Despite HPV’s impact on the health of both sexes, most countries’ HPV immunization programmes are exclusively for females. In the UK, girls 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 and now over 30 countries either vaccinate boys or plan to do so.
After a five-year campaign led by HPV Action, gender-neutral vaccination began in the UK in September 2019. All boys and girls in Year 8 in England and Wales, Year 9 in Northern Ireland and S1 in Scotland should be offered the vaccine at some point during the 2019/20 school year.
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. Over 15% of UK girls are not vaccinated so the risk to boys is not negligible here either.
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 or groups are therefore much more likely to be exposed to HPV.
Vaccinating boys protects unvaccinated girls. If the vaccination rate in girls should fall, perhaps because of an unfounded safety scare, vaccinated boys would make the national vaccination programme as a whole more resilient.
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 man who has sex with men 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. If there was no gender-neutral vaccination programme, with each year that passed, about 400,000 more boys would be left unprotected.
There has been a growing trend for more affluent and informed parents to vaccinate their sons privately. If there was no national vaccination programme for boys, this would 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 them.
There is no good evidence that boys (or girls) suffer any serious or long-term side-effects as a result of vaccination. HPV vaccination is extremely safe.
HPV Action is now pushing for a catch-up vaccination programme for boys. This would ensure that boys who are too old to be vaccinated as part of the main vaccination programme are still offered protection against HPV infection before they are 18. Most of these boys could be vaccinated at school or college.
