Major non-communicable diseases - NCDs (cardiovascular disease (CVD), cancer, chronic obstructive pulmonary disease (COPD), and diabetes) are responsible for 85% of the deaths and 70% of the burden of disease in Europe. The costs of managing those diseases create an enormous economic burden for many countries throughout the European Union. Substantial clinical evidence shows that the clinical and socioeconomic burden of NCD can be markedly attenuated through appropriate integrated approaches to health policies, including individual risk reduction (aimed at high-risk individuals), population risk reduction (aimed at social determinants), the rational use of health services (by empowering primary health care providers), and referral system support. Scepticism about effectiveness, bureaucratic inertia, and competing interests all contribute to the resistance in preventing NCD diseases and promoting healthy lifestyles. As a result, the health system of most European countries, and indeed, throughout the world, are not adequately structured or funded (to respond to these emerging health care needs. Further, the ongoing worldwide economic crisis is also expected to jeopardize the availability of resources within individual countries for investment in health care systems in both the private and public sectors.
The 2008-2013 Action Plan for the Global Strategy for the Prevention and Control of non-communicable diseases (Action Plan http://www.who.int/nmh/Actionplan-PC-NCD-2008.pdf) was developed by WHO with Member States. It is based on an overall strategy for the prevention and control of NCDs or chronic diseases finalized in March 2000, and it defines the objectives for the period 2008-2013 and the actions to be implemented. The Action Plan was endorsed at the Sixty-first World Health Assembly in May 2008 by delegates from 193 Member States. The action plan includes several objective such as: a) to raise priority given to chronic diseases in national and global development plans and strategies; b) to improve national policies and plans; c) to reduce the major modifiable risk factors; d) to promote research, partnerships for prevention and control of chronic diseases; e) to monitor chronic diseases and their determinants and evaluate progress at the national, regional and global level. For the first time ever, the United Nations General Assembly will hold a non-communicable disease (NCD) Summit involving Heads of State, in September 2011, to address the threat posed by NCDs to low- and middle income countries (LMICs). The UN General Assembly [unanimous] decision was congratulated by the World Heart Federation (WHF), International Diabetes Federation (IDF), International Union Against Cancer (UICC) and the International Union Against Tuberculosis and Lung Disease (The Union). This alliance of nongovernmental organizations (NGOs) represents the four diseases – cardiovascular disease, diabetes, cancer and chronic respiratory diseases – that are responsible for 35 million annual deaths globally, 80% of which occur in LMICs. The alliance has been at the forefront of advocacy efforts to ensure the rising burden of NCDs was addressed in the global health and development agendas.
Although the mentioned diseases are named not communicable, there is an increasing evidence that some of them are linked to communicable (infectious) agents. For example, there is an increasing evidence of the direct correlation between Influenza virus and Coronary heart disease, (Ann Intern Med 1995; 123: 518-27; Circulation 2000; 102: 3039-45; Am J Cardiol 1984; 53: 481-82; NEJM 2000; 343: 1778-87; JAMA 2003; 289: 179-86; Circulation 2003; 108: 2730-36; Epidemiol Infect 2005; 133: 255-62). More established is the correlation between Human Papilloma Virus – HPV infection and cancers. In general, HPV is thought to be responsible for about 100% of cervical cancers, 85% of anal cancers; 70% of vaginal cancers; 40% of vulvar cancers; 40% of penile cancers (Vaccine 2008; 26 (suppl 10): K17-28).
Prevention in this area is becoming even more effective. The screening of cervical cytological modifications has paved the way to an early detection dysplasia or neoplasia of uterus with consequent impact in reducing cancers in women. Despite the important benefit is due to cervical cancer screening programs, a high number of cervical cancers are still diagnosed every year, and many women are still dying for this disease.
This program nevertheless presents some organizational limits as 29% of Italian women have never been screened over their life.
Today a prophylactic vaccination is presenting a more effective way to prevent HPV linked cancers as cervical cancer in women, and penis and head and neck cancer in men. Vaccines are and are available for males and females to protect against the types of HPV that most commonly cause health problems.
Two registered vaccines (Gardasil and Cervarix) are very effective against HPV types 16 and 18, which cause most cervical cancers. So both vaccines are available to protect females against the types of HPV that cause most cervical cancers. Both vaccines are made with very small parts of the human papillomavirus that cannot cause infection with HPV, so neither of the vaccines can cause HPV infection. Both vaccines are given as shots and require 3 doses. Both vaccines are very safe.
One of these vaccines (Gardasil) is also licensed, safe, and effective for males ages 9 through 26 years: it protects against most genital warts because it protects also against HPV-6 and HPV 11 genotypes.
National and regional programs of vaccination of girls (one or more cohorts starting from a cohort of 12-year-old girls) are running in many countries, and there is a high evidence of the effectiveness of vaccination in reducing HPV infections, and consequently the vaccination is expected to reduce the long term appearing cervical cancer (J Natl Cancer Inst 2010, 102 (5): 325-39).
What it is surprising is the number of barriers that are obstructing a large eradication of the HPV infection. Limited budgets in vaccination policies, reduced number of cohorts, not full adhesion to vaccination calls, not complete compliance to the number of shots, the absence of young males in the eradication programs, the increasing distrust of citizens on the value of vaccinations, are some examples of barriers. The budget limitation is nowadays a wrong approach in the cost containment of the Health National Systems (not just in Italy). The solution to the problem of efficient healthcare resource allocation cannot only be based on a search for the minimum cost for goods or services. A vaccination policy should not be seen as a cost, but an investment. Studies on the matter show that an appropriate HPV vaccination program is saving money in a medium (warts) and long (cancers) terms. Both anti-HPV vaccines have been clearly demonstrated to have values per QALY-gained below the current threshold value to evaluate the cost-effectiveness of healthcare interventions (Vaccine 2009; 27: A54-A61; Gynecologic Oncology 2009; 112: 370-376).
Another mistake is relevant to the not inclusion of young men in the vaccination policies. The absence of boy in the vaccination program is reducing the expected goal of HPV eradication.
Under some point of view the problems linked to the HPV vaccination are raising once more the not yet overruled inequality between genders.
The Giovanni Lorenzini Medical Science Foundation (Milan - Italy and Houston - Texas), and its sister the Italian Heart Foundation, since time are promoting and running projects devoted to support awareness and education activities in the field of prevention in the large field of Non Communicable Diseases: Mainly cardiovascular disease, diabetes and obesity. One of the goals is to overcome the barriers that are obstructing the bridging of science to health policy and health organization (Atheroscler Suppl 2009; 10 (1): 1-2). The still today not fully satisfied knowledge of differences between woman and man is a barrier to the better implementation in medical diagnosis, treatment and prevention of the innovative medicine. This is a reason why the Lorenzini Foundation decided to contribute in helping to reduce inequalities between genders in the prevention of chronic disease. Further on the experience of the Foundation in facilitating cooperation among stakeholders has been seen as support in the HPV vaccination model where a cooperation among scientists, clinicians, health organization experts, authorities, families and citizens could help in reducing barriers to the bridging science to health policy. A panel of experts, in fact, has been convened to focus on the topic, and a document is already published (*) and diffused to decision makers in the Italian national and regional context. Local promotional events supporting vaccination policies with girls and boys are programmed.
(*) See Summary from:
“Protezione della Salute del Cittadino nella Società: Il Modello HPV” pubblicato sul Quaderno de “Il Sole 24 Ore Sanità” del 18 Maggio