Whether the national immunization program (NIP) for the human papillomavirus (HPV) vaccine should be extended to cover males remains a hot issue in Korea.

With the NIP applied for its use in girls aged 12 years or older, the government extended the program to include those aged 13 to 17 (born between 2004 to 2008) and low-income women aged 18 to 26. In countries such as the US, male HPV vaccination is also covered through NIP, but the agenda is still under discussion in Korea.

However, as President Yoon Suk-Yeol had announced vaccination to males aged 12 years older using NIP as an election pledge, whether this will really be implemented is gathering attention.

For this, the Korea Disease Control and Prevention Agency was found to have been carrying out a research project to analyze the cost-effectiveness of extending NIP to HPV vaccinations in adolescent males on the 3rd.

Director Geun-Yong Kwon, Division of Immunization, Bureau of Healthcare Safety and Immunization at KDCA, said, “The new government fully agrees on the need for male HPV vaccinations, and we are in the process of securing evidentiary material to support this. We plan to reflect its inclusion in the budget by early next year." However, the conclusion may not be so easily drawn as it would cost a considerable amount.

Due to its characteristics and the NIP, HPV vaccines are better known in Korea as a cervical cancer vaccines. However, men also do get infected with HPV, and the most common clinical manifestation is genital warts in men.

At a media session that was held by MSD on the 3rd on the 'A to Z of HPV,’ Seung-Ju Lee, President of the Korean Association of Urogenital Tract Infection and Inflammation (Urology, St. Vincent Hospital) stressed the need for male HPV vaccinations.

According to Lee, the prevalence of genital warts in Korea had increased threefold over the past decade, from 25,208 patients in 2010 to 65,203 patients in 2019 prior to the pandemic.

Also, although the prevalence of genital warts was higher in women than men, it was highest in men 25-29 years of age. In Korea, genital warts occur mainly in the younger age group, and its incidence tended to be higher in men than in women.

Also, there were views that it is important to vaccinate men to prevent cervical cancer, for which the NIP is currently applied to HPV vaccinations for women only.

With the yearly rise in the HPV vaccination rate, the prevalence of HPV infections are expected to be decline, however, when considering the time required to achieve herd immunity, Lee explained that it would be more effective if both women and men are vaccinated at the same time.

According to MSD, its predictive modeling study in Europe and Belgium showed that allowing HPV vaccination for both men and women was expected to be cost-effective in most countries. while allowing the high vaccination rate to be maintained among girls.

Lee said, “Although the domestic HPV vaccination rate exceeded 80% for initial vaccinations, the rate becomes lower when taking into account the second vaccinations. Korea is quite new to applying NIP to HPV vaccines yet, therefore, to create herd immunity, it would be much more effective and also better for preventing male diseases to concurrently allow HPV vaccinations for men under NIP as well.”

Among the 110 countries that are conducting HPV vaccinations under NIP, 52 countries including the US, UK, Canada, Australia, Switzerland, Italy, and Austria have extended its vaccinated subjects from girls to boys (as of March 2022), therefore, it is not unusual that this discussion is being made in Korea.

As the government has also been selected extending eligibility for HPV vaccinations using NIP as its national task, it is true that there are positive forces underway supporting the implementation of the system.

However, the issue mentioned above is its cost-effectiveness. The KDCA estimates that a budget of approximately KRW 19 billion won will be required every year if HPV vaccination is expanded to boys.

In this sense, the results of KDCA’s research project that will be disclosed in the first half of this year may determine the direction of whether the NIP will be expanded to male HPV vaccination in Korea.