Abstract
While many European Union/European Economic Area (EU/EEA) countries recently expanded human papillomavirus (HPV) vaccination to boys, HPV vaccine supply is currently limited for girls in low- and middle-income countries (LMIC) that are severely affected by HPV.Globally, about 50% of countries have introduced HPV vaccination. Some LMIC with high burden of cervical cancer have not yet introduced HPV vaccination, or are reaching suboptimal vaccination coverage. While WHO issued a call for cervical cancer elimination in 2018, a global shortage of HPV vaccines is currently predicted to last at least until 2024.We reviewed national policies of EU/EEA countries and recommendations of the World Health Organization (WHO) Strategic Advisory Group of Experts on immunisation to discuss current challenges and dose-sparing options. Several EU/EEA countries have extended HPV vaccination to boys and the European Cancer Organisation has issued a resolution for elimination of all HPV-associated cancers in both sexes. The European Centre for Disease Prevention and Control concluded in its 2020 guidance that cost-effectiveness of extending routine vaccination to boys depends on several context-specific factors. The extension of HPV vaccination to boys in EU/EEA countries may affect global availability of vaccines. Temporary dose-sparing options could be considered during the COVID-19 post-pandemic period.
Highlights
Human papillomavirus (HPV) infection is the most frequent sexually transmitted disease and the second most common cause of cancer attributable to an infectious agent globally [1]
The rationale was based on immunological criteria with the objective of maximising the protection against HPV types 16 and 18, the two high-risk serotypes responsible for over 70% of HPV-associated cancers, while giving enough immunity against the seven additional types included in the 9-valent HPV vaccine responsible for additional HPV-associated cancers and anogenital warts
Too many girls living in LMIC with a high burden of cervical cancer are not vaccinated against HPV, the global call for action for cervical cancer elimination
Summary
Human papillomavirus (HPV) infection is the most frequent sexually transmitted disease and the second most common cause of cancer attributable to an infectious agent globally [1]. Cervical cancer is by far the most common malignancy causally associated with HPV infection. Other less prevalent anogenital cancers, some emerging HPV-associated oropharyngeal cancers, and non-malignant but common anogenital warts are causally associated with HPV infection and can affect both sexes [1]. We review and discuss the implications of the expansion of HPV vaccination to boys in the European Union/ European Economic Area (EU/EEA) in light of the current cervical cancer elimination goals and of the global shortage of HPV vaccines, which is mainly affecting girls in low- and middle-income countries (LMIC). Low- and middle-income countries have the lowest rates of introduction of HPV vaccination and some are struggling with its introduction while experiencing a high burden of cervical
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