The EU project PERCH: A united fight against HPV-related cancer

Infections with human papillomaviruses (HPV) are among the most common sexually transmitted infections worldwide. It is assumed that most sexually active people become infected with HPV at least once or multiple times in the course of their lives, often during the first few years of their sexual activity.

There are over 200 different types of HPV, whereby a distinction is made between low-risk and high-risk virus types. HPV of the low-risk type can cause unpleasant but generally harmless warts on the genitals, anus and, more rarely, in the mouth. However, these are highly contagious. HPV infections of the high-risk type remain persistent in around 10 % of cases. These persistent infections can lead to cell mutations and subsequently to cancer. In addition to cervical cancer, HPV can cause oral and pharyngeal tumours, cancer of the vagina or vulva, anal or penile cancer. Vaccination significantly reduces the risk of HPV-related cancers. Nevertheless, vaccination coverage remains low in many countries, including Germany, where the Standing Committee on Vaccination (Ständige Impfkommission STIKO,) has recommended the HPV vaccination for girls since 2007 and for boys since 2018. In 2021, only 54 % of 15-year-old girls and 26.5 % of 15-year-old boys in Germany had been fully vaccinated against HPV. Vaccination coverage (complete vaccination) for girls in Europe in 2020 varied between less than 5% and more than 90 %. This vaccination gap needs to be closed.

The PERCH Project (PartnERship to Contrast HPV) aims to contribute to this goal, with a special focus on regions with low vaccination coverage.

The PERCH project involves 18 European countries with 34 partner organisations. It will run for 30 months, from 1 November 2022 to 30 April 2025, and will be managed by the Istituto Superiore di Sanità (ISS) in Rome, Italy.

PERCH has four objectives to prevent HPV-related cancers:

• Improve capacities of EU member states to plan and implement HPV vaccination campaigns by sharing knowledge and experience.
• Improving data and monitoring systems for HPV vaccination and screening.
• Improve knowledge and awareness on HPV-related diseases and prevention in specific target groups, e.g., for girls and boys/adolescents.
• Improve knowledge and abilities of healthcare professionals in HPV vaccine communication.

WP 1: Project management and coordination 
Ensuring the coordinated governance and management of the Joint Action.

WP 2: Communication and dissemination
Ensuring well-coordinated communication in each phase of the Joint Action.

WP 3: Evaluation 
Monitor and evaluate the progress of the Joint Action to assure that the defined objectives have been achieved. These are operationalised using process and result indicators.

WP 4: Integration and sustainability
Aims to frame the conditions to achieving and maintaining a high HPV vaccination coverage. The first step is a situation analysis of the individual countries’ structures, processes and conditions. With the involvement of a Governmental Advisory Board, strategies for increasing HPV vaccination coverage are discussed and pilot projects and vaccination campaigns are set up and evaluated. In addition, systematic literature reviews are conducted on the following topics: HPV vaccination in men, one-dose HPV vaccination schedule, HPV vaccination in adults and effectiveness of interventions to increase HPV vaccination rates. Furthermore, this work package addresses the current costs of HPV vaccines in Europe.

WP 5: Monitoring
Description of how HPV vaccination is currently monitored in the participating countries. Development of possible systems to record vaccination coverage in the population.

WP 6: Improving knowledge and awareness to increase vaccine uptake in target communities
Investigating attitudes and concerns about HPV vaccination among parents, teachers and schoolchildren. A toolbox will be created containing existing measures for the above-mentioned target groups and, if necessary, plans for further measures. Appropriate tools can be brochures, videos or worksheets, for example. Collected tools will be evaluated. Furthermore, roundtables with various stakeholders will be organised in the individual countries.

WP 7: Training and support in vaccine communication for healthcare professionals 
First, determine the structures and training needs of doctors, medical assistants and other healthcare professionals on vaccinations in general and the HPV vaccination in particular. Based on this, develop a training curriculum which serves as a “checklist” for planning and implementing training courses in the individual countries. This will also contain selected teaching materials as examples. The aim is to enable professionals to feel confident in vaccine communication, even in challenging conversations with the target groups, and to strengthen the dissemination of comprehensive, target- group-specific advice. Finally, the aim is to evaluate the success of the training courses.

The Federal Centre for Health Education (BZgA) is leading WP7, in close cooperation with the Robert Koch-Institute and the other institutions involved in this work package.