Explainer: The HPV vaccine is free for boys from next month - here's why that's important

FROM THIS SEPTEMBER, the nation’s free HPV vaccine programme will be made available to secondary school boys for the first time. 

The vaccination programme was rolled out to teenage girls in 2010, but for a number of reasons is only being made available to boys in secondary school now.

HPV is very common virus, and the most common sexually transmitted infection worldwide. Most HPV infections have no noticeable symptoms and over 90% are cleared by the body’s immune system. But in some cases, HPV can develop into cancer in both men and women.

In Ireland, the HSE’s free HPV Vaccination Programme is first administered to girls in their first year of secondary school. The vaccines are given in schools because studies show it leads to an increase in uptake; that and it’s easier to follow-up with second doses.

The first dose is administered in September, and the second dose is then administered six months after the first (in April). Parents are given information packs ahead of the vaccine teams’ visit, to help them make a well-educated decision on whether to give their child the vaccine.

Ahead of the campaign launch for boys, parents might want to ask questions about HPV, what it does to the body, how it can develop into cancer, and how the vaccine works. 

To answer some of those questions, we asked an expert. 

What is HPV?

HPV stands for Human papillomavirus. It’s a family of viruses that can infect the skin and mucosal membranes of humans, and cause common warts on our hands and feet. In some cases, it can develop in a way that leads to cancer, including cervical, anal, oropharyngeal, penile, vaginal, and vulval cancer.

There are over 200 types of HPV: 40 of which can infect the genital tract. Of these 40, 13 are considered to be high-risk or capable of causing cancer. 

HPV is transmitted primarily by direct skin-to-skin genital contact during sexual intercourse. Condoms aren’t completely protective from this, because you can get warts from other areas that condoms don’t cover.

The virus is fairly resilient: it needs a host to replicate, but HPV can survive outside the body for a number of days on a surface or an item something belonging from someone else (like a piece of clothing or a sex toy).

If you think about a verruca, that can be spread through walking on the same floor as someone else, or at a swimming pool (which is why they encourage people to wear flip-flops).

Despite this, HPV isn’t considered to be highly contagious, and generally speaking it can be weeks to months before symptoms could emerge.

“You may never realise that you have HPV,” says Cillian De Gascun, a consultant virologist and Laboratory Director at UCD.

If you get genital warts you can see that, but if you get a lesion in your cervix, it may never cause you any problems. The body will resolve 90% of new HPV infections after two years. 

How does it cause cancer?

Some papillomaviruses can cause cancer.

When HPV gets into your skin, it causes ‘papillomas’ to form, or lumps of skin. The virus gets into the cell and grows within it; it then loses bits of itself to transmit from person to person. But when it interacts with a certain protein, it can develop into cancer.

In the 1970s and 1980s, Harald Zur Hausen demonstrated the association between HPV and cervical cancer in humans, and was awarded the Nobel Prize for this work. Since then, it has become apparent that HPV is also responsible for a significant amount of other cancers, including anal, oropharyngeal, penile, vaginal, and vulval. 

As scientific studies probed the link between HPV and cancer, it first proved it could lead to cervical cancer, and so, because the evidence was there, when the vaccine was created it was targeted at young girls. The vaccine is given at 12 years of age because it is more effective if given before sexual debut, and the immune response is superior at that age (more on the vaccine later).

There’s also the ‘herd immunity’ approach: if enough girls/women were immune to high-risk HPVs, then most boys/men would also be protected. This, however, didn’t protect men who have sex with men, and didn’t take into account the impact of misinformation on uptake rates of the vaccine.

Since Ireland’s national HPV programme was rolled out to girls in 2010, the rate of uptake went from a high of 87% in 2014, down to 51% in September 2016. This was due to a fierce campaign of misinformation online – both by people looking to spread scaremongering stories about the vaccine, and those with good-intentions sharing that information on. 

The uptake rate is now at around 70%, after a public information campaign by the HSE to share the research and scientific evidence behind the HPV vaccine.

Why is it important for boys?

In the majority of cases of cervical cancer, the time of infection of HPV to time of malignancy is 10-30 years. In 90% of cases where HPV is detected, the body will rid itself of the infection. For women, a cervical smear test can detect abnormalities, and these are monitored for further tests, and if they are precancerous, are treated. 

But for men, there is no national screening service to detect HPV. If they want to be tested for it, they must ask for it specifically – and if it is detected, in 90% of cases, the body will rid itself of the infection. 

Now that the HPV vaccine is being made available for free for the first time, there’s a chance of preventing HPV infections in men that could develop into something more serious. 

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“Giving boys the HPV vaccine will primarily provide them with direct protection against HPV-associated disease,” De Gascun says.

The vaccination of boys will provide additional protection to girls, as it reduces the amount of circulating HPV. Ultimately, extending the programme to boys however makes the elimination of HPV-related cancer a genuine possibility and aspiration.

• What to do if your daughter didn’t get the HPV vaccine before, but wants it now

How does the HPV vaccine work?

Because of the HPV’s potential to cause cancer, using a vaccine with the virus itself (as is the basis for the flu vaccine, etc) wasn’t acceptable.

“The way the vaccine works is you inject the virus-based vaccine, which generates an immune response that will neutralise the infection,” De Gascun says. “But we know from going back to the ’70s and ’80s if you could inject an active bovine or canine Pap virus into a cow or dog to try to infect them, they couldn’t do that.”

But there’s a protein from the virus that, in essence, when it’s produced it rearranges itself into virus-like particles which prompts the required immune response. Because this vaccine doesn’t contain any DNA, it can’t cause an infection and it can’t cause cancer, and produces an antibody response that actually appears to be superior to that which is observed in the course of natural infection.  

Like the flu, there are different types of HPV, and the vaccine only protects against some of them, as De Gascun explains:

We’ve had three HPV vaccines: the first protected against HPV 16 and 18; the second one, a Gardasil vaccine covered 16 and 18 but also genital warts under 6 and 11; and the third, Gardasil 9, retains the original four, but also adds another five: 34, 33, 35, and 52 and 58.

“At the individual level, the vaccine protects against the HPV types that are included in the vaccine. At the population level, assuming satisfactory uptake, the vaccine will provide us with the opportunity to virtually eliminate the risk of HPV-associated cancers in Ireland.”

On the reported side effects, De Gascun says there have been no safety concerns with the vaccine found after rigorous testing following misinformation spreading rapidly.

To parents who might have concerns about the vaccine, De Gascun says: “I would say that this is an extremely safe and effective vaccine that has the ability to prevent their children from getting certain types of cancer.”

This is a really good news story, and something for which we have been striving for ages – both as a profession, and as a society. Over 100 million people have been vaccinated worldwide, and there have been no safety concerns – or associations with any chronic illness – identified.

“If they still have concerns, I would encourage them to seek advice from their GP, or their practice nurse, or other reliable sources, such as hpv.ie or hpsc.ie. I would advise them against seeking opinions from strangers online.”

In this episode of The Explainer recorded in March, we discuss how the recent 208% rise in measles cases in Ireland came from the misinformation online and from the success of the MMR vaccine, which eradicated the disease to such an extent, we forgot just how bad it was.

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