December 11. 2023. 11:56

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Bulgaria fails with vaccinations against cervical cancer

Fake news about vaccines, mistrust, and refusal of immunisation by parents, teachers, and the whole society led to a drastic drop in HPV immunisation coverage among girls in recent years, an investigation by Euractiv Bulgaria found.

This vaccine is not in Bulgaria’s mandatory vaccination calendar but is recommended.

Official statistics indicate that in 2019, the human papillomavirus vaccine coverage was 4%; it dropped to 2% the following year, and in 2022, it was only 1%.

“Bulgarian anti-vaxxers are 15% of the population, but they are noisy as if they are 115%. Our weapon to combat this, unfortunately, is not science. The decision to vaccinate is emotional. People must understand that vaccination is for their own good,” the chief state health inspector Assoc. Angel Kunchev says.

In Bulgaria, free vaccination against HPV has been provided to girls since 2012. Initially, only 12-year-old girls were eligible, adding 13-year-olds in 2015 and broadening the age group to girls aged 10-13 in 2021.

With the program’s start 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, which 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 followed.

According to data from the European Cancer Society for 2020, all cases of cervical cancer in women in Europe are the result of infection with a high-risk (oncogenic) type of HPV.

It is all about money

“It’s all about money”, doctors, who wished to remain anonymous, commented to Euractiv regarding why boys are not included in the free program.

The health ministry also admits that it is practically about money.

In response to Euractiv, the ministry commented that free vaccination is part of the National Program for the Primary Prevention of Cervical Cancer.

The ministry cited the 2022 WHO Immunization Expert Group position that HPV immunisation programs should aim for high coverage and that achieving more than 80% coverage in girls reduces the risk of HPV-related infections in boys.

It is indicated that immunisations for other target groups are recommended only if possible and financially achievable, and in no way should funds be diverted from the prevention of girls.

“Currently, the main goal is to increase the vaccination coverage among girls aged 10-13, who are the designated target group of the national program. The inclusion of boys in the current program does not meet its goal, which is to reduce the incidence and associated mortality from cervical cancer,” the ministry said in its response.

Two women die every day

According to data from the Bulgarian National Statistical Institute, in recent years, the cases of cervical cancer in Bulgaria have been increasing – 15,691 cases in 2017 and 16,006 cases in 2019.

Every day, two women in the country lose their lives from cervical cancer and every year, it is the cause of death for 8-10 per 100,000 women.

This makes cervical cancer the second leading cause of death in young women after breast cancer. “Every third woman in Bulgaria between the ages of 14 and 55 is a carrier of an HPV infection,” Dr Kremena Parmakova from the Ministry of Health explained during a press conference recently.

For the prevention of cervical cancer, however, boys are also required to be vaccinated.

Total ignorance

“What is happening in Bulgaria [with HPV vaccines] is total ignorance, including on the part of the parents”, Dr. Hristiana Batselova commented to Euractiv.

She is a specialist in the Epidemiology of infectious diseases and one of the doctors who educate the public about the benefits of vaccines and debunks the myths of anti-vaxxers.

As she points out, the HPV vaccine has almost no contraindications.

Dr Batselova hopes that starting in 2025, the free vaccination program will include boys. The doctor cited a WHO report that indicates that the spread of the virus is affected in countries where boys can be vaccinated.

Currently, discrimination against boys in Bulgaria is visible, Dr. Batselova said, adding that the vaccine is not sex-restricted.

Parents of boys, however, 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. This is not a small amount of money in the poorest EU country.

Dr. Batselova admits that there are doctors who refuse to vaccinate against HPV, and this is a huge problem. In a small town, parents may not be able to find anyone to vaccinate their child and give up.

When asked whether the anti-vaxxer sentiments stop the inclusion of the HPV vaccine in Bulgaria’s mandatory immunisation calendar, Dr Batselova replied that a handful of anti-vaxxers should not lead experts.

The health ministry indicates that in 2024, the possibility of providing free HPV vaccination for both girls and boys will be discussed. The ministry assures that it intends to continue implementing national programs after 2024.

[By Krassen Nikolov – Edited by Vasiliki Angouridi |]

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