Vaccination against the human papillomavirus (HPV): France is far behind other countries
Press release from the French National Academy of Medicine (*)
June 23, 2022
Human papillomavirus (HPV) infection is a very common sexually transmitted infection that affects more than 80% of people (both men and women) at the start of their sexual life. In France, these viruses are responsible, each year, for more than 100,000 benign genital warts, more than 30,000 pre-cancerous lesions and more than 8,000 cancers of the genital, anal and oropharyngeal regions [1]. Following the demonstration of the role of some human papillomavirus (HPV) in the development of cervical cancer (in 1985), as well as anogenital and oropharyngeal cancers (in 2009), the targets of the first anti-HPV vaccines marketed in 2007 have been progressively broadened to include, since 2018, the 9 types of HPV as a cause of benign tumors, pre-cancers, and cancers.
In 2007, the global health recommendations for HPV vaccination only concerned girls aged 11 to 14. In France, in 2019, the vaccine recommendations were extended to boys of the same age group [2, 3] with 65% coverage by the French Health Insurance from January 1, 2021.
In Europe, in 2020, vaccination coverage exceeded 50% in 20 countries and 75% in 11 countries including Portugal, Spain and the UK. In France (in 27th position), it only reached 28%, mostly in girls, (29% for a single dose at 15 and 24% for a full two-dose vaccination schedule at 16) [4]. The following year, after the extension of the recommendations to boys, French vaccination coverage stood at 41% (45.8% for girls and 6% for boys), a level far from the objectives set by the National Sexual Health Strategy and the Cancer Plan: 60% among adolescent girls aged 11 to 19 by 2023 and 80% by 2030 [5,6].
Concerning this second vaccination program for cancer prevention (after vaccination against hepatitis B), the insufficient vaccination coverage observed in France can be explained by
– a ten-year cancer control strategy (2021-2030) mainly focused on the prevention of cervical cancer, therefore limited to girls [6];
– a lack of political and strategic coordination by the Regional Health Agencies [7]. Actions to improve HPV vaccination coverage are rare in France, not always in line with the political will and carried out by disparate actors, that leads to a lack of coordination, resources and validity of the information provided.
– a lack of confidence among some health professionals who thus no longer try to convince their patients. Indeed, various surveys show that 40% of doctors do not systematically recommend this vaccination, evoking an act “badly perceived” by parents.
The French National Academy of Medicine has repeatedly expressed the need to implement a national HPV vaccination program for adolescents of both sexes [2], emphasizing the efficacy and good tolerance [8,9] of marketed vaccines. Considering the low level of vaccination coverage achieved in France, it recommends:
– to restore trust in this vaccination among the public and health professionals, with the support of the National Cancer Institute which provides them with documentation to help them inform their patients
– to make the vaccination offer systematic for children aged 11 to 14, and to encourage non-immunized adolescents to be vaccinated, which is possible up to 19;
– to overcome socio-economic inequalities through an easier access to vaccination, particularly in areas where live the most disadvantaged populations, in such a way that no advance payment is required. In some countries, school-based vaccination, has resulted in vaccination rates above 70%.
References
- de Martel C et al. Worldwide burden of cancer attributable to HPV by site, country and HPV type. Int J Cancer. 2017; 141(4): 664-70.
- Villet R. Press release. Vaccinate girls and boys against human papillomavirus (HPV): a necessity to eliminate cancers of the cervix but also of the oropharynx, oral cavity and anus. Bull Acad Natl Med. 2019; 203: 659-61.
- Haute Autorité de Santé. Overview of vaccination guidelines «Papillomavirus vaccination in boys », December 2019.
- Fonteneau L. Evolution of Human Papillomavirus (HPV) vaccination coverage in France – 2008-2018, BEH 2019, 22-23: 424-30.
- French Ministry of Solidarity and Health. National Sexual Health Strategy. Agenda 2017-2030.
- French National Cancer Institute. Ten-year cancer control strategy 2021-2030 – roadmap 2021-2025.7.
- Report of the French Court of Auditors 2021: the prevention policy in health. https://www.ccomptes.fr/fr/documents/57947
- Bégué P, Bricaire F. Press release of French National Academy of Medicine ” About possible serious adverse effects of human papillomavirus vaccination in France “, December 4, 2013.
- Shimabukuro TT et al. Safety of the 9-Valent Human Papillomavirus Vaccine. Pediatrics. 2019 144 (6): e20191791.
(*) Press release from the Academy’s Rapid Communication Platform validated by the members of the Board of Governors on June 22, 2022
