Data from Public Health England highlight how the UK’s national cervical cancer vaccination programme has greatly reduced the prevalence of human papillomavirus (HPV) in young women, providing encouragement for a future reduction in cervical cancer mortality. HPV, however, is implicated in other cancers in both sexes (eg, oropharyngeal and anal cancer), and HPV infection also causes genital warts in both sexes. HPV-related oropharyngeal cancer is the cancer with the fastest growing incidence in the UK, and is soon to become more common than cervical cancer in the USA. Given the results of the Public Health England study, a gender-neutral vaccination programme would provide substantial protection for the overall UK population.
Boys and girls are vaccinated as part of a universal strategy in an increasing number of countries, which now includes Australia, Austria, Bermuda, Brazil, Canada, Croatia, Germany, Israel, Italy, Lichtenstein, New Zealand, Serbia, and the USA. However, despite mounting evidence and support from clinical, scientific, and patient advocacy communities, the UK has been slow to move towards universal HPV vaccination. The Joint Committee on Vaccination and Immunisation (JCVI) has been considering the merit of a universal vaccination strategy since 2013, but issues such as putative herd immunity and cost-effectiveness were cited as reasons to postpone vaccination of adolescent boys.
Herd immunity for boys will only occur in areas where rates of female vaccination are high (≥80%). Substantial reductions in female vaccination rates have occurred in Denmark, Japan, and, most recently, Ireland (51% uptake), although a high-profile government campaign led to vaccination rates in Ireland increasing to more than 60%. Uptake in the UK varies substantially by region (eg, a 48% uptake in Stockton-on-Tees compared with a UK average of 83%). Herd protection will not protect men who have sex abroad or with older unvaccinated women.
Our findings and those of others have indicated that universal vaccination can deliver substantial health economic benefits. An analysis also indicates that the mathematical modelling studies underpinning policy recommendations regarding universal HPV vaccination might have been flawed. The additional cost of vaccinating boys in the UK would be £20–22 million annually at most (<0·02% of the UK National Health Service’s annual budget). However, this cost is offset by the annual costs of treating genital warts (about £58·5 million), HPV-related oropharyngeal cancer (>£21 million), and anal cancer (about £7 million). Wider economic benefits (increased productivity and earnings, enhanced tax revenue) would also ensue. Thus, universal vaccination can save lives and yield economic savings for our health-care system.
The mounting evidence has led to the JCVI finally recommending a universal HPV vaccination strategy. Although the Departments of Health in England, Scotland, and Wales have now indicated their willingness to vaccinate boys and girls on the basis of the JCVI recommendation, the Department of Health in Northern Ireland has been disappointingly silent on the issue to date. It is crucial that this decision is implemented rapidly and equitably across the UK to spare the approximately 400 000 adolescent boys each year who are left unprotected against the serious life-threatening and health-debilitating diseases that result from HPV infection.