Some 2.5 million Greek women could face long waits in accessing testing for human papillomavirus (HPV), a leading cause of cervical cancer, as a government initiative, financed by the EU, unexpectedly changed the technical requirements for healthcare companies to participate and is set to be scrutinised by the European Commission.

Screening in Greece’s healthcare system has long been a sore subject due to low investments and chronic political indifference to boosting the sector.

The situation started to change after the conservative New Democracy government (EPP) pushed forward the ‘Spyros Doxiadis’ action plan of public health screening, which promoted the screening of breast and cervical cancer, among others.

To speed things up, the government also put the scheme under Greece’s Recovery and Resilience Facility (RRF) in a bid to receive EU funds.

The breast cancer screening, which pre-existed under the “Fofi Gennimata” programme – named after the late leader of the socialist Pasok party, who personally battled with the disease – is working smoothly, and according to data, 300,000 women have already participated.

However, the cervical cancer prevention programme is facing challenges.

Changing technical requirements

The cervical cancer prevention programme, earmarked for 2.5 million women aged 21-65, was voted as a bill and was published in the Greek government’s official journal in July 2022.

Four months later, in November, the government provided the particular technical requirements for companies and laboratories to participate in the project, but the National Organisation For Health Care Services (EOPYY), which was in charge of implementing the project, suddenly put it on hold with no explanation.

The move was a surprise as companies and laboratories had already started investing in the required diagnostic equipment based on the bill’s technical requirements.

On 15 March 2024, the government published a new note about the project in the official journal, changing the technical requirements and creating a tailor-made approach for a company which produces a specific HPV DNA medical device, according to sources in Greece’s healthcare market who contacted Euractiv.

The same sources said that in addition to competition distortion, the limitation to just one medical device does not make sense from a scientific point of view, considering that other medical devices existing in the market could have the same results.

Moreover, the new technical requirements will significantly limit women’s access to screening as only large laboratories can carry out examinations.

When contacted by Euractiv, the Greek Health Ministry did not answer questions about why the project was suddenly halted or why the technical requirements were changed.

Under EU scrutiny

Meanwhile, the issue has sparked concerns in Brussels as it is funded by the EU Recovery Fund, which the EU Court of Auditors recently issued warnings about.

The EU’s auditing body warned that the European Commission’s strategy of relying on member states to ensure that the money of the pandemic recovery fund is properly spent is heightening the “risk of irregularity or even corruption”.

Commenting on the Greek project, an EU source told Euractiv that the completion of all the projects linked to “Spiros Doxiadis National Public Health Prevention Programme” will be assessed by the Commission in the context of milestone 165, which is part of Athens’ ninth payment request.

“As is the case for all milestones and targets, we do not speculate on the outcome of our assessment. We will only communicate on this matter once Commission services have completed their assessment and it has been adopted,” the EU source said.

The source added that decisions for awarding contracts, including those related to milestones under the Greek plan, fall within the remit of the relevant Greek authorities and national courts in cases where involved parties resort to judicial review to resolve disputes related to public procurement tenders.

“Likewise, the primary responsibility to ensure compliance with EU and national rules on public procurement lies with the member states […] Pursuant to the RRF Regulation, the Commission verifies that member states fulfil their obligations,” the source noted.

The EU source explained that the latest assessment in 2023 was “overall adequate” but stressed that the EU executive would continue to treat “every information or complaint we may receive within the scope of the powers foreseen under the EU Treaties and the RRF Regulation”.

Competition rules apply in RRF

Moreover, the EU source told Euractiv that competition rules “fully apply” to the measures funded by the RRF.

According to the rules, the source said the Commission can ask for additional information and carry out checks and on-the-spot controls to verify the completion of milestones and targets.

In case of fraud, corruption or conflicts of interest, the member states’ authorities must first correct these issues and then recover any affected funds.

“If the member state fails to initiate such corrections, the Commission will recover the funds,” the EU source warned, adding:

“In any case, OLAF, the Court of Auditors, the European Public Prosecutors Office and the Commission itself may access relevant data and investigate the use of funds if necessary”.

A long-term HPV plan is still missing

For Theodoros Agorastos, a medical professor and president of the Hellenic Society for Research and Treatment of the Papilloma Virus, the government’s initiative goes in the right direction but still falls short of the long-term perspective.

“It is an action, not a long-term and continuous national programme. A screening programme should be without an end date and with guaranteed funding,” the professor told Euractiv, saying that after 31 December 2025, the service will no longer be active.

“Women who will be tested once and those who are found positive will be able to do further tests […] but for the large mass of those tested negative, it’s unclear when they will be tested again,” he added and urged for a national plan, pointing out that “Sweden started relevant national programmes in the 1960s”.

According to various surveys, the percentage of women positive for HPV is around 7-8%.

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