Bulgaria’s Ministry of Health has announced boys will be included in the state’s human papillomavirus (HPV) prevention program from 2025, to combat the high incidence of cancer caused by the virus.
Free vaccination against HPV has been provided to girls in Bulgaria since 2012. Initially, only 12-year-old girls were eligible. In 2021, the state broadened the age group to include girls aged 10-13. From 2025, the vaccination coverage is expanding to include boys and girls up to 14 years of age. Vaccination against HPV in the country is voluntary.
Doctors had called out the discrimination in HPV vaccination against boys, who were not covered by the state programme, even though they can also be severely affected by the virus.
Dr Alexander Atanasov, who is a paediatrician and campaigner to increase awareness and coverage with voluntary vaccines, commented to Euractiv that boys should be included in the program to protect them, as they also run a high risk of developing HPV-related cancer.
According to Dr Atanasov, one of the most common HPV-related malignancies in men is cancer of the oral cavity.
“In countries where only girls are vaccinated, the incidence of oral cancer in men exceeds the incidence of cervical cancer,” he added.
Efforts falling short
The World Health Organization has launched an initiative for the elimination of cervical cancer that envisages 90% of girls fully vaccinated with the HPV vaccine by the age of 15.
However, the state-sponsored HPV vaccination campaign in Bulgaria has so far failed. Official statistics indicate that in 2019, the country’s human papillomavirus vaccine coverage was 4%. It progressively got even lower, dropping to 2% the following year. In 2022, it was only 1%.
It rose slightly in 2023 at 1.5% among the target group of girls aged 10-14.
Dr Atanasov commented that expanding the HPV vaccination program to boys cannot be interpreted as an attempt to compensate for the failed immunisation of girls. According to him, there is interest in vaccinating boys with the HPV vaccine. “I wouldn’t be surprised if it turns out that more boys than girls are immunised,” he said.
Currently, parents of boys have to pay €300 or €450 for their vaccination – €300 if it happens before the boy turns 15 because two doses are needed, and €450 if the child is older because then three doses are required.
Cervical cancer’s heavy toll
The Ministry of Health is also starting a new screening program for cervical cancer among women aged 20-30, which the state will finance with €6 million.
The alarming statistics in Bulgaria, where one woman dies from cervical cancer every day, led in 2023 to the creation of the HPV Coalition. A national non-governmental organisation for the effective prevention of diseases related to the human papillomavirus, the coalition was created by specialists in the fields of virology, oncology, paediatrics, and general medicine.
Bulgaria ranks third in Europe in terms of morbidity and fourth in terms of mortality from this type of cancer.
The experts from the HPV Coalition recommend promoting the lifelong vaccination model, which means that senior citizens should also be vaccinated, as immunisation is regarded as the best form of prevention.
Anti-vaxxers’ impact
Since the programme started in 2012, 23.83% of immunisation coverage was achieved, and 19.6% was completed in 2014. The following year, the rate dropped to 2.68% for 12-year-old girls, while for 13-year-olds, it was only 0.75%.
This sharp decline is related to a broad anti-vaccination campaign, as Euractiv reported in November 2023. The campaign alleged that HPV immunisation caused a 12-year-old girl to develop a severe autoimmune disease. Despite specialists concluding that there is no proven cause-and-effect relationship between HPV vaccination and the resulting disease, mistrust and refusal of immunisation persists.
[By Krassen Nikolov, Edited by Vasiliki Angouridi, Brian Maguire | Euractiv’s Advocacy Lab]
