Gender neutral HPV vaccination programs: Reconsidering policies to expand cancer prevention globally

Abstract

Human papillomavirus (HPV) infection is responsible for many cancers in both women and men. Cervical cancer, caused by HPV, is the fourth most common cancer among women worldwide, even though it is one of the most preventable cancers. Prevention efforts include HPV vaccination, however these programs remain nascent in many countries. In 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination including a goal to fully vaccinate 90% of girls with the HPV vaccine by the age of 15. However, very few countries have reached even 70% coverage. Increased vaccine availability in the future may allow the opportunity to vaccinate more people. This could add to the feasibility of introducing gender-neutral HPV vaccination programs. Adopting a gender-neutral HPV vaccine approach will reduce HPV infections transmitted among the population, combat misinformation, minimize vaccine-related stigma, and promote gender equity. We propose approaching programmatic research through a gender-neutral lens to reduce HPV infections and cancers and promote gender equality. In order to design more effective policies and programs, a better understanding of the perspectives of clients, clinicians, community leaders, and policy-makers is needed. A clear, multi-level understanding of these stakeholders' views will facilitate the development of target policy and programs aimed at addressing common barriers and optimizing uptake. Given the benefit of developing gender-neutral HPV vaccination programs to eliminate cervical cancer and address other HPV associated cancers, we must build knowledge through implementation research around this topic to inform policy-makers and funders for future policy shifts.

Human Papillomavirus Epidemiology and Prevention: Is There Still a Gender Gap?

“…The epidemiology of HPV has been heterogeneous between the sexes, with a higher prevalence of infection in anogenital areas among males, which is even higher in some subgroups. To date, the only way to block the chain of transmission is vaccination, but HPV vaccination programs are still in their infancy in many countries, particularly in less developed countries [81]. This makes it difficult to achieve herd immunity, especially in males who were only invited to vaccinate in the years after the first vaccine was introduced.…”

“…Herd immunity is impossible to achieve if males are not included in vaccination programs. In fact, adopting gender-neutral HPV vaccination schedules will reduce population-transmitted infections, combat misinformation, minimize vaccine-related stigma and promote gender equity [80][81]. To date, only a few countries have achieved 70% vaccination coverage [81] with a marked discrepancy between continents, ranging from 20% in sub-Saharan Africa to 77% in New Zealand.…”

“…In fact, adopting gender-neutral HPV vaccination schedules will reduce population-transmitted infections, combat misinformation, minimize vaccine-related stigma and promote gender equity [80][81]. To date, only a few countries have achieved 70% vaccination coverage [81] with a marked discrepancy between continents, ranging from 20% in sub-Saharan Africa to 77% in New Zealand. In a few African countries the bivalent and quadrivalent vaccine was made available free of charge (only for females), several years after the first one was approved in 2008 [82].…”

“…In Japan, female coverage reached 70% but following reports of adverse events, which were widely covered in the media and turned out to be unrelated to vaccination, vaccination coverage fell to less than 1% and has remained this low to date [84]. In 2021, the South-Eastern Asian country of Bhutan was the first country to adopt a gender-neutral vaccination strategy [80][81]. In the United States, vaccination has been recommended for females since 2006 and for males since 2011, furthermore, since 2016 only 9vHPV has been distributed [85].…”

The status and challenges of HPV vaccine programme in China: an exploration of the related policy obstacles

“…HPV vaccines are effective against the majority of high-risk subtypes of HPV,17 with three main types of vaccines currently produced globally: bivalent (covered HPV 16, 18), quadrivalent (covered HPV 6, 11, 16, 18) and 9-valent HPV (covered HPV 6, 11, 16, 18, 31, 33, 45, 52, 58) vaccines 17. In several countries, specifically LMICs, HPV vaccination is still relatively new 18. According to 2020 statistics, the proportion of women aged 9–45 in China who had received a complete HPV vaccination was only 3% 19.…”