Despite HPV’s impact on the health of both sexes, most countries’ HPV immunization programmes are exclusively for females. In the UK, girls aged 12/13 have been vaccinated routinely, mostly via a school-based programme, since 2008. Australia was the first country to implement a comprehensive vaccination programme for all boys aged 12/13 and now around 20 countries either vaccinate boys or plan to do so.
The UK has now decided to vaccinate boys but no start date for the programme has been announced. HPV Action is pressing for this to be in September 2019.
The case for vaccinating boys as well as girls is very strong:
Men can acquire HPV from sexual contact with women who have not been vaccinated. These are most likely to be women from countries with no or only a limited vaccination programme for girls.
In several areas within the UK, and in certain ethnic and religious groups, the vaccination rate for girls is well below 80% and men in these areas are therefore much more likely to be exposed to HPV.
Men who have sex with men (MSM) are at a higher risk of exposure to HPV infection because they are completely unprotected by a girls-only vaccination programme. Rates of anal cancer are rising among men generally but especially among MSM. In fact, the incidence of anal cancer in this group is estimated to be similar to that of cervical cancer in an unscreened population of women. It is not practicable to offer HPV vaccination to MSM only because, to be most effective, the vaccine must be administered before sexual ‘debut’ (i.e. by age 12/13) and questioning boys of this age about their sexuality would be both unethical and unreliable. The current policy in the UK is to offer HPV vaccination to MSM attending sexual health clinics but this is 'too little, too late': the average age of first attendance of a MSM at a clinic is 32 years by which time he will probably already have acquired HPV.
HPV Action estimates that, each year in the UK, around 2,000 men develop a cancer caused by HPV and over 40,000 develop genital warts. In the absence of a gender-neutral vaccination programme, with each year that passes, about 400,000 more boys are left unprotected.
There is a growing trend for more affluent and informed parents to vaccinate their sons privately. This will exacerbate existing inequalities in cancer incidence between richer and poorer social groups.
Vaccinating only girls helps to perpetuate the belief that the primary responsibility for health, especially sexual health, should be borne by females. Preventing ill-health should actually be a responsibility shared by both sexes.
Not vaccinating boys could well be unlawful on the grounds that it is sex discrimination against boys.
