Viral Protection: Achieving the Possible

Rui Medeiros and Daniel Kelly, Co-Chairs of the European Cancer Organisation’s HPV Action Network, introduced the session, subtitled The elimination of HPV cancers in Europe. The Network was launched a year ago with the aim of promoting the implementation of effective strategies to eliminate cancers caused by HPV by 2030.

The Network recently published a four-point plan to help Europe lead the world in eliminating HPV-related cancers.[2] It calls for the possibility to be achieved, and its chief recommendation is the EU should commit to matching and exceeding the WHO Global Strategy to Accelerate the Elimination of Cervical Cancer by targeting the elimination of ALL cancers caused by HPV.[29] Two Resolutions were also announced for the end of the session.

Row 1 - Cobi Reisman (European Society for Sexual Medicine); Tristan Almada, (HPV and Anal Cancer Foundation and the Noman Is an Island: Race to End HPV Campaign); Andrea Ammon (European Centre for Disease Prevention and Control). Row 2 - Emilie Karafillakis (London School of Hygiene and Tropical Medicine); Rui Medeiros (European Cancer Organisation’s HPV Action Network); Daniel Kelly (European Cancer Organisation’s HPV Action Network). Row 3 - Alessandra Moretti MEP (European Parliament’s Special Committee on Beating Cancer); Margaret Stanley (International Papillomavirus Society).

Compliance with HPV Vaccination Remains Low

Andrea Ammon, Director General of the European Centre for Disease Prevention and Control said HPV accounts for 39% of all cancers attributable to infections, and is the primary cause of cervical cancer.

Those EU Member States that have introduced a comprehensive HPV vaccination programme have seen large reductions in cervical cancer. If preventing cervical cancer is the primary goal of the programme, it is highly cost-effective if it targets girls and coverage is maintained. If the aim is to eliminate all HPV-related disease, it is cost-effective when both boys and girls are vaccinated.

However, the reality is coverage is persistently below 60% and barriers to vaccination are around compliance, access and provision. For compliance, the issue is the basic acceptance of vaccines, with a decline in vaccine confidence due to misinformation and disinformation. Vaccine hesitancy a bigger barrier than access.

The infrastructure and funding must be in place to deliver the vaccine, but an important factor is healthcare professional training. The quantity and quality of information is an issue, as well as concerns over adverse effects and mistrust of the healthcare system. Healthcare workers are strong influencers of public opinion but they may have concerns that need addressing. In April, the ECDC launched the European Vaccination Information Portal,[30] which has a section on HPV vaccination.

It is important that equity of access is achieved and programme effectiveness is improved. Moreover, gender-neutral vaccination should remain a priority and form part of all national cancer plans The pandemic will have ongoing effects on vaccination programmes in general, but HPV vaccination must stay on the agenda.

Challenging Anti-Vaccine Sentiment

Margaret Stanley, President of the International Papillomavirus Society, said she has a simple message: vaccines prevention infection, and they work. If enough girls and boys are vaccinated, HPV circulation drops by 80%–90% within five years, and the number of cervical cancer cases in women aged under 30 years can drop by up to 90%.

The challenge is to vaccinate enough boys and girls, and the biggest danger is anti-vaccine sentiment. The goal of eliminating HPV-related cancers by 2030 may not happen but they could disappear over time. It requires cooperation, adequate resources, sufficient organisation and sharing best practice. Then cervical, anal and pharyngeal cancer could go the way of tetanus and polio.

A Collaborative Response to Fake News

Emilie Karafillakis, European Research Lead at the Vaccine Confidence Project, London School of Hygiene and Tropical Medicine, said we live in a world of multiple realities and ‘fake news’ appears in a variety of contexts. However, ‘misinformation’ is preferred as it is broader and less political.

The issue is there is no singular truth. Information corresponding to an individual’s beliefs and their social world is their reality. Consequently, vaccination information reaches only those who already believe in it. There are also people simply posing questions that require answering.

While social media platforms are starting to tackle these issues, questions remain their objectivity and transparency, and users can simply migrate to other platforms. It is more than just social media, however, as word of mouth also plays a role. A collaborative response with platforms is required, as well as empowering individuals to make informed choices. There are plenty of fact-checking websites but they may reinforce myths.

Crucially, ‘Dr Google’ must not be blamed, rather the interaction between patients and healthcare professionals must change. This starts at school, where the quality of information needs to be assessed. Individuals’ concerns need to be understood and they should be engaged in decision making. There is no magic bullet and no one issue with vaccines. The key is to rebuild trust.

A Powerful Story Motivates the Most

Tristan Almada is Co-Founder of the HPV and Anal Cancer Foundation and the NOMAN Is An Island: Race to End HPV Campaign.[31] His journey started when he lost his mother to stage IV anal cancer, aged 53 years. With his sisters, he made a resolution to do everything in his power to stop this happening to other people.

They discovered there is a mass of people who need support because they are afraid to tell their story, but when it is explained HPV can be eradicated, it is very captivating. Progress has been quick. They campaigned for boys to be vaccinated in the USA and the government listened. They took their story to the UK and had a positive reaction there too.

However, HPV is not like COVID-19, as contracting the virus does not necessarily lead to cancer. Key to communicating with people is not statistics, as they do not motivate people, but a narrative and a story about the risks. That is powerful.

A Tremendous Opportunity

Cobi Reisman, Past President of the European Society for Sexual Medicine, said there are three crucial elements to a vaccination programme: it should be safe and effective; healthcare professionals and organisations should be trained and motivated; and the public needs to accept the intervention.

The HPV vaccine represents a tremendous opportunity, as it is arguably the first time in the history of medicine that there is an intervention that prevents cancer. Healthcare professionals need to be educated to help increase uptake, alongside different materials to allow people to find information.

An Unexploited Opportunity

Alessandra Moretti MEP, Member of the European Parliament’s Special Committee on Beating Cancer, agreed HPV vaccination represents a unique opportunity but it is not fully exploited. Vaccination is not available for girls in Poland and is available for boys in less than half of European countries. There needs to be a push for policies in each member state to achieve concrete results.

Fake news is very worrying but it is the same for every other vaccine. Science is bent and distorted to confuse people, which is unacceptable when it comes to human health and safety.

HPV-related cancers could be eliminated by the end of the century with vaccination and screening. The WHO estimates that, together, they could lead to 72 million fewer cases of cancer each year. Surveys indicate only 37% of people in Italy would accept a COVID-19 vaccine, and it is terrifying to see public trust in science so low. This a political and cultural battle and we have the chance to change the course history.