Sweden is trying to become the world's first country to eliminate HPV. Here's how
Sweden is increasing its efforts to become the first country in the world to eliminate human papillomavirus (HPV), a group of viruses that can cause cervical cancer in women and penile and anal cancers in men.
According to the World Health Organization (WHO), cervical cancer is the fourth most common cancer in women worldwide.
In 2021, the Swedish government started a national "Eradication Project" in collaboration with researchers, the country’s cancer society, and 21 autonomous regions.
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"I think that cancer is very difficult to eliminate. This would be one of the first options where we can really eliminate a form of cancer," Joakim Dillner, head of the Cervical Cancer Elimination Centre at the Karolinska Institute, told Euronews Health.
"When we have very effective tools to do this, we have an ethical requirement to actually use them to ensure that we don't have more cancer than necessary," he said, adding that it could also prompt other countries to follow suit.
Sweden began offering free vaccines to girls aged 10 to 12 in 2012 and boys in 2020.
Today, 90 per cent of girls and 85 per cent of boys are vaccinated.
The latest HPV vaccine is known to be effective and safe, preventing up to 90 per cent of cervical cancers by targeting nine HPV types, including those responsible for an additional 15 to 20 per cent of cases compared to older versions.
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Free 'catch-up' vaccines and mass screening
Most women born between 1994 and 1999 did not receive the latest version of the vaccine at school.
"It would probably have been sufficient to vaccinate only the previously unvaccinated girls. But it's a question of fairness, equity and ethics that everyone here should have the most up-to-date and most effective protection against cancer," said Dillner.
"So those who have taken the first generation vaccine are being offered the second generation vaccine on top". The "catch-up" vaccine is being offered free of charge.
"If we can have 70 per cent of women in this catch-up age group, and they are taking the vaccine, we can become the first country to actually eliminate cervical cancer already by 2027," Ulrika Årehed Kågström, secretary general of the Swedish Cancer Society, told Euronews Health.
Initially set to end by the end of 2024, Sweden has recently announced an extension of the free vaccination scheme by summer 2025.
The national project in Sweden consists of two phases.
By vaccinating and screening a strategically chosen cohort, the project aims to reduce the pool of HPV carriers, cutting off the virus's ability to spread.
Researchers will then start screening to find all pre-existing infections that might cause cervical cancer starting in the second half of 2025 "until HPV samples of the entire population are taken," according to Dillner.
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Accessible approach
According to researchers, about half of the women in the target group have so far taken the vaccine.
To increase uptake, the Swedish Cancer Society says it has been campaigning with unconventional strategies such as collaborating with influencers.
In November, it organised vaccination booths at local cinemas, attracting 600 women in just two hours at nine different locations.
“It shows that when they are offered it very close to their day-to-day life, close to their universities, their workplaces, where they go out in the evening, they are willing to take the vaccine, but they live busy lives,” Kågström added.
“Every second day, every third day, a woman dies of cervical cancer in Sweden,” she added.
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What happens next?
Many grown-up women hesitate to take the pricey HPV vaccine despite their awareness of its effectiveness because they hear the vaccine is not as effective after someone has sexual intercourse.
However, a long series of randomised trials shows that the vaccine is also effective in these age groups provided that the patient is HPV-negative when administered, experts said.
"We are offering an HPV test at the time when you are vaccinated. If you're positive, you will be followed up in the screening programme and be protected from cancer by that," Dillner said.
"If you're negative, you will have the same high protection against the infection and the cervical cancer precursors as has been demonstrated in the randomised clinical trials," he added.
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Eliminating HPV and cervical cancer isn’t free of cost - Sweden has allocated around €350,000 towards the effort for this year.
Dillner believes downsizing screening, which neighbouring country Denmark is reportedly considering amid high vaccination coverage, is risky even after Sweden has population immunity against HPV.
"If anything, it needs to be ramped up for better cancer protection. Actually, the fact that we don't have new infections any longer will result in the screening test becoming both more sensitive and specific," Dillner said.
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