“Systematic vaccination in school will make it possible to expand vaccination and therefore increase vaccination coverage in France. By creating group simulations, potentially concerned parents can be reassured and it will also make it possible to reach children whose parents have not been adequately informed.”
Just over a year ago, in an article on the importance of vaccination against human papillomavirus (HPV) infection in young people, I interviewed Dr. Georges-Pompido European Hospital (AP-HP), a virologist. Quoted by Helen Parre. For her, at that time, the introduction of vaccination in schools was an effective way to better reach young people when the vaccine, whose benefits and safety are no longer in doubt, is the most effective.
An idea shared by the French Society of Colposcopy and Cervico-Vaginal Pathology (SFCPCV), whose message remains today: “The main obstacle to anti-HPV vaccination is the difficulty in reaching the target population of children aged 11-14 years who no longer go to a pediatrician and rarely consult a general practitioner. Providing this vaccination in schools is a great way to give our youngest children this opportunity, as has been done effectively in many other countries.”
Coincidentally, on the same day my article was published, Emmanuel Macron announced the establishment of a generalized, non-compulsory and free vaccination campaign in fifth grade classes in public and private colleges under a voluntary agreement at the beginning of the 2023 school year. .
France remains a poor student in HPV vaccination
During September 2023, the parents (or legal representatives) of the students concerned usually received a letter and an information leaflet on the topic of HPV infection and vaccination, explaining to them the approach to the vaccination campaign, as well as an information form. Authorization and an envelope to return this authorization. “generally”Because many of the parents I spoke to for this article didn’t see anything happening…
The campaign itself began in October 2023, and its first results have not been satisfactory. Indeed, the General Directorate of Health revealed to Agence France-Presse that “As of December 23, 2023, at least 92,262 students were vaccinated in colleges, according to partial reports from regional health agencies” – which equates to a vaccination rate for fifth graders of about 10%.
“Everything was arranged too quickly, if not hastily, and the colleges found themselves helpless.”
Not really enough to make up for France’s big lag compared to other European countries, which places it twenty-eighth in terms of vaccination coverage, ahead of Kazakhstan (15%), Armenia (8.8%) and Bulgaria (4). %), and followed by Belgium (91%), Portugal (90%), Norway (88%), Sweden (84%), England (84%) and Spain (80%).
Lack of preparation and administrative burden
While there is no doubt that vaccination against HPV in schools is a key lever for achieving the 80% coverage objective (allowing a sharp reduction in the number of pre-cancerous lesions and cancers caused by the papillomavirus), it must be recognized that all conditions are met. not
Professor Aurelie Gauchet, professor of health psychology at Savoie Mont Blanc University and expert on barriers, attitudes and behaviors towards HPV vaccines, explains that she was not particularly surprised by this first assessment: “We suspected it. Everything was arranged too quickly, if not hastily, and the colleges found themselves helpless.
After working herself up to the need to fully inform parents, she laments “Absence of awareness and education phase for vaccination, whether among parents or among youth”. For her, who, through her work, was able to measure the impact of real support, “We’ll need two two-hour sessions at the beginning of the year.” To do things right – and not just a leaflet.
“I asked my GP, I looked at the health insurance website and the Ministry of Health information. If I consider myself well-informed, it’s because I was looking for information.”, testifies Thibault, whose child is in college. As for young people, there is no specific information system organized around HPV at institutional level, while there are educational tools – including a “serious game” – resulting from the work of eight research teams specializing in the human and social sciences. Biostatistics and General Medicine.
Every year in France, around 3,000 women develop cervical cancer and 1,000 women die from it.
For his part, Professor Geoffrey Canlorbe, gynecological surgeon at PTA Salpetriere and secretary general of the SFCPCV, regretted “Administrative Burden” Who chaired the campaign: “The fact that both parents have to sign the form beforehand doesn’t make things any easier.” So, for that, the administrative procedures must be simplified and it would be better to have the vaccination done basically – it depends on the parents who oppose it to come forward. Geoffroy Kenlorbe also deplores the lack of health professionals authorized to administer vaccines in schools: “If a young person is absent on the big day or if they forget their health record, they miss the boat.”
To these explanations, we must also add the death of a young man from head trauma due to vaginal discomfort after receiving the vaccine. A dramatic accident that has nothing to do with the HPV vaccine can damage confidence through an unfortunate shortcut. “Many young people, especially boys, feel uncomfortable after a blood test or vaccine”cites Geoffroy Canlorbe, who adds: “This is why it is recommended to keep them seated and watch till 5 10 minutes after the injection, which was probably not done.
Having observed this missed first meeting, how can we improve future campaigns? This sport is really worth trying because every year in France around 3,000 women get cervical cancer and 1,000 women die from it. In addition, we account for about 1,500 rectal cancers and 1,550 ENT cancers of all sexes combined, not counting condylomas (genital warts), which are benign but painful, caused by HPV.
Report more and better
That said: support and education on vaccinations, for both parents and children, is absolutely necessary and requires time and actual face-to-face sessions. To do things well, we must first identify the information needs and barriers to vaccination.
This seems to have changed somewhat in recent times, as Aurelie Gauchet points out: “The fear of side effects has diminished somewhat over time. On the other hand, there remains a greater cultural reluctance regarding sexuality and stereotypes linked to gender.” Indeed, apparently, HPV is transmitted during sexual relations, the sharing of information can be done with a certain embarrassment, or even, depending on the family, not at all.
“It’s certain that vaccination against HPV has never made the headlines.”
“I have nothing against vaccination, but I find it a bit premature for my 11-year-old son. I chose for him to decide for himself at the age of 18., Lucy explained to me when I launched a call for evidence on this topic – even though we know that the vaccine is more effective if it is administered before the age of 17, regardless of whether sex life has started or not. It is therefore important to clarify the benefits of early vaccination.
To clearly separate the HPV vaccine from entering sexual life, Geoffroy Kenlorbe suggests offering it from age 9: “This might prevent parents from feeling like they’re telling their teens, ‘Now that you’ve been vaccinated, you can start your sex life.'” But, however, this can create further problems in informing the young people involved in the decision: “When young people are in captivity, this has a huge impact on parents, and the differences between parents and children are very small.”Aurelie Gauchet points out.
Geoffroy Kenlorb also regrets the conversation around vaccination “Too academic, not enough”, which does not facilitate democratization of information. Specifically, he wants influencers to carry the message, especially among teenagers, and the media to further adopt this theme to effectively popularize it. “It’s certain that vaccination against HPV never made the headlines”He repents.
It also seems crucial to provide concrete information: “I’m totally in favor of vaccinating my daughter when the time comes because I’ve had concerns about HPV myself and I don’t wish that on her.”, Alexis, father of a 6-year-old, told me. The message may also be missing: the reality of people living with lesions or cancer caused by HPV. We are better able to volunteer to fight it when we know what harm it can do.
Aurélie Gauchet also invites us not to forget that young people, who sometimes have difficulty balancing immediate discomfort and significant long-term benefits, can be held back by fear of injections. So we should not take these fears lightly and be able to reassure them.
Finally, it seems that numerous initiatives to promote vaccination, sometimes carried out by associations, sometimes by learned societies and public bodies, coexist… but even as they join forces they do not communicate with each other (and budget they devote to communications) may be more than useful.
Reducing the administrative part of vaccination in schools, providing more and better information to parents and children, removing vaccine restrictions highly correlated with sexuality, and integrating information sharing: all ways to expand coverage against HPV.
