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Human papillomavirus vaccination in the European Union/European Economic Area and globally: a moral dilemma
Open accessAbstract
While many European Union/European Economic Area (EU/EEA) countries recently expanded human papillomavirus (HPV) vaccination to boys, HPV vaccine supply is currently limited for girls in low- and middle-income countries (LMIC) that are severely affected by HPV. Globally, about 50% of countries have introduced HPV vaccination. Some LMIC with high burden of cervical cancer have not yet introduced HPV vaccination, or are reaching suboptimal vaccination coverage. While WHO issued a call for cervical cancer elimination in 2018, a global shortage of HPV vaccines is currently predicted to last at least until 2024. We reviewed national policies of EU/EEA countries and recommendations of the World Health Organization (WHO) Strategic Advisory Group of Experts on immunisation to discuss current challenges and dose-sparing options. Several EU/EEA countries have extended HPV vaccination to boys and the European Cancer Organisation has issued a resolution for elimination of all HPV-associated cancers in both sexes. The European Centre for Disease Prevention and Control concluded in its 2020 guidance that cost-effectiveness of extending routine vaccination to boys depends on several context-specific factors. The extension of HPV vaccination to boys in EU/EEA countries may affect global availability of vaccines. Temporary dose-sparing options could be considered during the COVID-19 post-pandemic period.
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A large portion of women now reaching the screening age are likely to have been vaccinated (or offered the vaccine).
“as a large portion of women now reaching the screening age are likely to have been vaccinated (or offered the vaccine),8,19”
From Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review (2025) · cites this paper as [19]
The paper’s Background section, under “Policies on human papillomavirus vaccination in EU/EEA countries” (page unavailable), says all EU/EEA countries had introduced HPV vaccination by December 2021 and lists vaccination programmes dating from 2007. That supports the possibility that women reaching screening age had been offered vaccination, but the paper does not establish that a large portion of that group was offered or received it. (LLM, conf=0.78)
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Brisson, M., Kim, J. J., Canfell, K., Drolet, M., Gingras, G., Burger, E. A., Martin, D., Simms, K. T., Bénard, É., Boily, M.-C., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30068-4 · Cited by 943 · cited 1×
“Independent transmission-dynamic models have shown that high vaccination coverage of girls (> 90%) would lead to cervical cancer elimination in most LMIC by the end of this century [23].”
BackgroundWhitworth, H. S., Gallagher, K. E., Howard, N., Mounier-Jack, S., Mbwanji, G., Kreimer, A. R., Basu, P., Kelly, H., Drolet, M., Brisson, M., et al. (2020) · Vaccine · doi:10.1016/j.vaccine.2019.12.017 · Cited by 118
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Research works printed but not linked: 14
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Cited by
Sorted by citations
Shpendi, S., Norman, P., Gibson-Miller, J., & Webster, R. (2025) · Women's Health · doi:10.1177/17455057251324309 · Cited by 11
“Moreover, as a large portion of women now reaching the screening age are likely to have been vaccinated (or offered the vaccine), 8,19 it is important to also assess the possible impact of the immunisation programme on first-time screening behaviours.”
Metadata
- Authors
- Colzani, E., Johansen, K., Johnson, H., & Pastore Celentano, L.
- Affiliations
- European Centre for Disease Prevention and Control (SE)
- European Centre for Disease Prevention and Control, Stockholm, Sweden
- Venue
- Eurosurveillance
- Published
- 2021-12-16
- Volume
- 26
- Issue
- 50
- ISSN
- 1025-496X (ISSN-L)
- 1560-7917
- PMC
- PMC8728487
- OpenAlex
- W4200383936
- Cited by
- 86
- References
- 2
- Citations by year
- 2026: 5 · 2025: 20 · 2024: 29 · 2023: 25 · 2022: 6 · 2021: 1
- FWCI
- 10.99
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Eurosurveillance (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
- Social Sciences › Health › Vaccine Coverage and Hesitancy
- Health Sciences › Medicine › Surgery › Genital Health and Disease
- Keywords
- HPV vaccination, cervical cancer elimination, low- and middle-income countries, cost-effectiveness, COVID-19 pandemic impact on vaccination
- MeSH terms
- COVID-19, SARS-CoV-2, Uterine Cervical Neoplasms, European Union, Female, Humans, Immunization, Male, Morals, Vaccination, Papillomavirus Infections, Alphapapillomavirus, Papillomavirus Vaccines
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