Denmark: rebuilding confidence in HPV vaccination

The HPV vaccine protects against the human papillomaviruses that cause most cases of cervical cancer. HPV also causes other problems – including genital warts, penile and anal cancer, as well as head and neck cancer.

The vaccine has been used for more than a decade in dozens of countries around the world. For example, in Scotland, where HPV vaccination uptake is high, recent data have shown that cases of HPV infection have fallen significantly. Australia, an early adopter of the HPV vaccine, even hopes to become the first country to eliminate cervical cancer.

The WHO recommends the vaccination for all girls aged 9-14 years, as it is the most cost-effective public health measure against cervical cancer, in addition to cervical screening programmes for adults. Each year, an estimated 530 000 women globally contract the disease and 266 000 die of it. Studies show that countries that introduced the vaccine have seen up to 90% reductions in HPV infections in teenage girls and young women.

In Denmark, however, a free HPV vaccine programme has faced some unexpected problems. Since 2014, HPV vaccination coverage among 12-year-old Danish girls has dropped dramatically from around 90% initially to below 40%.

Why? Reports were circulating in the media of symptoms, such as pain and tiredness, in girls who had the vaccine, says the WHO Regional Office for Europe, based in Copenhagen. “An increasing volume of studies have since found these symptoms have no causal relationship to the vaccine.”

For Eigil Rosegar Poulsen, the controversy over the HPV vaccination in Denmark came as a shock. He was so moved by the public debate that he decided to share his story.

This story was adapted from material published on the WHO Europe’s website

Eigil’s story

In 2010 Eigil lost his wife, Trine, to cervical cancer, leaving him to raise their three daughters alone. Though the WHO-recommended vaccine against the most common types of the virus was only introduced in Denmark’s vaccination schedule in 2009, far too late for his wife to benefit, Eigil is a strong advocate for vaccination.

‘It’s fantastic that you can manage a disease as serious as cervical cancer with a vaccine. But it has made me sad to see the debate’” he says. ‘Nobody wants to experience what we have been through. And if that can be avoided with a vaccine, I find it hard to understand why parents would opt out.’

Tackling fake news

To help understand why so many parents of girls around 12 years of age were postponing vaccination, the Danish Health Authority conducted an analysis in 2016. It found that nearly all parents who doubted whether to vaccinate their daughters had heard stories about the alleged side-effects, primarily through media and online.

‘Even though we were putting out information about the importance of the HPV vaccines, most parents felt they were lacking the information they needed to really make informed decisions on whether to vaccinate or not,’ says Bolette Søborg, senior medical consultant at the Danish Medical Authority.

A year later, the Danish Health Authority, the Danish Cancer Society and the Danish Medical Association launched the campaign, “Stop HPV, Stop Cervical Cancer,” to help build confidence in the vaccine and remind people that the risk of getting cervical cancer far outweighs the risk of adverse vaccine events.

The campaign pitched articles about how to prevent cervical cancer to newspapers and lifestyle magazines throughout the country, and started a Facebook page to help answer parent questions and share stories, such as Eigil’s.

‘Much of the debate about the HPV vaccine takes place on Facebook, and this is where many parents get their information. This page is a way for us to reach out to the parents and create an opportunity for an open dialogue,’ says Louise Hougaard Jakobsen, consultant at the Danish Cancer Society. ‘We are open to all kinds of comments and questions we receive on the page and we seek to always be accommodating in our replies.’

New data reveals that less than nine months into the campaign, uptake in the number of vaccines is already increasing. During the past year, twice as many girls – nearly 31 000 girls – have started the HPV vaccination programme compared to just over 15 000 in 2016.

Sharing lessons learned across the European Region

Sustaining or rebuilding public trust in vaccines is an ongoing objective of immunization programmes around the world. Through a WHO-initiated peer group started two years ago, Denmark is sharing lessons learned on HPV with countries, such as Ireland, the Netherlands and Austria.

‘Several European countries have experienced declines in HPV uptake or have struggled with reaching high coverage. The WHO learning platform is the best way for these countries to support each other,’ says Katrine Bach Habersaat, Technical Officer, Vaccine-preventable Disease and Immunization in the WHO Regional Office for Europe.

‘Documenting and learning from Denmark’s experience is not only important to address the HPV crisis; it is critical to ensuring the success of new vaccines introduced in the future.’

Danish Stop HPV campaign site

HPV Q&A for parents and health professionals, plus HPV vaccine FAQs

Related: How Ireland rescued falling HPV vaccination rates