Commentary: Time to get boys, young males vaccinated against HPV
The Covid-19 pandemic has cast a spotlight on the importance of vaccinations, as well as their risks and benefits. In Singapore, while there is a recommendation for all girls between ages 12-14 to be vaccinated against HPV under the National Childhood Immunisation Schedule (NCIS), there is currently no such recommendation for males.
Even so, it's time to talk about vaccinating male teens and youths in Singapore against HPV.
HPV, or Human Papillomavirus, is a prevalent virus that affects 90 per cent of the general population at some point in their life. While most people will clear the infection within a year or two, 3-10 per cent may have persistent infections that can progress to pre-cancer and cancer stages. HPV is responsible for 90 per cent of cervical cancer cases, anal cancer cases, and 70 per cent of mouth and throat cancers.
Given its widespread and insidious nature, it is crucial for a population to receive an effective vaccine against HPV.
Australia is the first country in the world to incorporate HPV vaccinations as part of its national immunisation programme, which includes not only females aged 12 and above but also males. Most studies published in Australia have shown significant decrease in the prevalence of the various strains of HPV protected by either the 4-valent vaccine or the five additional strains provided by the 9-valent vaccine. The studies have also shown a herd immunity effect.
WHY DO DIFFERENT COUNTRIES HAVE DIFFERENT VACCINE RECOMMENDATIONS?
Generally, vaccine recommendations vary from country to country with considerations such as infection rates, vaccine efficacy and costs, as well as healthcare costs of the disease it defends against.
Authorities will take these factors into account and decide whether a vaccine should be recommended for the population.
WHY DOESN’T SINGAPORE RECOMMEND HPV VACCINATION FOR TEEN BOYS UNDER THE NCIS?
Singapore has a great national immunisation programme that is effective in preventing many communicable diseases which can cause serious conditions or prevent long-term complications from infections.
Despite the many advantages and benefits for teens to be vaccinated against HPV, one of the likely considerations Singapore has is whether it is cost-effective on a national level to include teen boys in the NCIS. The country's healthcare budget is finite; every dollar has to be funnelled to where it makes the largest impact or benefits the most people.
While it may not be cost-effective to do so nationally, it may well be cost-effective for teen boys and their parents to consider the vaccination on an individual basis.
SHOULD TEEN BOYS AND MALES IN SINGAPORE RECEIVE THE HPV VACCINE?
National initiatives aside, we as individuals should be more proactive in taking charge of our own health and that of our loved ones, because at the end of the day, when health problems happen, we are the ones who will have to undergo treatment discomforts, stigmas, inconveniences and sufferings.
While some may argue that are other serious conditions that we should focus our vaccination resources on, many of these conditions are rare in Singapore — meningococcal, for instance, saw only nine cases reported in 2018. Bear in mind that 90 per cent of the general population may be infected with HPV at some point in their lifetime.
The 9-valent HPV vaccine consists of three doses and costs roughly S$800. Among other things things including preventing several kinds of cancer, it helps reduce the risk of contracting common HPV strains that cause genital warts. In the US, 350,000 adults seek treatment for genital warts annually; recurrent episodes of such warts are common in Singapore as well.
While genital warts are not life-threatening, the cost of treating recurring episodes may amount to more than S$800 — not to mention the potential harm from getting them removed, emotional stress, and the stigma your child may face.
In addition, while the risk of penile cancers or anal cancers caused by HPV is small compared to cervical cancer risk in females, given there is an effective and safe vaccine, we should encourage teen boys to protect themselves and their future loved ones as much as possible.
PREVENTIVE CARE IS PROTECTION FOR ALL
A 2011 study involving 18 countries showed that the 4-valent HPV vaccine has a relative risk reduction of about 85 per cent in preventing persistent infection (that is, infection lasting more than six months), about 90 per cent in preventing external genital lesions in males aged 16-23, and about 90 per cent in preventing anal cancers in males.
Of note: by vaccinating two males, we can prevent one from having persistent infection, which increases the risk of HPV-related diseases and cancers. We also reduce the reservoir of males having persistent infection, therefore reducing the risk of them spreading HPV to their partners. A 2022 study that involved males in 16 countries noted similar efficacy for the newer 9-valent HPV vaccine, which covers nine HPV types and is approved for use in both males and females aged between nine and 45.
Given the data, it is not inconceivable that by vaccinating males, we can further reduce the prevalence of HPV in the whole population, regardless of gender. In addition, encouraging males to receive the HPV vaccine can contribute to broader preventive health promotion efforts, reminding them to take responsibility for not only their own health but the health of their family.
Importantly, getting our teens to vaccinated against HPV is in NO way encouraging them to be “promiscuous”. The fact is that they will have sex sometime in the future — and, even if they only ever have sex with just one person, they can still get infected.
In my 13 years as a doctor, I've witnessed many young people pick up the wrong or misleading information from the Internet, often leading them to anxiety and, in some unfortunate cases, regret and anguish.
Getting our teens vaccinated is but one way to educate them on taking responsibility for their health, as well as respecting their bodies and that of their future partners.
ABOUT THE AUTHOR:
Dr Julian Ng graduated from the University of Sydney with a Bachelor of Medicine and Bachelor of Surgery. Prior to his medical degree, he had obtained Masters of Science in Microbiology from the National University of Singapore. He has worked in Sydney in areas of respiratory medicine, vascular surgery, rehabilitation medicine and adult emergency medicine.
Since his return to Singapore, he has worked in children’s emergency medicine and microbiology, as well as at a polyclinic where he manages chronic diseases such as diabetes, hypertension and hyperlipidemia. He has also served as the chief medical officer in a private group practice.
Now at Boon Lay Clinic & Surgery – Singapore Paincare Center, his special interests include paediatrics, chronic diseases management, sexually transmitted diseases and HIV.
