Vaccination against HPV: broader protection is the best investment in health – Polish and Lithuanian experts say unanimously

Only universal, free vaccinations against HPV (human papilloma virus), both for girls and boys, are effective protection against the cancers it causes, and it is not only cervical cancer, but also e.g. cancers of the vulva, vagina, anus, throat or larynx, say experts from Poland and Lithuania. In their opinion, the best protection is provided by the broadest spectrum vaccine – the nine-valent one.

Poland is currently the last EU country that does not provide free access to HPV vaccination.

The Ministry of Health announces that this will change from this year. As he informs, “the start of universal HPV vaccination (recommended and free of charge under the National Oncology Strategy) enables the entry into force of the Act of December 1, 2022 amending the Act on the Medical Fund and some other acts (Journal of Laws of 2022 item 2674). It is the legal basis for activities related to the prevention of infectious diseases, in particular through the purchase of vaccines for carrying out recommended preventive vaccinations under the Protective Vaccination Programme. This act is the basis for spending funds for the purchase of vaccines in 2023.”

According to the Ministry’s information, HPV vaccination is to be carried out at primary health care vaccination points. Free vaccines will be available to girls and boys aged 12 and 13. The start date of vaccination has not yet been set.

As pointed out by Dr. n. med. Ernest Kuchar, chairman of the Polish Society of Vaccinology, Poland is already lagging behind the assumptions of the NSO. “Poland is one of the last countries to introduce a universal HPV vaccination programme, even though it has been included in the National Oncology Strategy for years. Let me remind you that according to it, universal vaccination of girls was to be introduced in 2021, we are in 2023, so we are already behind even what we assumed ourselves” – says Prof. cook.

It is also not yet known which vaccine will be covered by full funding for selected years. Three types are available in Poland: 2, 4 and 9-valent. The largest number of virus types is contained in the 9-valent vaccine – not only types 16 and 18, but also oncogenic types 31, 33, 45, 52 and 58. This product also protects against HPV 6 and 11 infections, which are caused by almost all genital warts ), i.e. very embarrassing changes in the genital area for patients.

“The vaccination program works best in Australia, which very quickly introduced vaccinations for both sexes. There, they first used a 4-valent vaccine, and then a 9-valent vaccine – says Dr. cook. – The state should look at the problem in a long-term and holistic way, from the point of view of public health. It is obvious that the cheapest solutions are rarely the best. What is currently the best is the 9-valent vaccine, which is why it is used e.g. in the USA, Germany, France and also in the Baltic republics. Even in Great Britain, which is the country of the manufacturer of the bivalent vaccine – he emphasizes. “Obviously, local health technology assessment agencies have given positive feedback in these countries.”

From February 1, boys and girls in Lithuania will be vaccinated free of charge with this vaccine. This is defined by the regulation of the Minister of Health Arunas Dulkis. So far, from 2016, the free vaccination program covered only 11-year-old girls and was implemented for the first year with a quadrivalent vaccine, and then with a bivalent vaccine.

“This is a very long period of our work – the Lithuanian Society of Obstetricians and Gynecologists – explains prof. Žana Bumbuliene, obstetrician-gynecologist. – We wrote to the Ministry of Health and explained that even in the case of cervical cancer, protection with a bivalent vaccine is 70 percent, and with a 9-valent vaccine it is already 90 percent. At the same time, we explained that HPV is not only cervical cancer, but also cancer of the pharynx, oral cavity and larynx, penile cancer, anal cancer, which is more and more common and boys also need protection against” – he says.

As pointed out by prof. Bumbuliene, in the letters to the ministry it was also emphasized that neighboring countries, e.g. Latvia, had already introduced a 9-valent vaccine also for boys. “A country smaller than Lithuania and able to pay for the vaccine, why can’t we do it for our children – we asked. So we persuaded decision makers in different ways. There are also doctors among them, to whom these arguments have begun to reach. And somehow we succeeded,” admits the expert.

Meanwhile, in Poland, the Transparency Council issued an opinion on December 27 in which it wrote that the human papilloma virus (HPV) vaccines available in Poland “are effective in preventing cervical cancer, and in the absence of reliable evidence for clinical superiority of any of them in terms of clinically significant endpoints , the choice of preparation should be determined by the price and the resulting economic efficiency”.

Experts disagree with this opinion. “There are over 200 HPV viruses, but more than a dozen count. Each of these viruses is a separate pathogen, similar in name but with different pathogenicity, 16 and 18 are the most common oncogenic types in the world. Local epidemiology may differ, other serotypes are also important in Poland, e.g. 33. If we want to protect ourselves against other types of HPV viruses, we must also include them in the vaccine – explains Dr. Hab. cook. “The claim that every HPV vaccine is the same undermines the credibility of such an opinion” – he points out.

