When Lela Bakradze began her career as a medical doctor in Georgia over 40 years ago, there was no vaccine to protect against high-risk types of human papillomavirus (HPV), which can cause cervical and other cancers.
“HPV vaccination didn’t exist when I started my medical career back in the early 80s. It’s a miracle that today we can consider cervical cancer as a largely preventable cancer,” she says.
Lela reflects on one of the biggest developments in the field of vaccination over her long career. After becoming a doctor, she worked for the International Federation of Red Cross and Red Crescent Societies, the Georgian Red Cross Society and the United Nations Population Fund. Today, her focus is on social rights in Georgia, particularly among older populations.
“Vaccination has been very relevant to my career, and it’s still close to my heart as a public health issue of growing importance for people aged 65 plus.”
Benefits for older people
Lela cites the growing evidence that vaccination is not just linked to preventing infectious diseases but can also reduce the burden of some noncommunicable diseases, such as cancer and cardiovascular diseases, and even has an impact on rates of dementia.
“Vaccines have been evolving during the last decade, and now also make a huge difference to the lives of older adults,” she continues. “This information must be provided to populations, to target the groups who can benefit from this triumph of science.”
Within Georgia’s national immunization calendar, for example, hepatitis B vaccination of infants helps prevent chronic hepatitis B infection, which is a major factor in liver cancer.
HPV vaccination, which in Georgia is part of the national immunization calendar and recommended for both adolescent girls and boys, has led to plummeting rates of HPV infection, pre-cancerous lesions and, over time, also cervical cancer in countries with high uptake.
Lela is keen to see barriers to vaccination for frail older people removed, as well as more research into vaccine acceptance. “Clinicians’ recommendations have a strong influence, so we need to specifically train and empower our health professionals to confidently counsel and advise, especially older adults regarding vaccination,” she notes.
Tackling misinformation
Lela says a lot still needs to be done to identify the patterns and barriers that guide attitudes to vaccination within different communities and societies in order to tackle vaccine hesitancy and uncertainty, especially among younger generations.
Despite the widespread availability of HPV vaccination, including catch-up vaccination for those beyond the targeted age, many in Georgia do not take the opportunity to get protected, largely due to a lack of awareness of its important role in preventing cancer or misinformation about the vaccine.
“With HPV, it’s not only about access anymore, but also about generating demand for vaccination,” Lela explains. During the coronavirus disease 2019 (COVID-19) pandemic, she worked to confront the tide of misinformation about the COVID-19 vaccine, promoting vaccination among pregnant and breastfeeding women through developing online and printed information materials. “We published more than 30 000 copies of brochures aimed at pregnant women in Georgia, including ethnic minority communities,” she says.
“In Georgia, although there are gaps and regional disparities, routine childhood immunization coverage is relatively high overall, so people perceive that those vaccines are safe, but then many people mistakenly believe that the HPV vaccine is not safe, or that the COVID vaccine is not safe.”
She urges those who have been protected by vaccines to speak up about their experiences to increase trust. And, despite the challenges, she remains positive about the prospects of vaccination to enhance health, throughout the life course of future generations.
“I’m very optimistic for prospects for vaccination, because it is one of the most effective public health interventions so far that humankind has invented.”
Behavioural insights research in Georgia
Nationally, HPV vaccination uptake was below 30% for both girls and boys in 2024, with coverage varying widely across regions. A qualitative study gathering behavioural insights was conducted with support from WHO/Europe in areas of Georgia with low routine immunization coverage, including for HPV, between February and July 2023. The study aimed to identify barriers to and drivers of routine vaccination uptake.
The study uncovered various factors contributing to suboptimal vaccination uptake, including a lack of vaccine confidence among some health workers (especially related to HPV vaccination), low awareness or misconceptions among caregivers and challenging environmental factors. The results were used to develop tailored interventions to increase vaccination coverage focused on improving tracking and reminder systems, the capacity-building of health workers and addressing caregiver needs.