preventing the HPV infection. The decision to introduce the HPV vaccine in more or less the same time with the cervical cancer screening campaign also represents excellent opportunity to integrate these two prevention methods in terms of health promotion and education strategies. However, having in mind the economic aspects of the strategy for HPV vaccination as described in this research, one could not avoid the question whether this approach is not too expensive for a country with an income level of Macedonia. Only the purchase of the doses of the vaccine necessary for the population vaccination program, is expected to cost 2,4 million EUR, which, as a comparison, accounts to almost 2% of the total budget of drugs and medical consumables. Additional financial burden was the design of the pilot vaccination phase, which happened before the official decision for introduction of the routine vaccination took place. Although regarded by some as a “catch-up” campaign (I_10_TG_SK), the design of this ‘pilot vaccination’ does not really resemble the design of the catch-up campaigns in the other European countries. The pilot vaccination in Macedonia initially indeed aimed to offer equal opportunities to the girls of the older age groups and included the girls aged 9-26, as per the examples in some other countries. However, the best practices show that the “catch-up” campaigns are initiated in parallel timelines with the routine vaccination and take place in a course of few years (NHS 2009; King et al. 2008); however in Macedonia it took place in a short period of time of only 2 weeks, and was performed on a “first-come-first-served” basis, due to the low envisaged coverage (the resources were envisaged to cover 4.500 girls, which represent ~ 2% of the target population). This fact directly compromised the goal to offer equal opportunities for this vaccine to all girls. Therefore, the more appropriate term for this program would be “pilot vaccination” or “HPV vaccination promotion campaign”, aimed at investigating the expected response level among the population, as stated by high level politicians as well (M_А1_Vacc_27.11.’08). The research could not identify any economic evaluation performed as part of the planning stage of the process, which could have contributed significantly to justification of the decisions for implementing of the vaccination and its specific delivery strategies. This can be taken as an example of the lack of scientific approach to the priority setting in health in Macedonia. Although seemingly much less important than the previously discussed points related to the HPV vaccination, the counseling of the girls and women plays an important role in sustaining the “rights-based” approach of the strategy. Paying particular attention to informing and motivating women to attend the screening programs, even if they have been vaccinated, would be crucial in alleviating the possible, very serious side effect of the vaccination in terms of offering the vaccinated girls a false sense of security, resulting in lower attendance at screenings, and reduced effectiveness of the existing screening program. Keeping the continuous attention to the importance of the control of risk factors is of great significance as well.
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