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. Only the United States, Austria, Canada and Australia and around 10 other countries recommend vaccination for males as well. Australia was the first country to implement a comprehensive vaccination programme for all boys aged 12/13.
In the UK, it has been argued that it is only necessary to vaccinate girls aged 12/13 because, once vaccination take-up exceeds 80%, ‘herd protection’ ensures that boys are automatically also protected against HPV infection. The UK vaccination rate for girls currently exceeds 80% and it is therefore not seen as cost-effective to extend the programme to boys.
But the case for vaccinating both sexes is stronger:
In several areas within the UK, such as London, and in certain ethnic and religious groups, the vaccination rate for girls is well below 80% and herd protection is therefore less likely to exist in those communities. This leaves both males and females at risk.
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. With each year that passes, about 400,000 more boys are being left unprotected by vaccination.
Men can still 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.
Men who have sex with men (MSM) are still at a high risk of exposure to HPV infection because they are completely outside the vaccinated ‘herd’. 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 alreday have acquired HPV.
There is a growing trend for more affluent and informed parents to vaccinate their sons privately. This could exacerbate existing inequalities in cancer incidence between richer and poorer social groups.
An increasing number of clinicians, public health professionals and patient organisations in the UK are recommending routine HPV vaccination for boys. As well as HPV Action’s 50 member organisations, Cancer Research UK and the BMA now support vaccinating boys.
The current cost-effectiveness analyses do not include the full range of economic costs as they focus on the costs to the NHS of treatment. They also ignore the human costs to individuals and their families and friends. HPV Action estimates that the cost of adding boys to the HPV vaccination programme would be about £20-22 million a year and probably significantly less than this.
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.
The case for vaccinating boys is also very clearly set out here:
HPV Action, Jabs for the Boys: The case for gender-neutral HPV vaccination (February 2016).
