Analyses

Likewise, though Portugal implemented a successful vaccination initiative in 2008, it initially only targeted girls, delaying broader gender-inclusive prevention effort.

Belgium, Cyprus and Portugal have each taken targeted measures to strengthen cervical cancer prevention, focusing on improved screening and HPV vaccination strategies

In Flanders, Belgium, the Centre for Cancer Detection (Centrum voor Kankeropsporing – CvKO) collaborated with the regional government and the Belgian Cancer Registry to integrate patient and screening data. This enables CvKO to send targeted screening invitations to eligible individuals and share results directly with general practitioners, facilitating personalized follow-up. Anonymized data is also made available to stakeholders, and annual updates are provided to policymakers to support informed decision-making. 

Similarly, to improve prevention and early detection, Cyprus is preparing to launch a nationwide, population-based cervical cancer screening initiative. Furthermore, it introduced the nine-valent HPV vaccine for children aged 11–13, supported by a coordinated awareness campaign involving government bodies, healthcare providers and civil society. As a result, vaccination coverage reached 92% for girls and 79% for boys by 2023.

In contrast, Portugal has focused on prevention through vaccination by incorporating the HPV vaccine into its National Vaccination Program (PNV) as early as 2008. Although this initiative initially targeted only girls, Portugal expanded the programme in 2020 to include boys born in or after 2009. Vaccinations were free and available at all primary care units. Additionally, Portugal introduced the centralized digital registry VACINAS, which is used by primary healthcare nurses to track vaccination records and follow up in cases of delay. The expansion of the programme proved effective. HPV vaccination coverage for 12-year-old boys reached 88% in 2023 (closely aligning with the high rates already achieved among girls), highlighting a gradual but expanding commitment to gender-inclusive prevention.

Stakeholder collaboration, governance and digital tools were critical for the implementation of large-scale programmes

Successful implementation of cervical cancer screening and vaccination programmes in Belgium, Cyprus and Portugal was largely driven by strong governance and coordinated collaboration among stakeholders (Governance). In Belgium, clear and immediate incentives, such as quality improvements, cost reductions and practical benefits, motivated partners to work toward a common goal (Resources). Similarly, Cyprus highlighted the importance of coordinated efforts among the Ministry of Health, paediatricians, school health services, NGOs and the National Cancer Committee. This broad collaboration helped raise awareness and contributed to the high HPV vaccination coverage (Service delivery). 

A robust digital infrastructure proved critical in supporting data-driven decision-making (Information). In Belgium, detailed cancer screening data was used to shape policy and deliver targeted, evidence-based screening invitations. Likewise, Portugal’s VACINAS registry ensured not only continuity of care, but also improved overall vaccination coverage through active communication with families.

Integration into primary healthcare structures is essential for target-centred care

Integrating screening and vaccination programmes into primary care was essential to ensure accessibility and continuity (Service delivery). By cooperating with GPs, Belgium’s screening programmes was implemented in a targeted and low-threshold manner. This facilitated enhanced efficiency, reduced unnecessary testing and strengthened coordination across the health system. In Cyprus, HPV vaccination was delivered in coordination with schools and paediatricians, embedding it within routine services. Portugal similarly incorporated vaccination into primary healthcare and child health consultations, making access easier and more systematic. Portugal also placed special emphasis on the role of healthcare professionals, particularly nurses, in health promotion, patient education and outreach (Workforce).

Some enabling factors were more country-specific, with Cyprus noting the importance of dedicated funding to support its programmes (Funding). Portugal focused on ensuring equitable access, by offering universal and free HPV vaccination. This, and the long-standing culture of trust in immunization, contributed to the high uptake rates in vaccinations in Portugal.

Complex organizational effort and a lack of communication between stakeholders hinder implementation

The sheer complexity of organizing and executing large-scale screening and vaccination programmes presented logistical challenges across all countries. Ensuring timely delivery, managing supplies and reaching target populations required high levels of coordination that were sometimes difficult to maintain (Service delivery). In Cyprus, limited data availability and system maturity made it difficult to accurately estimate participation rates, vaccine demand and the size of eligible populations (Information). These gaps complicated planning efforts and required reactive adjustments, illustrating how underdeveloped information systems can undermine efficient service delivery. 

Additionally, lack of clear, consistent communication among stakeholders hindered coordination and weakened programme rollouts (Governance). Belgium specifically emphasized the critical role of transparent communication with both stakeholders and the public, as a critical factor in ensuring effective implementation. 

Furthermore, in Portugal, the rollout of the expanded HPV vaccination programme coincided with the COVID-19 pandemic, placing additional pressure on the health workforce and affecting capacity (Workforce, Service delivery).

The increase in the number of people reached suggests the success of the programmes

All programmes have shown success in their implementation, as evidenced by an increase in screening and vaccination rates (for example, Cyprus and Portugal).

However, the success of such programmes is also dependent on the availability of adequate workforce and the presence of a robust digital infrastructure to support coordination and monitoring. Additionally, regular evaluation of implemented measures is essential to assess their impact and to ensure that programmes are continuously adapted to better address the needs of specific target populations.

Resources