OPINION: Girls in Hong Kong Will Get Free HPV Shots. What About Boys?

OPINION: Girls in Hong Kong Will Get Free HPV Shots. What About Boys?
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Hong Kong will vaccinate schoolgirls against HPV. It should vaccinate boys as well.

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In her recent policy address, Hong Kong Chief Executive Carrie Lam announced that schoolgirls in grades five and six would be eligible for free Human Papillomavirus (HPV) vaccinations.

This is absolutely the right thing to do.

We know that HPV is the most commonly transmitted sexually transmitted infection (STI) in the world and affects millions every year. We know that HPV is associated with many different conditions, among them genital warts, cervical, head, and neck cancers, and possibly even cardiovascular disease. We know that one in 10 women who undergo cervical screening in Hong Kong test positive for HPV and that HPV is associated with the vast majority of cervical cancer cases. We also know that the HPV vaccine is safe and effective in protecting against high-risk HPV strains. Vaccinating schoolgirls for free before they potentially get HPV is the right public health decision.

But what about schoolboys? Why are they excluded in this vaccination scheme?

Critics often say that vaccinating girls is enough, that there’s no need to vaccinate boys as well. They often worry about the cost effectiveness of administering the vaccine for free to boys, or the effectiveness and safety of the vaccine in general.

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Credit: Reuters / TPG
Hong Kong's schoolboys are being left out of a nationwide HPV immunization program.

However, to protect the people of Hong Kong from HPV, boys must also be able to access the HPV vaccine easily and affordably.

HPV is transmitted through sexual contact and can easily spread from person to person. The risk of HPV spreading increases along with the number of sexual partners one has. Preventing HPV from spreading among the population is crucial. To do so, we need as much of the population as possible to be immunized to HPV. This protects those who cannot be vaccinated for medical or other reasons (this is known as herd immunity). Vaccinating boys will improve population immunity and ensure that the unvaccinated are also protected from HPV.

Vaccinating boys from HPV also protects them if they’re not a part of the so-called “herd” – such as having sex with someone outside the vaccinated population. Only vaccinating girls also ignores an important high-risk population: men who have sex with men (MSM).

MSM have an increased risk of contracting HPV compared with heterosexual men. Among the many cancers associated with HPV are anal and penile cancers, and MSM are 15 times more likely to get anal cancer compared to heterosexual men. Penile cancers are particularly concerning for Hong Kong as well, with penile cancer rates being up to 20 times higher in Asian men compared to other groups.

Maybe then, one would say we should only offer the HPV vaccine to MSM for free. But how can we tell which schoolboys are or will become MSM, when they themselves are at an age where they are just beginning to discover their sexual identity? And even if we could, is it fair to exclude other boys who may also be at risk of HPV for other reasons?

Penile cancers are particularly concerning for Hong Kong as well, with penile cancer rates being up to 20 times higher in Asian men compared to other groups.

Then there are the questions about the cost-effectiveness of giving the HPV vaccine to boys, with the answers being less clear-cut. It’s hard to say whether it’s worth it from a financial standpoint, with the evidence being mixed. But many of the studies which suggest that vaccinating boys for HPV would not be cost-effective do not account for MSM. Accounting for MSM often tips the balance towards support for the cost-effectiveness of vaccinating boys for HPV.

In any case, more than cost-effectiveness should be considered when it comes to HPV vaccination. Cancers caused by HPV are life-changing, and can affect not only physical health, but psychological and emotional health, with the impact lasting for years.

The HPV vaccine, like any other treatment, has been rigorously tested for both safety and effectiveness. The most common side-effects of the vaccine are similar to any other shot. Countries with a similarly high level of healthcare to Hong Kong such as Canada, Australia and the UK have realized the safety, effectiveness, and benefits of the HPV vaccine and have begun or will soon begin to offer it free for boys. Why not Hong Kong?

We know that the HPV vaccine is effective and safe in both girls and boys and that vaccinating both sexes protects against HPV and associated diseases. Not all boys will have female sexual partners, and vaccinating boys will protect MSM from contracting the most dangerous forms of HPV, which can cause life changing cancers.

Carrie Lam should ensure that schoolboys are also vaccinated and protected from HPV in the future. It is simply the right thing to do.

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Editor: Nick Aspinwall (@Nick1Aspinwall)

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