Modelling the impact of vaccinating girls and boys against HPV: a European perspective

The arrival of prophylactic HPV vaccines has opened up a unique opportunity to reduce global cancer burden by a substantial amount. In the 12 years since HPV vaccines were first licensed, there have been successes as well as challenges with HPV vaccine introduction and implementation. Because HPV vaccines were originally developed for cervical disease prevention, most of the countries worldwide have introduced HPV vaccination of preadolescent girls to lower cervical cancer incidence. However, the health and economic burden of HPV-related diseases have gradually been shown to also include males. Despite this evidence, only few countries in the world are presently offering free-of-charge HPV vaccination to males. The most commonly reported barriers to expansion of HPV vaccination to males have been the high introductory cost of HPV vaccination and the limited marginal health gains from vaccinating boys when girls-only programmes are in place and have achieved high vaccine uptake rates. Their combination, according to previous health and economic assessments, deemed sex-neutral HPV vaccination cost-ineffective for inclusion in national immunization programmes. This thesis addresses these considerations and shows that, in many European countries: i) the cost of HPV vaccination has substantially been reduced owing to the establishment of reduced dosing schemes as well as to negotiation procedures for the purchase of the vaccines used in publicly funded vaccination programmes; ii) the health gains from boys vaccination can be substantial when considering all HPV-related outcomes; and iii) the cost-effectiveness of sex-neutral HPV vaccination compared to girls-only programmes most likely constitutes a good-value-for-money investment in different European tender-based settings. Furthermore, in many countries including the Netherlands, girls-only programmes have achieved suboptimal levels of vaccine uptake and HPV-related disease burden among males is increasing faster than among females. Collectively, these issues indicate sufficient scope from boys’ vaccination for improved protection in both women and men against vaccine-targeted HPV infections. In the Netherlands, the State Secretary of Health, Welfare, and Sport announced in September 2019, that sex-neutral HPV vaccination will be implemented from 2021 onwards. Wider adoption of sex-neutral HPV vaccination is anticipated in the coming years, primarily in the developed world, and successively in low- and middle-income countries once affordable and effective HPV vaccines become available in these settings, where the need for HPV vaccination against cervical disease is greatest. Ultimately, improved protection against HPV infections can have a major impact on cancer prevention throughout the 21st century.