Literature review summary

Descriptions of cancer have been recorded from ancient times and since then physicians have been trying to find out causes and cures. Several theories have been supported throughout history. Nowadays, the concept of viruses causing cancers is no novel. In 1983, Zur Hausen was able to demonstrate the presence of HPV 16 and 18 in cervical cancer biopsies. HPVs are a family of viruses that are extremely common worldwide and cause 100% of cervical cancers. Every year, almost 500 000 women develop cervical cancer and 274 000 die from the disease.

The introduction of the HPV vaccine, in terms of dealing with cervical cancer, constitutes a big shift in health policy and health promotion practice. Specifically, cervical cancer has for a long time been a health issue of routine secondary level of prevention i.e. screening with an aim to catch a disease at its early stages before symptoms occur. However, in recent years dealing with cervical cancer has also become an issue of the primary level of prevention i.e. vaccinating individuals in order to prevent the occurrence of the disease.

Communication of this information is of paramount importance with regards to the successful implementation of HPV vaccination programs. For the majority of the general public, health care providers constitute a formal source of information regarding any health issue while the mass media plus family and friends constitute informal sources of health information. The way media influences the publics’ attitudes regarding controversial science issues is very complex and largely dependent on pre- attitudes as well as individual sense making and interpretative processes. How are HPV vaccine messages framed; as a cervical cancer prevention vaccine or as a sexually transmitted disease prevention vaccine?

An overview of HPV vaccination policies around the world has revealed many commonalities but also great differences. Based on European Cervical Cancer Association data (2009), recommendations for HPV vaccination are also very different across European countries. United Kingdom has launched a school vaccination program for young girls while in Denmark families receive a letter of invitation to take their children for an HPV vaccine while in Austria the HPV vaccination is going to be offered to children of both genders. In Greece, the national recommendations for HPV vaccination were put together in 2008. The HPV vaccination is offered free of charge for females aged 12-26 and it is given on demand. However, public health experts support the notion that school-based vaccination programmes tend to achieve higher coverage compare to provision on demand vaccination, even if this is supported by direct invitation by a health care professional or public education programmes.

There are several issues to consider when discussing the HPV vaccination and some of them are serious ethical dilemmas. The main target groups for vaccination are pre-adolescents and adolescents – are they capable of making informed health decisions for themselves? Will vaccination change sexual behavior of adolescents? Do parents who decline vaccination put their children’s health at risk? The World Health Organisation recognises HPV related diseases and specifically cervical cancer as a public health problem of global importance. Recommendations include the integration of HPV vaccination in national immunization programmes provided that prevention of cervical cancer or other HPV-related diseases, or both, constitutes a public health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured; and the cost effectiveness of vaccination strategies in the country or region is considered.