We’re working very closely with another charity, called NOMAN Is An Island: Race to End HPV, and we’re jointly launching a new initiative on global gender-neutral HPV vaccination. Our aim is to change policy, so we have a target of achieving gender-neutral vaccination worldwide by 2030. We think that’s a very achievable target, and the reasons that we’re doing it are that we’re never going to eliminate all the cancers caused by HPV if we don’t vaccinate boys as well as girls. At the moment, gender-neutral vaccination is delivered, not always very well, but it’s delivered in about 70 countries out of the 140 countries that have HPV vaccination programmes. Of course, that leaves 50 countries with no vaccination programmes at all. We want every country to have a vaccination programme and in all those countries the vaccination programmes to be gender-neutral.
We’re saying that because not only will it accelerate the elimination of cervical cancer, which is obviously very important as it’s the most common cancer, or the cancer most commonly caused by HPV, but we’ll also tackle the other cancers: penile cancer, anal cancer, oropharyngeal cancer, as well as genital warts and other conditions caused by the HPV virus. We’ll tackle them for both boys and girls, men and women. So if we have a universal approach, we’re going to achieve our target of eliminating all the cancers caused by HPV, and we’ll do it much faster.
What is the Manifesto for Gender-Neutral Vaccination about and why is it needed now?
It’s needed now because progress is actually far slower than it should be in terms of eliminating all the cancers caused by HPV. We could do much better if we had a gender-neutral programme, and the opportunity now exists to do this. For a while, we were constrained by issues of vaccine supply: there simply weren’t enough vaccines around. We now have five vaccine manufacturers worldwide. The vaccine supply issue is probably sorted out already, but it certainly will be by 2030, which is our target date, so that is no longer a significant problem.
The other thing that has changed, which is of crucial significance, is that the WHO is now recommending single-dose HPV vaccination programmes. Previously, young people had to have two or three doses of the HPV vaccine. Moving to single dose makes the administration of the programme so much easier, and it also of course halves the cost. Previously where girls were offered two doses, we can now vaccinate both boys and girls for the same cost, with the same infrastructure as we had for delivering two doses to girls.
What is the plan to promote gender-neutral HPV vaccination in LMICs?
This is where the main problem exists. I said before that 70 countries now have gender-neutral programmes. Most of those are high-income countries. Not all high-income countries vaccinate both boys and girls – South Korea, for example, doesn’t – but many, many do. The problem is really shifting to the middle and lower-income countries. Some of those are actually now vaccinating both boys and girls, so we are seeing a trend in the right direction, but in those countries it’s far too slow. So what we need is a change of policy, and we need the political will to actually make it happen in all those countries that currently have vaccination programmes delivered only to girls, but also to bring in those countries that have no vaccination programmes at all. That’s not to say it will be easy. It won’t be easy, but it’s certainly doable, and it’s achievable if the political will is there.
What are some of the obstacles to providing this vaccination?
There are the practical obstacles, in terms of health system capacity, infrastructure, training people to deliver the programme, all the things that already exist with delivering programmes to girls only. And money, of course, finance is a considerable problem as well. But if the political will is there, we can actually do this.
What we need to do is change the way we think about HPV. We need to think about it not just as an infection that causes cervical cancer, but think about all the other cancers that it causes as well, and also to take account of the volume of men, the number of men, who are affected. We’ve seriously underestimated the number of men who have HPV-related cancers. We estimate that about 180,000 men a year worldwide develop an HPV-caused cancer. That’s a number far in excess of the normally accepted or normally stated number. It’s over twice as many. We think there’s been a serious underestimation of the impact of HPV cancers on men. We know that in the United States, for example, about 42% of all HPV cancers are in men, so this is not an insignificant problem. The rates of oropharyngeal cancer in men and penile cancer in men are increasing significantly, and that’s almost entirely down to HPV infection.
Now, just to add a couple other points as to why this idea makes sense, gender-neutral vaccination. We know that gender-neutral systems, gender-neutral vaccination programmes are more resilient. That means that if there’s a problem like a fall in vaccine confidence, as we’ve seen in Ireland, Denmark and Japan, largely resolved in Ireland and Denmark, less so in Japan, but where there’s a fall in vaccine confidence that causes uptake to dip, when there’s a problem like a pandemic, we saw that with Covid, or a natural disaster, or conflict, vaccination rates fall inevitably. But if a greater proportion of the population is vaccinated, the impact is less. That’s why gender-neutral programmes are more resilient.
They’re also more equitable, because they share responsibility and the burden of vaccination between men and women. In many ways, it’s actually unfair that girls, young women, have to bear the burden of vaccination and make it entirely their responsibility, when it should be the responsibility of everybody, boys, girls, women and men, which is another very strong argument. The equity argument is extremely powerful as well.
Many men don’t realise HPV can be an issue for males. Are there any programs in place for awareness in countries that already provide gender neutral vaccines?
We have a problem here, because we know in those countries which deliver gender-neutral vaccination, uptake in boys is lower. In almost every case, it’s lower than for girls. In Australia, for example, and Sweden, there are relatively small gaps between boys and girls, but in other countries there are quite large gaps. I think the problem is that where gender-neutral vaccination is delivered, young people and their parents and carers haven’t been made fully aware of the reasons why boys need to be vaccinated. It’s not just vaccinating them to protect their future partners, which is obviously very important, but it’s also to protect them from the cancers that can affect boys and men as well.
So we need to do much more in terms of awareness raising. At the moment, I’m not aware of any country that’s actually introduced a targeted programme to actually make young people and their parents and carers aware of why it's such a good idea to vaccinate boys. I think we need to do more there.
What is the burden of cancer for men?
Well, Global Action on Men’s Health is focusing on cancer policy issues at the moment. HPV is part of that. We’re also very interested in prostate cancer and making the case for prostate cancer screening. There’s now real opportunity to detect prostate cancers sooner rather than later using new technologies like MRI scanning. What’s often not understood is that men are more likely to develop a cancer, if you look at all the cancers combined, more likely to develop a cancer and much more likely to die from it than women. We need to do far more to raise awareness of this and to work out how we can do more to prevent those cancers in men by taking action on tobacco, alcohol, weight, and so on, but have those more targeted at men, but also get men diagnosed sooner.
We have opportunities there we’re not taking advantage of. Prostate cancer screening is one of them. We have in many countries now bowel cancer screening, but even though men are more at risk of bowel cancer than women, they’re less likely to actually take up the offer of screening. That’s another issue that we need to tackle. This is not about doing something for men at the expense of women, or doing more for men than women, it’s about actually thinking about the needs of both sexes and genders, and working out what we can do for men, and also what we can do for women, so we actually improve the health of everybody.
