Boys in England to get HPV vaccine from next yearBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3237 (Published 24 July 2018) Cite this as: BMJ 2018;362:k3237
All rapid responses
Nobody can deny that it is good to prevent. And when prevention means immunisation, you ought to.
Equally it makes sense not to immunise those who do not need to be immunised.
HPV vaccine should be made available to populations where sexual activity is prevalent. Epidemiology should help.
Do we find certain religious orders practising celibacy? Yes. Buddhists monks, Christian monks and nuns.
May I assume that HPV vaccine is not wasted on these populations?
There are, still, some populations where girls are not even allowed to be in the proximity of boys.
Can we be assured that HPV vaccine is not wasted on these girls?
Competing interests: No competing interests
Giving the quadrivalent Gardasil vaccine only to girls was, in a sense, discriminatory by avoiding boys (1).
The science now indicates that boys should have the vaccine too.
Medical issues apart, excluding one section of the community from a public health programme must always imply the possibility of discrimination.
Gay men 'do not benefit from any herd protection' (2).
In London STD clinics today, the quadrivalent vaccine has been given to gay men under 45 since April 2018, but not to those over 45 (3).
Again, whatever the medical rationale may be, there is a problem of potential discrimination - ageism.
Here is an example of the dilemma of medicine. Medicine is part science, part ethics - and juggling the two is not meant to be easy.
The tale of HPV vaccination is typical of the 'modern' NHS. Provision for HPV has proved piece-meal and penny-pinching. At first, the inferior bivalent vaccine was preferred to the quadrivalent one. The vaccine was initially restricted to girls (boys will be receiving it a decade after them - as is just too long, even too dangerous, a wait). Only in 2018 was the vaccine extended to gay men - but solely those under 45.
The question also emerges of creeping privatization. The vaccine is expensive - the item is sold in pharmacies, at a cost of around 500 pounds. It is cruel to make vulnerable older gay men (and others not protected) pay so much for a sexual health treatment.
The suspicion remains that a vaccination intervention is half-baked that is not absolutely universal in scope.
(1) Editorial. HPV vaccination. What about the boys? Margaret Stanley, Colm O'Mahony, Simon Barton. BMJ 2014;349:g4783.
(2) Vaccinate boys as well as girls against HPV. Gillian Price. BMJ 2014;349:g4834.
(3) Boyz. (Gay magazine). 1 November 2018. Boyz Doc: Anal Warts. Dr. Laura Waters.
Competing interests: I am an elderly sixty year old man.
Kmietowicz’s article entitled “Boys in England to get HPV vaccine from next year” showed me a ray of hope for my country, Mauritius. While we gained independence from the United Kingdom in 1968, we still value the examples set by the country in terms of prevention, law and order, and medical care.
In 2016, the minister of health and quality of life of Mauritius announced a new vaccination program for females who are aged between nine and thirteen. This has been a long due requirement for the country as there are about 150 new cases of cervical cancer reported annually and about 50 deaths also. Parents in Mauritius are very hesitant to allow their children to be vaccinated as they believe that they are not sexually active at such a young age and it is an unnecessary vaccine. The common hurdle in the Mauritian health system and physicians is to properly educate the parents and promote the proper vaccination system. According to an interview with a gynecologist in Mauritius, some parents might even think that the teenager might interpret it as permission to be sexually active.
While sex remains a major taboo here, I sincerely hope that the same system of vaccination follows for the boys in the country.
Competing interest: I have not been paid to write this article and I have no competing interest to declare.
1 Kmietowicz Z. Boys in England to get HPV vaccine from next year. BMJ 2018; 362: k3237.
2 Yasin Karimbocus. Cancer du col de l’utérus: le vaccin ‘Human Papilloma Virus’ introduit dans les écoles. 2016. https://defimedia.info/cancer-du-col-de-luterus-le-vaccin-human-papillom... (accessed July 31, 2018).
3 Nafissah Fakun. HPV Vaccines: Much hesitation despite benefits. 2018. https://defimedia.info/hpv-vaccines-much-hesitation-despite-benefits (accessed July 31, 2018).
Competing interests: No competing interests