HPV vaccination should be extended to boys as part of the Hong Kong Childhood Immunisation Programme

In Hong Kong, the two-dose nonavalent HPV vaccine, which offers protection against subtypes of HPV that cause cancers as well as recurrent benign lesions, is offered free of charge to only female primary school students, as part of the Hong Kong Childhood Immunisation Programme.1As of 31 December 2020, the vaccine uptake rate for the first dose was at 85% and is expected to increase with the ongoing service and positive response.2The extension of HPV vaccination to boys should be considered, especially with the rising global incidence of HPV-related diseases in males.3 Worldwide, only 32 countries have introduced gender-neutral HPV vaccination programmes, none of which are in East Asia.4 Risks of human papillomavirus infection for boys Men have a poorer immune response to HPV infection, with seroconversion after infection being detected in only 20% to 30% of men, compared with about 70% of women.5 This results in increased susceptibility of males to HPV infection and related malignancies.5 Hong Kong has a rising incidence of oropharyngeal and penile cancers which are often related to HPV infection and not amenable to effective screening measures, resulting in late diagnosis with increased morbidity and mortality.6In Hong Kong, HPV-related genital warts are more common in males than in females.7 Liberal attitudes towards sex are also observed in Hong Kong, with 10% of youth having their first sexual intercourse by age 15, and 50% never using condoms for safe sex.8 The most recent Youth Sexuality Study9 revealed 13% of secondary school boys were unsure about their sexual orientation, and this may increase their exposure to HPV infections while experimenting with their sexuality. Female celebrities were used in advertisements, and the HPV vaccine was referred to as the ‘cervical cancer vaccine' in Cantonese. [...]the HPV vaccine might be perceived as lacking relevance or benefit for boys, and parents might not consent to the vaccination of their sons. By 2024, the global supply for HPV vaccines is anticipated to be adequate.12 Cost-effectiveness The current girls-only HPV vaccination programme in Hong Kong is primarily based on considerations of cost-effectiveness, because high vaccination coverage of around 90% among females also provides benefits for their heterosexual male partners, resulting in herd immunity.13 However, a gender-neutral programme also provides resilience when fluctuations in uptake are present in the short term or there is overall low upt