why boys should get vaccinated

The President of the Republic announced on Tuesday February 28 the establishment of a “generalized” free vaccination campaign in colleges for students in 5^e in order to eradicate the papillomavirus, responsible each year for more than 6,000 new cases of cancer. On this occasion, we offer you this article from The Conversation and published in 2019.

En December 2019, the High Authority for Health (HAS) published a recommendation aimed at “extending vaccination once morest human papillomaviruses to young boys”. In a press release, the Ministry of Health indicated that it wanted “this recommendation to be integrated into the 2020 vaccination calendar for implementation by the summer”. In September, the Academy of Medicine had also officially declared itself in favor of vaccinating girls AND boys once morest the papillomavirus, and on March 20, already, a group of 50 learned societies and medical unions had sent an appeal to the public authorities asking the “free or reimbursed universal vaccination, without distinction of sex or risk”, once morest these viruses.

But why also vaccinate boys once morest papillomaviruses, which are known to be responsible for almost all uterine cancers? Because they do not only affect women, but actually threaten both sexes: a third of cancers and half of genital warts they cause concern men! Reminders.

Papillomaviruses are responsible for nearly 100% of cervical cancers.

Every year, 3,000 French women learn that they have cancer of the cervix. And each year, 1,100 of their fellow citizens die of this disease, which makes it the tenth cause of death by cancer among women in France.

Over the past twenty years, screening for precancerous lesions of the cervix has halved the number of new cases, as well as the number of deaths. It’s good. But it might be much better.

READ ALSOWHO efforts to eliminate cervical cancerIndeed, cancer of the cervix is ​​attributable, in nearly 100% of cases, to infection by one or more human papillomaviruses (HPV or HPV – Human PapillomaVirus). These viruses, of which there are various stereotypes, are transmitted through sexual contact. They are among the deadliest cancer inducers (or “oncogenes”). The tumors of the cervix that they cause develop on average 10 to 15 years following a persistent infection. They lead to death in more than a third of cases, and therefore have a major cost both in terms of human lives and health care and expenditure.

However, there is a preventive vaccine that protects once morest most of them, making it possible to prevent 2 cancers of the cervix out of 3. Can we imagine having a vaccine available providing protection, even imperfect, once morest a cancer that kills more than one in three patients, and refuse to use it? Yet this is what is happening in France.

Between the deadly communications of the anti-vaccine which misinform the population, with scientifically false arguments, and the reluctance of the authorities on this subject, the vaccination coverage does not increase. A proactive policy combining vaccination and screening might, however, save millions of lives worldwide, as confirmed by a study published on February 19 in the prestigious medical journal The Lancet.

13 million preventable cancers

Kate Simms and her colleagues modeled the cumulative effects of the global expansion of vaccination coverage and screening (which still remains beyond the reach of many countries) on the number of cases of cervical cancer. Their work focused in particular on the frequency of these cancers in low- and middle-income countries.

Their conclusion is clear: if, by 2020, a rapid increase in vaccination made it possible to reach 80 to 100% vaccination coverage (via a broad-spectrum anti-papillomavirus vaccine), nearly 7 to 8 million cases cervical cancer might be prevented globally. In the most advanced industrialized countries, such as the United Kingdom or Australia, coverage is greater than 85%, which suggests that papillomavirus-induced cancers will disappear by 2030.

If, in addition to this vaccination, 70% of women in low- and middle-income countries had screening twice in their lifetime, at ages 35 and 45, between 12 and 14 million cancers of the cervix would might be avoided over the next 50 years.

Insufficient vaccination coverage, which is not progressing

Unfortunately, in France, the lack of solid scientific and medical information and the audience of fake news disseminated on the subject via social networks result in particular in reducing the vaccination coverage once morest the papillomavirus below 20% for young women. This level is dramatically lower than the objective of 70% theoretically set by the health authorities and shows no progress.

At the end of 2015, less than 20% of young girls had received at least 1 vaccine dose at age 15 (compared to 86% in the United Kingdom, 76% in Denmark, 71% in Italy, 73% in Spain and 87% in Portugal). After a slight increase (in 2017, 26% of 15-year-old girls had started vaccination, 21% had received the full regimen of the recommended two doses), the rate started to fall once more in 2018, and fell back to a dismal 19%.

In terms of public policy, it is also regrettable that the recent marketing of the nine-valent HPV vaccine in France (Gardasil 9, protecting once morest nine different HPVs) was not accompanied by a withdrawal of the less protective older vaccines ( Gardasil with four valences, or even Cervarix protecting once morest only two viruses).

This lack of prophylactic action by the public authorities, combined with the lack of information of the population and practitioners, results in less than half of the young women vaccinated in 2019 benefiting from the most protective nine-valent vaccine!

The maintenance of less protective obsolete vaccines therefore further aggravates the absurdly low rate of overall vaccination coverage in France, which is at the level of that of low- and middle-income countries in the study of the Lancet.

HPV vaccine prevents other cancers

It is also essential to emphasize that human papillomaviruses do not only cause cancers of the cervix. They are also the cause of many other scourges: cancers of the vagina, vulva, ENT sphere or anus (in both men and women), as well as cancer of the penis.

Logic therefore dictates that vaccination coverage should also be extended to boys. Agnès Buzyn questioned the High Authority for Health on this subject, whose recommendation is eagerly awaited. In this context, the Grand-Est and Auvergne-Rhône-Alpes deserve a tip of the hat: at the forefront, these two French regions are trying to promote the vaccination of boys and girls. At the end of January, the Belgian Federal Center for Health Care Expertise gave the green light to the HPV vaccination for boys. According to some estimates, in Europe, vaccination with the nine-valent vaccine might in particular prevent more than 350,000 condyloma (genital warts) in men each year, nearly 5,500 oropharyngeal cancers, more than 2,300 anal cancers or more than 1,100 penile cancers.

The positive effects of a well-affirmed health policy, like that of some of our European neighbours, are nevertheless visible. Thus, the legal obligation to vaccinate young children with vaccines combining 11 valences is already producing beneficial effects.

We can now hope to better protect the population once morest the most frequent infectious diseases and, incidentally, once morest the cancers which may result from them, sometimes years later, as in the case of hepatitis B or papillomaviruses. The WHO estimates that an improvement in global vaccination coverage, all vaccines combined, might prevent 1.5 million deaths each year.

Much remains to be done, particularly in France where inconsistencies remain in terms of vaccination policy. At a time when infectious diseases and cancers remain major scourges and when the efficiency of health expenditure is sought, an active prevention policy today can only reduce health expenditure tomorrow and contribute to the well-being of all citizens.

* Michel Cogné, professor of immunology at the Faculty of Medicine of Limoges, member of the Institut universitaire de France, Inserm U1262, University of Limoges