Australia launches national scheme to vaccinate boys against HPV

As Australia has begun to vaccinate boys against human papillomavirus, fresh calls have been made for the United Kingdom to follow suit.

The move sees Australia become the first country in the world to publicly fund HPV vaccination of boys in a bid to protect against genital warts and anal, penile, and throat cancers.

Starting this month, boys and girls alike in Australia will receive three doses of the quadrivalent vaccine Gardasil at ages 12-13, as part of a national, federally funded school based programme. A catch-up scheme will also run for 14-15 year old boys until the end of the school year in 2014.

The expansion of the existing programme, which has been vaccinating girls since 2007, is being rolled out across all states and territories throughout February. It will cost the federal government A$21.1m (£13.8m; €16.2m; $21.7m) over four years, including an information campaign, vaccine register, and adverse event monitoring, said the health minister, Tanya Plibersek.

A spokeswoman for the federal Department of Health and Ageing declined to disclose the exact cost per dose of vaccine, saying that this was confidential. However, the current contract for HPV vaccination of boys and girls for 2013 and 2014 had been agreed at $A98m, after negotiations with CSL in 2012, she said.

Basil Donovan, head of the sexual health programme at the University of New South Wales’s Kirby Institute in Sydney, said that the greatest effect would be likely to be seen in men who have sex with men, who were not receiving the benefits of herd immunity from the existing programme.

“If the federal government hadn’t done this, they would have been at risk down the track of being accused of discriminating,” he told the BMJ.

“But I think the game changer was that the vaccine company [CSL, which makes Gardasil in Australia] seriously discounted it for boys. At the normal commercial price there’s no way it would have been cost effective.”

Donovan receives research funding from CSL and has previously served on a CSL advisory board.

The incidence of genital warts in Australia fell significantly among heterosexual but not homosexual men between 2007 and 2009, shows a study by Donovan and his colleagues.1 Their follow-up data to the end of 2011, in press with the BMJ, show that the incidence of genital warts has dropped by more than 90% in young, Australian born women and more than 80% in heterosexual men, Donovan said.

However, the impact of vaccination on throat and anal cancers was unlikely to show fully for another 20-30 years, he added.

The US Centers for Disease Control and Prevention has recommended since 2011 that boys receive the HPV vaccine as well as girls.

However, the Department of Health for England has so far stood firm, saying that it had no plan, on the basis of current evidence, to include boys in the NHS programme.

“Vaccination of boys was not recommended by the Joint Committee on Vaccination and Immunisation because, once 80% coverage among girls has been achieved, there is little benefit in vaccinating boys to prevent cervical cancer in girls,” a spokesman told the BBC this month, in response to a call by the Throat Cancer Foundation for boys to be vaccinated.2

The Terrence Higgins Trust, a charity that aims to reduce the spread of HIV and other sexually transmitted infections, told the BMJ that it believed “men have a right to the same protection from the virus as women.”

Jason Warriner, its clinical director, said, “The female vaccination programme will indirectly protect some men. However, those who have sex with men or women who aren’t vaccinated will remain at risk. This is particularly concerning given the rates of HPV related anal cancer and genital warts among gay men.”