The UK took a huge step last month when it introduced human papillomavirus (HPV) vaccination for men who have sex with men (MSM) under the age of 45 which is now available on the NHS [1]. However, this huge step for the UK still leaves us lagging behind our colleagues down under in Australia where routine HPV vaccination for all men was introduced alongside the female vaccination regime in 2013 [2]. This begs the question – should all men be vaccinated against HPV in the UK?

HPV vaccination is given to women in the UK as part of the childhood vaccinations programme. HPV is responsible for well over 70% of all cervical cancers and is the cause of most genital warts [3]. The rationale for giving the vaccine to women is therefore clear, and the vaccine is highly effective in women [4].

However, HPV also has a strong link with oropharyngeal and anal cancers which also affect men. The move to vaccinate MSM is essential in increasing herd immunity amongst MSM, although heterosexual men rely on female immunity.

To try and decode this debate, here is a summary of the main arguments around the vaccine being introduced to all men:

Benefits:

• HPV infection is common in heterosexual men, who are currently the only group not covered by the vaccine [5]
• The vaccine has been shown to be safe and effective for use in men [2]
• The vaccine would likely be easy to implement due to the infrastructure for females already being in place
• The vaccine would likely reduce the burden and psychosocial impact of HPV-related anal and oropharyngeal cancers as well as genital warts
• Would contribute to overall herd immunity

Barriers:

• Questions have been raised over the cost-effectiveness of vaccinating all men [6]
• Vaccinations in general remain controversial since the MMR scandal of the 1990s
• Little data is available showing a real world application of the male vaccination programme (Very little data is available from Australia, but the literature released shows reduction in HPV infection in men but it is likely too soon to hear about reduction in long-term consequences [7])

To me, the answer is simple. All men should be given the HPV vaccine. The literature indicating the downsides to the vaccine’s introduction is limited. In the coming years data should become available indicating the cost-effectiveness and benefit of the vaccine’s use in men. Until then, a suitable intermediate step is the use of the vaccine in MSM. The future remains bright for the HPV vaccine!

References 

[1] Department of Health and Social Care. 2018. ‘HPV vaccination programme for men who have sex with men.’ Available from: https://academic.oup.com/jid/article/210/2/192/2908545 [Accessed 01/06/18]

[2] Brill, D. ‘Australia launches national scheme to vaccinate boys against HPV’ British Medical Journal, 2013;346:f924. [Accessed 01/06/18]

[3] World Health Organisation. 2018. ‘Human papillomavirus (HPV) and cervical cancer’ Available from: http://www.who.int/news-room/fact-sheets/detail/human-papillomavirus-(hpv)-and-cervical-cancer [Accessed 02/06/18]

[4] Garland, S. et al. ‘Impact and Effiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience’ Clinical Infectious Diseases, 2016;63:4 [Accessed 11/06/18]

[5] Duarte Moreira, E., Giuliano, A. et al. ‘Incidence, Clearance, and Disease Progression of Genital Human Papillomavirus Infection in Heterosexual Men’ The Journal of Infectious Diseases, 2014;210:2. [Accessed 02/06/18]

[6] Wise, J. ‘Teenage boys shouldn’t be given HPV vaccine, says joint committee’ British Medical Journal, 2017;358:j3523. [Accessed 03/06/18]

[7] Lee, L., Garland, S. ‘Human papillomavirus vaccination: the population impact’ F1000 Research, 2017; 6:866. [Accessed 11/06/18]