Gender-neutral HPV vaccination in Africa
Authors: Ruo-Yu Zhuang, Hemant Goyal, Hua-Guo Xu
Journal: The Lancet Global Health (2019)

Onyema Chido-Amajuoyi and colleagues (January, 2019)1Chido-Amajuoyi OG Domgue JF Obi-Jeff C Schmeler K Shete S A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in Africa.Lancet Glob Health. 2019; 7: e20-e21Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar appeal for the introduction of gender-neutral human papillomavirus (HPV) vaccination to national immunisation programmes in Africa, as has been done in many developed countries such as the USA and Australia. Gender-neutral HPV vaccination seems to have become a trend worldwide, but its introduction might not be a simple task to achieve in Africa. First, African countries have a large burden of cervical cancer, but only 1–2% of girls and women aged 10–20 years in Africa get vaccinated.2Bruni L Diaz M Barrionuevo-Rosas L et al.Global estimates of human papillomavirus coverage by country and income level: a systematic review.Lancet Glob Health. 2016; 4: e453-e463Summary Full Text Full Text PDF PubMed Scopus (487) Google Scholar Therefore, increasing vaccine coverage in this group should be a priority because a herd effect exists even when coverage is as low as 20%.3Brisson M Benard E Drolet M et al.Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models.Lancet Public Health. 2016; 1: e8-e17Summary Full Text Full Text PDF PubMed Scopus (166) Google Scholar Second, countries eligible for subsidisation by Gavi, the Vaccine Alliance, are the lowest-income countries, whereas other lower-middle-income countries are ineligible for this support.4Turner HC Thwaites GE Clapham HE Vaccine-preventable diseases in lower-middle-income countries.Lancet Infect Dis. 2018; 18: 937-939Summary Full Text Full Text PDF PubMed Scopus (20) Google Scholar Thus, female-only vaccination might be an acceptable alternative in these countries. Finally, the global HPV vaccine shortage might adversely affect the progress of introduction of gender-neutral vaccination. We strongly recommend that vaccination for females be included in national immunisation programmes first, followed by the inclusion of vaccination for males. We believe that HPV vaccination in males is meaningful to reduce the risk of cervical cancer in the population, but introduction of gender-neutral vaccination still has a long way to go globally. We should proceed cautiously and steadily towards the global goal of universal HPV vaccination for males and females while keeping financial issues in mind. We declare no competing interests. HGX receives funding from the National Key Clinical Department of Laboratory Medicine of China in Nanjing, Natural Science Foundation of Jiangsu Province of China (grant number SBK2018022334), Key laboratory for Laboratory Medicine of Jiangsu Province (grant number ZDXKB2016005), and the Priority Academic Program Development of Jiangsu Higher Education Institutions. A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in AfricaHuman papillomavirus (HPV) causes more than 90% of cervical and anal cancers, more than 70% of oropharyngeal cancers, and a substantial proportion of vaginal, vulvar, and penile cancers. About 85% of women and 91% of men with a sexual partner will be infected with HPV in their lifetime.1 However, if countries can attain 80% HPV vaccination coverage in both men and women, HPV-associated cancers could be eliminated.2 The theme of the upcoming European Research Organization on Genital Infection and Neoplasia conference, due to be held in December 2018—"From control to elimination of HPV induced cancers: time to match visions with actions"—could not be more pertinent to the African continent. Full-Text PDF Open AccessGender-neutral HPV vaccination in Africa – Authors' replyWe thank Ruo-Yu Zhuang and colleagues for their interest in our recent Comment.1 We acknowledge their points in support of an initial introduction of human papillomavirus (HPV) vaccination for females, later followed by the inclusion of males. Full-Text PDF Open Access