EDITORIAL: Boys also need the HPV vaccine

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The government will offer free human papillomavirus (HPV) vaccinations to girls in their first year of junior high school after school starts next month, but boys are still not eligible for the state-funded vaccine.

The Health Promotion Administration launched the HPV immunization program in December 2018, and the agency said last week that the immunization rate of female students entering junior high school in 2020 was 84.7 percent.

HPV infection is fairly common, and nearly all people — an estimated 80 percent — will get it at some point in their lives. Most new infections occur in adolescents and young adults.

About 90 percent of HPV infections clear up on their own within a year or two, but sometimes they can last longer and cause cancer. According to the WHO, more than 95 percent of cervical cancers are caused by HPV, while the US Centers for Disease Control and Prevention (CDC) says HPV is responsible for 70 percent of vaginal and vulvar cancers, more than 60 percent of penile cancers , and it has also been linked to anal, rectal, and oropharyngeal cancer.

Taiwan will use a nine-valent HPV vaccine for the first time. It protects against nine types of HPV, which cause about 90 percent of cervical cancers, and prevents other cancers and genital warts, but is more effective when given before people are exposed to the virus.

A British study published last year in The Lancet magazine found that HPV vaccines reduced the rate of cervical cancer in women in their 20s, aged 12 and 13 vaccinated with a bivalent vaccine via the British National Health Service’s immunization programme were reduced by 87 percent.

However, HPV does not only affect women. The US CDC says more than four in 10 cases of HPV-associated cancer occur in men. Cervical cancer is the most common HPV-associated cancer in women and oropharyngeal cancer is the most common in men. As rates of cervical cancer in young women fall in many countries where Pap smear testing and HPV vaccines have become more popular, the incidence and mortality rates of oropharyngeal cancer, particularly in men, have steadily increased over the past two decades. The US CDC says that about 70 percent of oropharyngeal cancer cases in the US are caused by HPV.

Several doctors have also warned that the incidence of oropharyngeal cancer in Taiwan has already exceeded that of cervical cancer, while local clinical studies found that about 30 percent of oropharyngeal cancer cases are linked to HPV, raising awareness of HPV-associated cancer risks is required to grow up among men. Many doctors and local health groups, such as the Formosa Cancer Foundation, have said men should also get the HPV vaccine because it can protect against some anal, genital, head and neck cancers and potentially reduce transmission to their sexual partners.

More than 30 countries have expanded their government-funded HPV vaccination programs to include boys and men, including Australia, Brazil, Canada, Germany, Israel, Italy, the Netherlands, New Zealand, the United Kingdom and the United States. The British National Health Service in 2018 also included vaccines for men who have sex with men up to the age of 45 when attending specialized sexual health services and HIV clinics in the UK.

In 2020, the WHO adopted a global strategy to eliminate cervical cancer by 2030, which includes more than 90 percent of girls being fully vaccinated by the age of 15.

As coverage of first-year middle school girls in Taiwan is close to this goal, the government should consider expanding the HPV vaccination program to boys and men to better protect them from HPV-related cancers and achieve herd immunity.

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