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 for decades to come.
A group of doctors, policymakers and patients is calling for boys to be included in the programme. Others are not so sure, arguing that successful HPV programmes for adolescent girls would offer significant benefits for boys too: if the viruses are no longer circulating so widely, it may curb cases of HPV-related cancer in men.
Those advocating extending the programme say there are two reasons to consider this option. ‘A gender-neutral HPV vaccine programme could directly benefit males by reducing their risk of head and neck cancer, and it would potentially benefit the entire community by reducing the spread of HPV generally,’ said Dr Robert O’Connor, Head of Research at the Irish Cancer Society. ‘This would further reduce cervical cancers thanks to the herd effect.’
Speaking at a workshop at the European Parliament, Dr O’Connor said the overall incidence of HPV-related head and neck cancers is rising, prompting several European countries to expand their programmes to all children aged 11-12. He emphasised the life-changing effect of HPV-related cancers, adding that treatment for head and neck cancers can have a profound impact on quality of life.
‘Surgery and radiotherapy for head and neck cancers can be hugely debilitating,’ he said. ‘Having part of your neck, mouth or tongue removed, or suffering radiation damage can affect the ability to eat and communicate.’
Dr O’Connor said he had arranged for his own son to have the HPV jab privately, and knows several clinicians who have done likewise. ‘Having looked at all the information on safety and efficacy, I had no problem encouraging my own son to have the vaccine,’ he said. ‘Most cancer doctors I’ve spoken with have had their kids vaccinated because they see how easily this can be prevented.’
However, Dr O’Connor said that while scientists and doctors have the information and resources to ensure their sons are vaccinated, it would be far better if this protection were recommended to all.
Italy protecting boys and girls
Professor Paolo Bonanni, University of Florence, said the case for vaccinating boys and girls continues to strengthen. ‘It has progressively become clear that males are also affected by important and sometimes lethal HPV-related diseases and – unlike women – they are not covered by any screening programme,’ he said. ‘In the meantime, the decrease in vaccine costs and the reduction of the recommended number of doses in adolescents have made HPV vaccination of boys an important and cost-effective measure.’
Professor Bonanni, who is also a member of the Vaccines Today Editorial Board, said several countries – including Italy – have taken the lead by introducing universal adolescent HPV vaccination. ‘My hope is that this crucial preventive tool is soon offered to all adolescents in Europe,’ he said.
While attendees at the workshop made the case for extending the programme to boys, other experts caution against rushing a decision. The number of HPV-related cancers today remains high but few of the individuals developing these diseases now had the benefit of a HPV vaccination programme during their schooldays.
Where female-only HPV programmes have high uptake, this may provide a herd effect that also extends indirect protection to males. This would still leave gay men at risk, possibly requiring a targeted programme for that subpopulation.
As HPV vaccines are relatively new, they are still more expensive than established vaccines against diseases such as measles or tetanus. That is why the budgetary implications of expanding the programme to all are being closely studied.
In the UK, for example, an expert panel has been working with sophisticated mathematical models to determine whether the additional benefits of vaccinating boyss are great enough to justify the costs. Published minutes of a meeting of the group earlier this year show the issue was considered in detail.
Prof Marc Brisson of Laval University, Quebec, presented an analysis of 16 HPV vaccination models. He said that if coverage of girls is above 80%, vaccinating boys brings little additional benefit. ‘Vaccinating boys would only give substantial impact when coverage in girls is very low,’ the report noted. ‘The advantages in vaccinating boys were that you would get a more rapid impact and there is a possibility of even achieving eradication.’ Results of cost-effectiveness modelling are expected in June.