the decline in the frequency of visits to primary care practitioners in adolescence compared with childhood.

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N Campos et al. (June 2023). Refining Health Decision Models to Evaluate Novel Screening Strategies in Low-Resource Settings. www.HPVWorld.com, 233

The decision of whether and how to screen for cervical cancer in low-resource settings depends on feasibility, affordability, and cost-effectiveness. Given the typically long interval between the acquisition of a carcinogenic HPV infection and invasive cervical cancer, health decision models are valuable tools that consider the long-term natural history of HPV and the estimated costs and health benefits of prevention strategies to inform decision-making. However, the true underlying natural history of multi-stage carcinogenesis is neither directly nor completely observed.

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M Jit et al. (May 2023). Modelling 1-dose HPV vaccination. www.HPVWorld.com, 231

On 11 April 2022, the World Health Organization’s Strategic Group of Experts on Immunization (SAGE) revised their recommended schedule for HPV vaccination to allow countries to use either one or two doses for women aged 9-20 years old, based on evidence that a single dose delivers comparable protection against HPV to two doses. On 5 August 2022, the UK’s Joint Committee on Vaccination and Immunisation (JCVI) also issued interim advice recommending a change from two to one dose in the national schedule, with a final decision expected to be announced imminently. However, both SAGE and JCVI advice is that immunocompromised individuals, including those with HIV, should ideally still receive three doses. SAGE’s recommendations may also enable many countries to introduce routine HPV vaccination for the first time under a one-dose schedule, particularly if they had been delaying vaccine introduction due to HPV vaccine supply constraints, financial pressures or logistic challenges in delivering a two-dose schedule.

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YL Woo et al. (March 2023). The road to cervical cancer elimination in Malaysia. www.HPVWorld.com, 225

To achieve the WHO’s 90-70-90 three-pillar targets (achieving high-coverage of vaccination, screening and cancer treatment) towards eliminating cervical cancer as a public health problem, countries with their own unique circumstances will have to construct each ‘pillar’ differently. In Malaysia, cervical cancer is still the third most common and the fourth most deadly cancer among women. Hence, the argument is no longer whether we should be vaccinating and screening but rather prioritising investments and implementing solutions towards the elimination of cervical cancer.

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 Berkhof (February 2023). IARC Handbook on cervical cancer screening: value of this evidence synthesis for modeling. www.HPVWorld.com, 224

The International Agency for Research in Cancer (IARC) Handbook on cervical cancer screening (Volume 18, 457 pages) presents and summarizes published evidence on screening methods and practice through narrative and systematic reviews as well as quality assessments.

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EA Burger & JJ Kim (January 2023). Planning for cervical cancer elimination: The role of simulation modeling. www.HPVWorld.com, 221

Following the WHO Director-General’s global call for action towards the elimination of cervical cancer as a public health problem, there were fundamental questions asking what elimination definition and threshold should be used, what prevention strategies could lead to elimination, when elimination could be reached, how many cervical cancers and deaths could be averted on the path to elimination, and what strategies to reach elimination were the most efficient and cost-effective.

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M Smith et al. (January 2023). How does COVID-19 impact cervical screening? www.HPVWorld.com, 220

Even though few countries formally paused cervical screening services or programs during the COVID-19 pandemic, screening visits were reduced in many countries. This reflects a wide range of factors, including limited capacity to offer screening (clinically or in laboratories) and constraints on women being able to attend. These factors could in turn be due to staff shortages, competing work, illness, limited resources or consumables, lockdowns, anxiety about being exposed to COVID-19, or lower saliency of preventive healthcare, among others.

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C Chambers et al. (December 2022). HPV vaccine uptake among gay, bisexual, and other men who have sex with men in major Canadian cities. www.HPVWorld.com, 217.

Men who identify as gay or bisexual or otherwise have sex with men (GBM) are at increased risk for anal cancer and other diseases caused by human papillomavirus (HPV). Rates of anal cancer are 10 to 20 times higher in GBM compared to the general population and can be up to 80 times higher among GBM living with HIV. This population also receives little to no herd immunity from female-only vaccination programs. Thus, they are considered a priority population for HPV vaccination.

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M Heffernan et al. (October 2022). Addressing disparities in HPV vaccination among culturally diverse populations- a socioecological. www.HPVWorld.com, 212.

Infection with Human Papillomavirus (HPV) is the leading risk factor for the development of ano-genital cancers and a major health problem globally. Elimination of HPV morbidities requires four key pillars: prevention, screening, treatment and education. With prevention, global studies have shown that unique socio-cultural norms and environmental factors provide challenges for community acceptance of adolescent HPV vaccination. Furthermore, the empirical evidence highlights that implementation strategies for HPV vaccination programs cannot be generalised to culturally diverse populations.

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Despite the recommendations made by national immunization advisory committees around the world, HPV vaccination rates, especially in the United States, remain suboptimal. When asked about barriers vaccinating their children for HPV, some parents cite concerns about Risk Compensation. That is, they are concerned that vaccinating their children against a sexually transmitted infection (STI) will result in increased risky sexual behaviors. However, our recent systematic review of the literature found no evidence of risky sexual behavior after vaccination.

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L P Gordon, D R Platt, N Ramsey (2019). HPV Vaccine: It Is Not Just a Girl Thing. www.HPVWorld.com, 97.

It is astonishing that a safe, effective, and widely accessible cancer-preventing vaccine is not being widely used! This begs the question-- why is the US not aggressively vaccinating its young men when we know that following the 2018 guidelines would lead to a 62-82% reduction disease burden, and a 22-27% reduction in cancers in males within 30 years?

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K Pollock (2019). Adolescent male vaccination in the United Kingdom- a victory for equality. www.HPVWorld.com, 94.

The JCVI recommends implementation of vaccine programmes based on the issue of cost-effectiveness within the publiclyfunded NHS setting. Until July 2018, the main argument for not offering the vaccine to boys was that high uptake in girls (approximately 88% since 2008) confers significant herd protection to unvaccinated boys, and that offering vaccine to boys was therefore cost-ineffective. However, the argument not to have a gender-neutral programme is flawed several-fold.

Read the full publication here.