He was interviewed on 15 June 2015 at DKFZ by Peter Baker, HPV Action’s Campaign Director.
Why do you believe it is important to vaccinate boys as well as girls?
First of all, because in virtually all societies, men aged between 15 and 40 have more sexual partners than females of the same age group so they are very actively transmitting the virus. Secondly, the papilloma viruses are linked to some tumours that occur in males, and sometimes more frequently in males. These are cancers of the oropharynx, anus and penis. Thirdly, genital warts are an unpleasant problem for both genders that frequently recurs after surgical removal.
And the fourth reason is that we theoretically have the chance to eradicate these viruses completely if we are able to develop global vaccination programmes. In order to achieve eradication within a foreseeable period of time, I think it’s mandatory to vaccinate both genders. For me, these are ample and sufficient reasons to vaccinate boys and to start to do so as quickly as possible.
Does this argument apply in countries, like the UK, where the vaccination rate for girls is very high?
Those countries with high vaccination rates for girls will have lower infection rates for boys but my feeling is that, even in countries where the vaccination rates of girls exceeds 80%, it would still be very helpful to vaccinate boys as well.
You’ve been quoted as saying that if a country has a one-sex vaccination policy, it makes more sense to vaccinate boys than girls. Why?
I’ve said this frequently because, in most societies, males are the main transmitters of the viruses. Transmission is so effectively mediated by boys that vaccinating boys would actually prevent more cervical cancers. But in a country that doesn’t yet have a vaccination programme, I would strongly recommend that it introduces one for both genders. When I talk about just vaccinating boys, what I’m really trying to convey is the importance of vaccinating both boys and girls.
Is it worthwhile to vaccinate MSM via sexual health clinics, as is now being proposed in the UK?
It’s probably a good idea, although it does depend on the percentage of the population which is made up of MSM. But my gut feeling is that it’s probably better to vaccinate both sexes from the beginning.
Some research suggests that HPV might be implicated in prostate and lung cancer. What do you make of this?
The evidence for a connection is very weak. We have investigated prostate and lung cancers and found one HPV-positive lung cancer, out of 160 samples, in a woman who had previously had cervical cancer but this could have been due to a late metastasis of the cervical cancer. At one stage, we thought we might have found a link with ductal breast cancer but this turned out to be the result of contamination in the laboratory. The evidence of a link with HPV types 16 and 18 is very poor, although we don’t yet know whether unusual types of HPV may be involved because this hasn’t been investigated.
Is there any value in offering the vaccine to older men and women?
Probably yes, especially if the broader-ranging vaccines are used, because the latency period between infection and cancer can be 40-50 years.
Why weren’t boys vaccinated sooner?
Because the vaccine was seen to be just about protecting women against cervical cancer.
What about the cost of the vaccine – should this be a barrier to extending vaccination to boys?
No, because the high costs of the vaccine are not justified and some governments have been able to achieve substantial reductions in prices. All governments should push the vaccine companies to reduce their prices. Sooner or later they will have to do so anyway because their patents will run out.
In Germany, it costs €165 per shot for the bivalent and the quadrivalent vaccine. This is covered by health insurance for 9-14 year olds. Vaccination is provided by GPs, gynaecologists and paediatricians. Here, there’s a reluctance to vaccinate in schools because of fears of state control stemming from the Nazi era.
I also think that it would be worthwhile introducing the new nine-valent vaccine (Gardasil 9) as soon as possible as this will protects against more than 90% of the HPV types found in cervical cancer.
There’s another very interesting development taking place at the moment in Austria. It concerns the development of a kind of chimaeric L2 vaccine that has very broad antigenicity. If it works, and the human clinical trials look very promising, it will protect against almost all the types of HPV infection, both low and high risk, and would in addition probably also prevent some common warts.
Is the vaccine safe?
No vaccine is without side-effects but there’s no good data that shows that the HPV vaccine causes any serious harm. It’s one of the safest vaccines we have. There aren’t currently any significant safety concerns in Germany.
In relation to this, the vaccine companies made a mistake, in my view, in not promoting the role of the vaccine in preventing pre-cancerous cervical lesions and the surgery needed to treat them. Cone cervical biopsies can also lead to pregnancy complications in the future.
What’s your view of the position in the UK?
The vaccination programme for girls is marvellous – it reaches a very high proportion. It’s a fantastic achievement. In my opinion, the vaccination of boys is also of the utmost importance because virus transmission is due to male partners and men are affected by oropharyngeal, anal and penile cancers as well as genital warts.
I wish HPV Action well in its campaign to extend vaccination to boys.
Read more: Professor Harald zur Hausen: Nobel scientist calls for HPV vaccination for boys (The Independent)