Vaccines against human papilloma viruses (HPV) have been freely available to girls in many countries for a decade. The vaccines have reduced the number of cases of HPV infection, which is expected to translate into fewer cervical cancer deaths in decades to come.
Several countries, including Australia, Italy and Serbia, have decided to extend their national HPV immunisation programmes to boys. Experts believe this will reduce the spread of the viruses in the community and offer boys direct protection against head and neck cancers.
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Some health authorities have hesitated to include boys in the HPV prevention programme while they study whether the benefits are enough to justify the added costs.
In the UK, the Joint Committee on Vaccination and Immunisation (JCVI) – a panel of experts that advises the government – had previously questioned the value of universal HPV vaccination, suggesting that high levels of vaccine uptake among girls might sufficiently protect most citizens.
In Scotland, a vaccine programme dedicated to men who have sex with men (MSM) was introduced in 2017. However, some campaigners have expressed concern that this was not adequate to protect all boys and men.
To help reach an informed decision, the UK’s JCVI commissioned sophisticated modelling research to explore the public health impact and cost-benefit ratio of universal vaccination. Based on this new data, it concluded at its July meeting that a ‘gender neutral’ programme would be the best option for protecting the population.
UK Public Health Minister Steve Brine responded by announcing funding for extending the vaccine programme to boys in England. ‘The HPV vaccine for girls is already expected to save hundreds of lives every year and I am delighted that we will now be protecting even more people from this devastating disease by extending the vaccines to boys,’ he said.
Dr Mary Ramsay, head of immunisations at Public Health England (PHE), said she was pleased by the news and expended strong uptake among adolescent boys. ‘Almost all women under 25 have had the HPV vaccine and we’re confident that we will see a similarly high uptake in boys,’ she said.
Vaughan Gething, Health Secretary for Wales, and Joe Fitzpatrick, Scottish Public Health Minister, said they would also approve a universal programme. In Northern Ireland, officials have begun preparatory work on extended the programme ‘pending a decision by an incoming minister’.
2019: Ireland rolling out universal HPV vaccination
Meanwhile, the Irish government has said it will introduce HPV vaccination for boys from 2019 following an assessment by the Health Information & Quality Authority (HIQA). Leo Varadkar, Irish Taoiseach (Prime Minster) and Simon Harris, Minister for Health, have agreed to fund the rollout as part of a schools-based programme in September 2019.
The Irish Cancer Society said the move was essential to addressing health inequality. ‘Only boys whose families can afford to and choose to pay as much as €300 for the vaccine currently receive it through their GP, leaving many more unprotected,’ said, Chief executive of the Irish Cancer Society, Averil Power. ‘This is clearly an injustice.’
Earlier this year the Royal College of Physicians of Ireland called for boys to be included in the programme without delay. ‘Unvaccinated boys remain at risk from a range of serious HPV associated diseases that could be prevented by the HPV vaccine,’ said Dr Corinna Sadlier, consultant in infectious diseases at Cork University Hospital. ‘Provision of HPV vaccine for girls only will not fully protect boys and represents a significant health inequality that must be urgently addressed.’
Dr Sadlier was speaking at an RCPI event at which Professor Ian Fraser, an Australian Scientist who helped develop the HPV vaccine, was awarded an honorary fellowship of the college for his contribution to public health. Prof Fraser said HPV vaccination could ‘end cervical cancer within 20 years’. He has called for girls and boys in all countries – including those in developing nations – to be given access to HPV vaccines.
Norway begins universal HPV vaccination
Boys and girls will be vaccinated in Norwegian schools for the first time this year. The decision followed a systemic review of scientific literature on the effectiveness of HPV vaccinating boys, and the cost-effectiveness of introducing universal HPV vaccination.