3 reasons why we should vaccinate both boys and girls against HPV

Human papillomavirus (HPV) is now being reported as the most common sexually transmitted infection. Various types of contact can spread the virus, including kissing.

For the first time, boys as well as girls in the UK will now have equal access to the HPV vaccine, starting this September as part of a government health program. This is an important move for gender equality, offering boys the same protections. Girls in the UK have enjoyed 11 years of exclusive advantage with the introduction of routine HPV vaccination mostly through school programmes in 2008. This new expansion will cover boys aged 12-13 (year 8) free of charge, while boys aged 14 to 18, who will not be covered under this new scheme, will have to pay £150 per dose.

Preventive measures such as condoms may reduce the risk of contracting HPV, but they do not eliminate it. Studies have found that individuals who have a great number of sexual partners were more likely to be high risk for being HPV positive. HPV can also be transferred from a mother to her baby. Most people who are infected clear the virus, as the infection goes away by itself. However, some infections in a small group of people may persist, leading to some cancers.

HPV types are divided into “low risk” and high “risk”: low-risk HPVs are typically responsible for warts, while high-risk HPVs are generally related to cancers. HPV can cause the following cancers: in women, cancers of the cervix (90%), vagina (75%) and vulva (705%); in men, cancers of the penis (65%), anus (90%) and back of the throat (70%), including the base of tongue and tonsils in both men and women. According to the Centers for Disease Control and Prevention in the United States, about 80 million Americans have HPV, and another 14 million are infected with HPV each year, many of them in their teens and early 20s.

The HPV vaccine was first introduced in 2006, with a recommendation to vaccinate girls and women of ages 11 to 26. Now with growing evidence supporting the expansion of the vaccine, many countries are extending its coverage. In June 2019, the Advisory Committee on Immunization Practice at CDC in the United States recommended the HPV vaccine to be given to all boys and young men up to age 26. It also broadened the recommendation to include men and women up to age 45 to seek advice from their doctors about the vaccine.

In addition, Australia has been praised for their fairness in coverage through their implementation of a gender-neutral programme, as it introduced the HPV vaccine for girls in 2007 and for boys in 2013. Other countries already offering boys and girls HPV vaccine are: Austria, Canada, New Zealand and the United States. There are now three types of HPV vaccines available on the market: Cervarix, manufactured by GlaxoSmithKline (GSK), which targets two strains of the virus; Gardasil, manufactured by Merck and first approved by the US Food and Drug Administration (FDA) in 2006; and the expanded version Gardasil 9, which targets nine strains and was approved in 2014.

HPV vaccination school-based programmes in the UK:

England

Girls: HPV vaccine introduced to girls 12-13 in 2008

Boys: to be rolled out 12-13 years olds

Ireland

Girls: currently available to all secondary school girls in their first year of school

Boys: to be rolled out to boys in first year from September 2019

Scotland

Girls: started in September 2008 and routinely offered to secondary school girls from age 11-12 years (S1 to S3 girls). At the start of the programme, girls of ages 13-17 were also offered HPV vaccine through a catch-up campaign that ended in August 2011

Boys: from academic year 2019/20, HPV vaccine will be offered to S1 boys

Wales

Girls: HPV vaccine introduced to girls aged 12-13 in 2008

Boys: boys aged 12-13 to receive HPV vaccine from spring 2020

In June 2019, an extensive review and meta-analysis was published in The Lancet, demonstrating the positive impact of HPV vaccination. Another study involving the University of Strathclyde in Scotland reported HPV vaccine as contributing to the reduction in cervical pre-cancer at a reduction of about 90% in the cancer virus since the launch of HPV vaccination programmes in schools in Scotland about 10 years ago. With undeniable evidence of HPV vaccine’s effectiveness and growing knowledge of male exposure to HPV-related cancer such as anal, penile, neck and throat cancers, HPV vaccination for boys in the UK can prevent and lead to the reduction of HPV-related cancers in the UK by demonstrating that:

1. HPV vaccination programme emphasizes HPV-related cancer prevention. Prevention is the primary aim as it is crucial to HPV reduction. Once an individual has been exposed to HPV virus, it is too late to be vaccinated. Thus, the best time to vaccinate is during early adolescence prior to exposure to the viruses. With women, there is an opportunity for secondary prevention through screening; however, with men there currently exists no recommended screening test to detect the presence and status of HPV virus. Therefore, for the male population, prevention is necessary to prevent HPV-related cancers.

2. HPV vaccination confers herd immunity. As both women and men are carriers of HPV viruses, high vaccination rate confers herd immunity that benefits the population. A study shows that herd protection has been reported for about 81% decline in the prevalence of HPV in vaccinated women from the period of 2006-2017 as vaccination rate went from 0% to 84%. This protection rate is expected to increase with the expansion of HPV vaccine to men.

3. Recent reports have also shown an increase in the proportion of HPV-related head and neck cancers in men, with one study reporting that 78% of people suffering from head and neck cancers were men, and HPV vaccination programme for schoolboys could reduce head and neck cancers in men.

To prevent, control and eliminate HPV related-cancers, it is vital that both girls and boys have equal opportunity and access to prevention schemes.