^{Health Care Workers attend a WHO Montenegro training on effective communication on HPV vaccination.}
Photo credit: WHO Montenegro.

After the most critical phase of the COVID-19 pandemic was over, WHO catalysed HPV vaccination by mobilising resources for planning and preparation. With a shortage in resources, the government had only secured a limited number of vaccines meaning that the vaccination plan had to be revised. In order to be a success, the plan had to be favoured by all stakeholders. A WHO Montenegro expert, with technical inputs from two WHO Regional Office and five WHO headquarters technical experts, collaborated with counterparts in the Ministry of Health (MOH) to organize national stakeholder consultations around HPV immunisation. Parents, schools, and institutions across Montenegro were consulted and a draft national action plan was developed. In June 2022, WHO facilitated a multisectoral national dialogue on HPV vaccination. The draft national action plan was presented to attendees including the Minister of Health and Minister of Education, and consensus was generated on HPV vaccine introduction. With the problem of cervical cancer at the forefront, the MOH also decided to resume cervical cancer screening programmes in late 2022. Input from the country’s National Immunization Technical Advisory Group (NITAG) was crucial in driving the process forward. WHO had invested in strengthening NITAGs in Montenegro and other middle-income countries of the WHO European region for many years through training, technical support, and peer-to-peer learning. This included a 2019 training held in Montenegro for NITAG representatives from nine middle-income countries. To build sufficient technical capacity for vaccine administration at the subnational level, in October 2022, WHO trained 35 trainers from the MOH and other institutions.

The circulation of false or misleading information or infodemic in Montenegro was boosted by the COVID-19 pandemic, contributing to heightened vaccine hesitancy and lack of trust in health authorities. There was a risk that HPV vaccine hesitancy would be further intensified given that HPV virus is sexually transmitted, and HPV vaccine is ideally administered before the onset of sexual activity. To ensure uptake of the vaccines, it was necessary to ensure that parents understood the need for the vaccine as a proven intervention for cancer control. A communications expert from the WHO Regional Office created messages tailored for Montenegro’s cultural context, based on the data collected during the stakeholder consultation.

“The COVID-19 pandemic demonstrated that effective communication is a pillar of a strong response. Clear communication helps to counter any myths or misunderstandings, as well as build understanding and trust. The same is true for the HPV vaccine - to have a successful vaccination campaign, effective communication between healthcare providers and patients is essential”

-          Dr sci med. Mina Brajovic, Head of WHO Montenegro

On September 26, 2022, the HPV vaccine was rolled out in the country, targeted towards 9-year-old girls. The vaccine is expected to dramatically reduce the cervical cancer morbidity and mortality within a generation. By mid-November 2022, 654 doses had been administered, covering 13.07 percent of the target population. On October 28, 2022, WHO met with the National Health Parliamentary Committee to discuss issues related to health and well-being, and a political declaration on Universal Health Coverage was adopted. WHO continues to work with the government of Montenegro to strengthen HPV vaccination programmes. One of the major strengths of the approach taken so far has been the use of local instead of international experts, which has led to increased ownership, commitment, and institutional capacity that is likely to be sustained into the future.

* age-standardized estimate