HPV vaccine to be extended to boys

Major assessment carried out by HIQA
  • Deborah Condon

The HPV vaccine, which is currently offered to girls in their first year of secondary school, should be extended to boys, the Health Information and Quality Authority (HIQA) has recommended.

It carried out a health technology assessment on the clinical and cost-effectiveness of extending the vaccine to boys, and has concluded that such a move will provide ‘direct protection against HPV-related diseases to boys and indirect protection to girls who have not been vaccinated'.

Human papillomavirus (HPV) is a family of common viruses that are passed on via sexual contact. There are many types of HPV, most of which are harmless and go away on their own. However, some strains can be serious, such as those that cause certain types of cancer, pre-cancerous lesions and genital warts.

For example, HPV is the main cause of cervical cancer, which kills around 90 women in Ireland every year. However, it can also cause cancer in other parts of the body such as the penis and anus, and in fact, over 500 HPV-related cancers are diagnosed in Ireland every year.

HPV vaccination is a type of primary prevention aimed at reducing HPV-related disease. The current schools-based HPV immunisation programme began in 2010 and it is offered to all girls in their first year of secondary school. The current programme is based on the 4-valent vaccine, which offers protection against four strains of HPV.

However, the HIQA assessment also looked at whether this should be replaced by a 9-valent vaccine, which offers protection against an additional five types of HPV.

Based on this assessment, HIQA has advised that the National Immunisation Schedule should switch to the 9-valent vaccine.

"Vaccinating girls with the 9-valent vaccine is estimated to be cost saving and more effective than the existing girls-only 4-valent programme. Furthermore, a gender-neutral 9-valent vaccination programme, where both boys and girls are vaccinated, is estimated to be more effective than the girls-only alternative.

"It is likely that gender neutral 9-valent vaccination would also be cost-effective in light of the conservative assumptions used with regard to final cost, uptake rate and protection provided against all types of cancers," commented HIQA deputy CEO, Dr Máirín Ryan.

She pointed out that the assessment considered the ethical and organisational issues that would come about if the vaccine was also given to boys.

"Extending the HPV vaccine to boys provides direct protection against HPV-related disease to boys, indirect protection to girls who have not been vaccinated and would reduce HPV-related disease and mortality in Ireland.

"Over 20 years, a gender-neutral 9-valent programme will prevent an estimated 101 additional cases of cervical cancer compared with the current girls-only 4-valent programme," she explained.

The assessment included four systematic reviews, an economic evaluation, an ethical and organisational analysis, intensive engagement with an expert advisory group and a six-week public consultation, which received 242 submissions.

In relation to the safety of the vaccine, HIQA looked at data from over 70,000 trial participants and over 20 million individuals in observational studies, and found no increased rate of serious adverse events in those who received the vaccine compared with placebo.

"The burden of HPV-related disease is substantial, with HPV responsible for approximately one in every 20 cases of cancer across the world. This assessment demonstrates that the HPV vaccine provides effective primary prevention against HPV infection and HPV-related disease, and that the vaccine is safe," Dr Ryan added.

The assessment has been submitted as advice to the Minister for Health, the National Immunisation Office, the National Immunisation Advisory Committee and the HSE to inform decision making about the vaccination programme.

The Minister for Health, Simon Harris, welcomed it, noting that funding has already been made available in Budget 2019 for this initiaitve, 'subject to a favourable recommendation being made in the assessment report'.

He confirmed that the vaccine will be offered to boys in their first year of secondary school, hopefully in the new school year beginning in September 2019. 

The HIQA assessment can be viewed here


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