HPV vaccination to be offered for boys in England : What do parents think? by Dr Rebecca Richards


Photo credit: adiruch na chiangmai

In July this year, Public Health Minister Steve Brine announced that the human papilloma virus (HPV) vaccine will be extended to boys between ages 12-13 in England in 2019, as part of the school-based vaccination programme (Kmietowicz, 2018). The issue of whether to vaccinate boys or not was a controversial one and considerable lobbying took place to change the existing policy. On one side of the debate was financial considerations (would it be cost effective?), while on the other side health equality is important (men should be equally protected against HPV as women).


The rationale for not vaccinating boys previously was that vaccinating girls should indirectly protect heterosexual boys (known as ‘herd immunity’), however this does not protect men who have sex with men or men who have sex with unvaccinated women and vice versa. Thankfully, the decision was made to introduce the vaccine for boys following new scientific evidence and advice from the Joint Committee on Vaccination Immunisation (JCVI), an independent panel of experts. The new evidence showed that high-risk types of HPV can cause many cases of cancer in men, as well as genital warts. In men, HPV can affect the skin and moist membranes in the skin of the penis, anus and rectum and the lining of the mouth and throat. As a result, boys who become infected with high-risk types of HPV are at increased risk of penile, anal and some head and neck cancers. The vaccine will protect boys against these high-risk types of HPV.


As is currently the case with girls, parents will have to provide their consent for their sons to be vaccinated as part of the school-based vaccination programme next year and are therefore critical to ensure sufficient HPV vaccine coverage. So what do we know about parents’ attitudes towards the vaccine for boys in the UK?


So far, there have been two studies that have looked at the attitudes of parents in the UK. A 2015 study by Mortensen and colleagues surveyed 1,837 parents of sons in the UK, Germany, France and Italy (Mortensen, Adam & Idtaleb, 2015) found that 75% of UK parents were in favour of their sons being vaccinated. However parents were provided with brief information on HPV-related diseases in males prior to answering whether they were in favour of the vaccine.


More recently, a study of 186 parents of male pupils from secondary schools in Staffordshire and Stoke-on-Trent was conducted by Sherman and Nailer (2018). This study reported that only half of the parents had heard of HPV and the vaccine but of those who had heard of the vaccine, most were either definitely (49%) or probably (30%) willing for their son(s) to receive it. Once all parents had been provided with some brief information about HPV, the majority (86%) thought their sons should be offered the vaccine. This study also found that parents who would be willing to vaccinate their sons had higher levels of knowledge about HPV than those parents who would be unwilling or unsure. These findings therefore indicate the need to raise awareness of HPV and the vaccine for boys prior to implementation of the new programme next year. Further research is also needed as this small sample of parents isn’t representative of the wider UK population (see Table 1).


Table 1. Characteristics of the study sample (Sherman & Nailer, 2018).

Another way we can try and predict the attitudes of UK parents is to look at what has happened in other countries that have already rolled out vaccine to boys. A good example is Australia, where the HPV vaccination programme was extended to boys in 2013. Australia has seen similar uptake of the vaccine for both boys and girls - in 2016, 78.6% of 15-year old girls and 72.9% of 15-year old boys had been vaccinated. As a result, the HPV rate among women aged 18 to 24 dropped from 22.7% to 1.1% between 2005 and 2015, and immunisation rates have continued to rise since 2015! Hopefully, parents in the UK will respond similarly to those in Australia and we will see high coverage of the HPV vaccine for both boys and girls.


To sum up, the findings of the research in the UK and experience in Australia suggest that that: i) more awareness raising in general is needed about HPV, and ii) parents of young people - be they girls or boys - are generally in favour of vaccination, once they know about HPV. So overall, it’s looking promising and extension of the vaccination to boys is a large step in the right direction towards ‘eradicating’ cervical cancer. Following announcement of the new programme in the UK, Public Health Minister Steve Brine commented, “…As a father to a son, I understand the relief that this will bring to parents. We are committed to leading a world-class vaccination programme and achieving some of the best cancer outcomes in the world – I am confident these measures today will bring us one step further to achieving this goal” (Department of Health and Social Care, 2018).


[All views and opinions are my own].


References

Department of Health and Social Care. (2018). HPV vaccine to be given to boys in England. Retrieved from https://www.gov.uk/government/news/hpv-vaccine-to-be-given-to-boys-in-england

Kmietowicz, Z. (2018). Boys should be given HPV vaccine, says joint committee. BMJ; 362:k3163. doi:10.1136/bmj.k3163 pmid:30021775

JCVI. (2017). JCVI Interim Statement on Extending HPV Vaccination to Adolescent Boys. Available from https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/630125/Extending_HPV_Vaccination.pdfCited 4th September 2017.

Mortensen, G. L., Adam, M., & Idtaleb, L. (2015). Parental attitudes towards male human papillomavirus vaccination: a pan-European cross-sectional survey. BMC Public Health, 15(1), 624.

Sherman, S. M., & Nailer, E. (2018). Attitudes towards and knowledge about Human Papillomavirus (HPV) and the HPV vaccination in parents of teenage boys in the UK. PloS one, 13(4), e0195801.


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