Vaccination against HPV: Easier said than done?

This letter is a follow-up to the one we published in Human Vaccines & Immunotherapeutics¹ in light of current events.

Indeed, very recently, Bruni et al published in the Lancet Global Health remarkable evidence of the high incidence of human papillomavirus (HPV) in the male general population.² Based on 65 studies selected on the basis of specific objective criteria, they evaluated the global prevalence of all HPVs at 31% and that of high-risk HPVs at 21%. They also showed that HPV-16 was the dominant strain of HPV. Now, HPV-16 is associated with a high risk of cancer in humans and infections with this strain can be prevented by the three types of anti-HPV vaccine currently available.² The authors naturally call for vaccination for boys and girls. However, we have to say again here that vaccinating boys, and even girls, remains easier said than done.

The importance of vaccinating both sexes simultaneously has been clear for several years, to achieve two main goals: further decreasing the transmission of the virus in women and, thus, the incidence of the cancers it induces; and protecting men against some of these cancers.^3,4 However, in 2022, only 45 of the 194 member countries of the World Health Organization (WHO) were vaccinating boys, whereas three times that number were vaccinating girls, albeit with different degrees of vaccination coverage between countries.⁵

In our view, there are three main reasons, and bio-ethical issues, for this inadequate level of vaccination coverage worldwide: major geographic and financial inequalities in access to anti-HPV vaccines;⁶ growing skepticism worldwide concerning vaccination in general;^7,8 and, finally, the lack of social acceptance of certain mores – sexual relations outside marriage, homosexuality, etc. – morally or even legally proscribed in several countries around the world, on all continents, at the scale of entire societies or particular communities, for various reasons – religious, ideological, etc.¹

Despite the facts,² anti-HPV vaccination in boys is thus proving every bit as complex as that in girls, at both global and regional scales. In France, for example, vaccination coverage remains inadequate for both boys and girls.⁵ Therefore, from the start of the new school year in October 2023, it has been decided that all second-year secondary school pupils (7^th graders) will be able to get themselves vaccinated free of charge, provided they have parental agreement.⁹ In our opinion, at this regional level, rendering vaccination obligatory is not a bio-ethical solution that should be ignored,¹ 11 vaccines are already obligatory.¹⁰ Globally, more interdisciplinary studies, public health actions and intercultural discussions, of the price of vaccines and supply chains, fake news, taboos and prohibitions, appear essential.

Authors’ contributions

HCS, CH, SS and PB drafted the paper. JMA and JB made substantial contributions.

Consent for publication

All the authors have seen and approved the final manuscript.

Acknowledgments

We thank Foch Hospital for support.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.