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 recommend vaccination for males as well. In 2013, Australia became 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. It is also argued that there is no definitive clinical evidence that HPV vaccination protects against head, neck or penile cancers.
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.
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. If no change is made to the vaccination programme, there will be a growing inequality in the incidence of anal cancer between MSM and heterosexual men.
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.
Scientific and medical opinion now largely believes that HPV vaccination will be proven to prevent many cases of head, neck and penile cancer. 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 45 member organisations, Cancer Research UK now supports vaccinating boys as well as girls.
The current cost-effectiveness analyses do not include the protective effect of HPV vaccination against head, neck, anal and penile cancers.
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.
The case for vaccinating boys is also very clearly set out here: