A science-fiction mystery featuring five friends, an old photograph and a forgotten character is being used to raise awareness about human papillomavirus (HPV). The comic, titled The Fifth, was presented at the 60th edition of Lucca Comics & Games and uses friendship, algorithms and a futuristic social scoring system to introduce a public-health message: understanding a virus can help people prevent its consequences.
The project reflects the growing interest in graphic medicine, a field that uses comics, graphic novels and illustrated narratives to explain diseases, treatments and prevention. The term was coined in 2007 by British doctor and cartoonist Ian Williams. Since then, the approach has attracted healthcare professionals, psychologists, researchers, artists and communication specialists.
Graphic medicine is not limited to simplifying complex medical information. Comics can also depict fear, uncertainty and the difficulties of living with illness, using characters, dialogue and emotions to offer a perspective different from that of conventional scientific explanations.
Evidence about its effectiveness is developing. A review published in the International Journal of Environmental Research and Public Health examined 34 randomized studies involving comics in different healthcare settings. The findings suggest that graphic medicine can improve health knowledge, encourage patient engagement and, in some circumstances, support more informed behavior.
Carlo Signorelli, professor of Hygiene and Public Health at Vita-Salute San Raffaele University in Milan, said comics can make scientific concepts more accessible, improve memorization and reach audiences that traditional communication often struggles to engage. However, he stressed that comics should complement rather than replace health information, and that their content must remain scientifically accurate.
A study in Nigeria involving 396 girls aged between 9 and 14 found that an educational intervention including an HPV comic increased knowledge about the virus. The proportion of participants who considered the vaccine safe rose from 62% to 81%. Researchers did not, however, find a statistically significant link between the increase in knowledge and vaccinations received.
Another review of strategies to increase childhood MMR and HPV vaccination rates gave high effectiveness ratings to multicomponent approaches, including comics. Caterina Rizzo, professor of Hygiene and Preventive Medicine at the University of Pisa, described the overall evidence as encouraging but not conclusive: comics appear to improve knowledge and intentions, but there is not yet direct proof that they increase vaccination coverage.
The format may be particularly useful for adolescents and young adults, who do not always seek health information independently. A story can place medical information in a recognizable context, while images, expressions, symbols and sequences allow readers to connect facts with the experiences of the characters.
Rizzo noted that attracting attention is different from producing a concrete health decision. Learning about HPV, related cancers and vaccination is only the first step. The desired progression is to discuss the topic with a doctor, get vaccinated and attend screening when recommended.
In Italy, HPV vaccination is recommended and offered free of charge to girls and boys around 11 and 12 years of age. The standard schedule consists of two doses given six months apart. When vaccination begins after the age of 15, three doses are required. Young people who are already sexually active may still benefit, although protection is greatest when vaccination takes place before possible exposure to the virus. Unvaccinated girls can request vaccination up to their 25th birthday, while unvaccinated boys can do so until they turn 18, according to the information provided in the project. Families are advised to contact their family doctor, local health-authority vaccination centres or regional health-information services.
The Fifth was created through a collaboration between MSD and Lucca Comics & Games, with the aim of reaching young adults. Peach Momoko designed the cover, Luca Enoch wrote the script, and Giacomo Bevilacqua and Paolo Barbieri worked on the illustrations.
The story is set in a future where a digital score called “SCORE” determines people’s social success. When four old friends meet again, a photograph revives the memory of a fifth member who appears to have been forgotten. The mystery eventually leads the characters back to a past episode connected with HPV and to a promise to learn more about prevention.
Enoch said the challenge was to create a story that worked as a narrative first, without making the educational message too obvious. The comic therefore introduces medical themes through the characters’ experiences rather than presenting a complete medical lesson. It was distributed free of charge during the festival, with further information available through hpvitalia.it and the Lucca Comics & Games app after the event.
HPV is a common infection that often causes no symptoms and is eliminated spontaneously by the immune system in most cases. When infection with certain high-risk HPV types persists, it can contribute to the development of cancers, particularly cervical cancer, as well as cancers of the anus, penis, vulva, vagina and oropharynx.
According to the information presented with the project, more than 5,700 HPV-attributable cancer cases are estimated in Italy each year among men and women. Signorelli stressed that HPV is not exclusively a women’s health issue and that vaccination is an important preventive tool, especially before exposure to the virus.
Vaccination and recommended screening are separate prevention measures. In particular, cervical screening remains important for women after vaccination. The effectiveness of a comic-based campaign must therefore be assessed not only by the number of copies distributed, but also by whether readers understand the information and act on it.
Rizzo said evaluation could include measuring distribution and digital engagement, followed by questionnaires before and after reading and again several weeks or months later. These assessments could examine changes in HPV knowledge, perceptions of vaccine risks and benefits, and intentions to discuss vaccination with a doctor.
Recent research on HPV education for young adults indicates that knowledge and intentions increase after communication interventions, and that stronger intentions are associated with higher vaccination coverage. Comics may therefore serve as an accessible entry point to health information, helping readers begin conversations about HPV and prevention without replacing medical advice or scientific guidance.
Sources: Focus.it.