We are not taking full advantage of the HPV vaccine. Here’s why

This article is brought to you thanks to the collaboration of The European Sting with the World Economic Forum.

Author: Alicia Patterson-Waites, Coordinator, Network and Partnerships, World Economic Forum

• The human papillomavirus (HPV) has a serious impact on sexual and reproductive health everywhere.
• Universal access to vaccination is critical to preventing most cases of HPV-attributable cancer, but the strong gender bias towards women in HPV immunization campaigns ignores male disease carriers.
• Including all children and adult genders in HPV immunization programmes helps protect all populations, including minorities, LGBTI, transgender men and MSM community members.

The human papillomavirus (HPV) is one of the most common viral infections and has a serious impact on sexual and reproductive health everywhere. It is responsible for 630,000 infections and 4.5% of cancers globally. The World Health Organization (WHO) reports an estimated 300 million women have an HPV infection worldwide, which is the primary cause of cervical cancer and anal cancer among men who have sex with men (MSM).

While universal access to the HPV vaccine is widely available, most research and immunization only targets women, despite men being carriers of the disease. Awareness, prevention and control measures of the virus are often directed towards the female population, possibly as a result of a lack of knowledge and potential taboo in the male population.

The gender bias towards women

Although women are at a higher risk of contracting cancers from HPV than men, namely cervical cancer, studies suggest a significantly higher prevalence of the HPV virus in men than women.

A gender bias is defined by Cornell Law as a person receiving different treatment based on that person’s real or perceived gender identity. The strong gender bias towards women in HPV immunization campaigns ignores male disease carriers and their risk of developing cancers, warts and other diseases particularly common in MSM communities, including anogenital and oropharynx (throat) cancers. Anal cancer is one of the most common cancers affecting immunodeficiency virus positive (HIV+) individuals and leaves them susceptible to multiple HPV infections and prolonged viral persistence.

While the male population often cure themselves of HPV-related infections over time, they remain largely asymptomatic and carriers of the disease. This means they are unlikely to be screened or tested for HPV and they may infect anyone they have intimate relationships with along the way. This represents risks for both male and female populations. As a result, researchers’ findings support broadening HPV vaccine coverage and increasing surveillance in the male population.

A cervical cancer public health campaign Image: WHO

Universal access to vaccination is critical to preventing most cases of HPV-attributable cancer. Raising awareness and routinely vaccinating male populations of ages 9 to 26 against HPV would provide substantial public health benefits and is a cost-effective method for protecting all genders from contracting HPV-associated diseases. All countries are affected by HPV, but the incidence rate remains high in low and middle-income countries, whose populations account for nearly 90% of deaths worldwide from the disease.

Another area of concern is that studies to date have focused mainly, and often exclusively, on women. More inclusive studies should be undertaken concerning HPV. The vaccine should be encouraged for all members of the community. Recently there has been a slight change in culture towards more openness in gender identification and recognition, which would also benefit future awareness campaigns.

Achieving full immunization of the illness requires both male and female populations to be vaccinated, so why are we only promoting it for young girls and women? To close the gender gap between immunized girls and boys, a public health campaign should be directed towards the male population and their role in the spread of HPV between partners.

Family doctors and schools should have immunization campaigns and push for boys to be vaccinated. This would help break down taboos associated with HPV, including anogenital and oropharyngeal cancer risks from HPV, usually associated with those in the LGBTI communities. It would also result in an improved quality of life from its preventative properties towards genital warts in men.

Researchers possibly have a preference towards studying female populations owing to their high prevalence of cervical cancers. Screening and immunization programmes are already in place, making it easier to recruit participants and conduct retrospective and prospective research.

Include all genders in research and immunization programmes

Including all children and adult genders in HPV immunization programmes helps protect all populations, including minorities, LGBTI, transgender men and MSM community members.

The vaccine is administered at age nine (before sexual activity begins) at school or by the family doctor, but parents often remain hesitant. Johns Hopkins Medicine found that parents are worried about safety, lack of necessity, lack of knowledge and an absence of physician recommendation. They assume their children are not sexually active and, lacking awareness, are concerned about the necessity for boys to be vaccinated.

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Additional funding and support in all-gender patient recruitment through records or factors encouraging patients to enter research should be made available.

The WHO proposes a global strategy to eliminate cervical cancer that will require political support from international and local leaders, coordinated cooperation among multi-sectoral partners, broad support for equitable access in the context of universal health coverage, effective resource mobilization, health system strengthening and vigorous health promotion at all levels.

Increasing health awareness education of HPV will boost vaccination rates and help young boys understand the importance of protecting themselves as well as their female counterparts. Eliminating cervical cancer also depends on a global effort to ensure supply meets demand of the HPV vaccine.