HPV vaccines became available more than 16 years ago. Dr. hab. Kuchar reminds us that most of our neighbors vaccinate the entire youth population, both girls and boys. “Because the HPV virus in its oncogenic varieties, i.e. those that have a carcinogenic effect, is the cause of about 10 percent. total cancers. Cervical cancer is such a flagship cancer, but it turns out that today more and more cancers of the throat and larynx, which affect both sexes, and even more often occur in men, are caused by HPV. Boys are also responsible for the transmission of viruses among girls – says the expert. – Of course, sometimes decades pass between infection and cancer, but if infection does not occur, there will be no cancer in the future. The whole problem with HPV is that we associate it with sexual transmission, but the virus can also be transmitted through deep kissing or other close contact. Since HPV has found its way to the throat, it is also spreading this way, which is also due to changes in habits and the popularity of oral sex” – she adds.

The HPV virus is also the cause of genital warts, otherwise known as genital warts, which, although not oncogenic, are a big problem because they are very embarrassing, painful and burdensome for patients. Most often they take the form of cauliflower-like formations in intimate places, but they can also occur in the respiratory tract. They are very difficult to treat, if cut out they grow back. They are caused by HPV types 6 and 11 and the 9-valent vaccine protects against them, but the 2-valent vaccine does not.

“According to studies, the 9-valent vaccine protects not only against cancer, but also against condyloma acuminata. Genital warts during pregnancy and childbirth, on the other hand, are a major risk factor for juvenile laryngeal papilloma, which causes vocal cord growths in children: they interfere with speech, air circulation in the upper respiratory tract and shortness of breath. You have to lean over it and there is no other way than a vaccine. If there is a choice, the best one is always chosen” – emphasizes prof. Zana Bumbuliene.

When choosing a vaccine for reimbursement, the issue of price usually plays an important role. However, according to experts, such savings are only apparent.

“I would recommend what is best and possibly wide prophylaxis, covering boys and girls. Compared to the huge costs of treating oncological diseases, this prophylaxis is relatively cheap. Let’s take into account that oncological treatment is not only very expensive, but also has many side effects, which sometimes have a devastating impact on the further life of the patient and his family. The problem with prevention is that it takes a long time to see the effects. Because sometimes several decades pass between the infection and the detection of cancer. But the effects in the form of a reduction in the incidence of genital warts are visible after only a few years, which was observed in Australia” – points out Dr. hab. Cook.

“In Lithuania, the ministry also paid attention to the price, which is why we had a bivalent vaccine for so many years. The Lithuanian Society of Obstetricians and Gynecologists tried to prove in its writings that you save money when you administer 9-valent, because then there are fewer diseases, and the costs of cancer treatment are many times higher than the cost of the vaccine” – explains Prof. Bumbuliene.

He adds that in Austria, the cost of treating cervical cancer or recurrent papillomatosis of the larynx, when condylomas constantly have to be removed, was calculated. “Once they saw how much money it was taking, the next decision was for the government to start vaccinating both sexes. In Lithuania, we relied on Austrian research,” says the Lithuanian expert.

In Lithuania, the decision to universally vaccinate both sexes with the free 9-valent vaccine was made at the beginning of last summer. It was officially announced on December 15, 2022.

“The Lithuanian model is one we should look at. The situation in Poland is tragic when it comes to cervical cancer, it is detected late and kills several thousand women a year. Elsewhere, this problem has long since been resolved. The Baltic Republics are many years ahead of us in vaccination, although their per capita income is similar to Poland’s, admits the chairman of the Polish Society of Vaccinology. – The percentage of HPV vaccinations in Poland, if only because of the price barrier and the lack of education, is simply symbolic, i.e. maybe several thousand people a year. This is nothing. Local governments have done a lot, now it’s time to do it on a national scale and ensure equal access for everyone,” he adds.

Experts also consider it necessary that the vaccination program should be accompanied by the education of family doctors, paediatricians, but also parents and children, on the importance of being vaccinated against HPV and thus preventing later consequences resulting from infection with it.

“It is also very important that doctors themselves understand the need for HPV vaccination. Because they usually have to be recommended by pediatricians or family doctors, and they often don’t see the need. On the other hand, for the patient, the doctor’s opinion is most often decisive, so let’s be guided by evidence-based information and value the trust of our patients” – concludes Prof. Bumbuliene.

Information source: PAP MediaRoom

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