The article reported that, as of July 2010, 18 out of 29 European countries had integrated human papillomavirus (HPV) vaccination into their national immunisation programmes. The study found that vaccination policies varied widely, with most countries covering pre-pubertal girls, apart from one country that introduced vaccination for both girls and boys. Delivery methods and vaccination coverage rates differed, with routine vaccination coverage ranging from 17% to 81%. Financial constraints were the main reason why 11 countries had not yet introduced the vaccine. Most countries offered the vaccine free of charge and used public health or school programmes for delivery. The survey highlighted that only a few countries achieved high coverage rates, and further analysis was ongoing to understand local factors influencing HPV vaccine introduction.
This highly cited overview showed that most newer EU Member States, despite having higher overall rates of cervical cancer, did not implement universal HPV vaccination. In contrast, many western and southern European countries—the so‑called “old” Member States—introduced universal vaccination early, even though they already had more effective cervical cancer prevention through screening programmes. The maps illustrating this paradox were widely used for many years on conferences to highlight the importance of basing vaccination decisions on comprehensive cost–benefit analyses that consider the full burden of disease, rather than focusing solely on vaccine costs.