Case Studies

Preventing human papilloma virus (HPV) infection is the most effective strategy for eliminating cervical cancer and significantly reducing the incidence and mortality of other HPV-related cancers (for example, anogenital and head-and-neck cancers). This underscores the importance of vaccinating preadolescent girls and boys against HPV.

In 2008, HPV vaccination was included in the National Vaccination Program (NVP) to reduce the incidence and mortality of cervical cancer by reducing HPV infections (Diário da República, 2008). In 2020, the NVP was expanded to include boys born in or after 2009 (Diário da República, 2019), reinforcing efforts to reduce high-risk HPV infections and contribute to the long-term elimination of cervical cancer and other HPV-related cancers. Since its introduction, HPV vaccination coverage for boys aged 12 reached 56% in 2021 and increased to 80% in 2022 and 88% in 2023, nearly matching coverage rates for girls.

The NVP is integrated into primary healthcare. HPV vaccination is recommended at the age of 10 for both girls and boys, in a two-dose schedule, 6 months apart, with the nonvalent vaccine. The recommended age is 10, but vaccination can begin up to age 17 and be completed by age 26. Children and young people are regularly monitored through medical and nursing consultations under the National Child and Youth Health Program, which aligns these consultations with the NVP’s vaccination schedule to enhance accessibility. 

Additionally, primary healthcare nurses use the VACINAS platform, a centralized digital registry (Information) to monitor vaccination records. In cases of delayed vaccinations, parents or legal guardians are notified, and a schedule for HPV vaccine administration is proposed, ensuring continuity and high vaccination coverage. Further, there is an Electronic Vaccination Bulletin on the personal portal of the National Health Service (in portuguese, Serviço Nacional de Saúde – SNS) or the SNS mobile application (SNS 24), where individuals can consult information on administered, overdue and upcoming vaccines.

The same system for follow-up, support and evaluation that had been used for girls was applied when the strategy was extended to boys. HPV vaccination is monitored annually, with results published in freely accessible reports on the Directorate-General of Health website.

Enablers were the universal and free program that ensures equitable access to vaccines for everyone in Portugal, emphasizing accessibility. The program is seamlessly integrated into primary health care (Service delivery), leveraging the country’s strong immunization culture. Children and young people are regularly monitored through medical and nursing consultations under the National Child and Youth Health Program, which aligns these consultations with the NVP’s vaccination schedule to enhance accessibility. Healthcare professionals (Workforce) play a vital role in promoting health literacy and encouraging adherence to vaccination. Additionally, primary healthcare nurses use the VACINAS platform, a centralized digital registry (Information) to monitor vaccination records. In cases of delayed vaccinations, parents or legal guardians are notified, and a schedule for HPV vaccine administration is proposed, ensuring continuity and high vaccination coverage.

Barriers included a low perception of the cancer risk associated with HPV in the male population; low literacy on the benefits of HPV vaccination for boys; the program’s implementation during the COVID-19 pandemic also hindered promotional efforts and may have discouraged healthcare visits due to fear of infection.

Overall, Portugal’s HPV vaccination program reflects a commitment to advancing health system goals such as equity, accessibility and population health improvement. The NVP is a universal, free and accessible initiative based on fundamental principles of universality and seizing every opportunity to vaccinate.

Lessons learned: Portugal has been achieving high HPV vaccination rates among boys and girls. This highlights the importance of equitable access, as the HPV vaccine is universally available and free through the NHS. A strong legal framework, aligned with best practices and international guidelines, ensures its credibility and sustainability, while clearly defined roles at national, regional and local levels support coordinated implementation. The program’s long-term impact, particularly in reducing cervical cancer and other HPV-related cancers, requires time due to the disease’s long incubation period. Public awareness campaigns, financial investment and strong political commitment have been key enablers. Additionally, Portugal’s established immunization culture has played an important role in boosting public trust and adherence.