The matter in summary The Norwegian Institute of Public Health (FHI) recommends that the HPV vaccine be free for young men and risk groups. The HPV vaccine is free for girls and boys in the child vaccination program in the 7th grade. In 2009 it was offered to girls, in 2018 to boys. In 2016, girls up to the age of 26 were offered a free HPV vaccine. Such a pick-up program for boys has not happened. A professor reacts to that. He calls it discrimination and an ongoing offence. The vaccine can prevent cancer, but is best before sexual debut, according to FHI. The HPV virus can cause several types of cancer, including cervical cancer, anal cancer, penile cancer and cancer of the mouth and throat. FHI also recommends that the vaccine be offered free of charge to men who have sex with men, as they are in a high-risk group for HPV-related cancer, but that it is challenging to give the vaccine to a group based on sexual orientation. The decision to make the vaccine free for these groups will be taken by the Ministry of Health and Care. The summary is made with a little help from an AI service from OpenAi. The content is quality assured by news’s journalists before publication. – Especially when all other age groups who are younger than us have received the offer, it would be very good if we had also had the opportunity to take it, says Gabriel Skaare Hov (18). The HPV virus is well known for being able to cause cervical cancer, but it can also cause cancer elsewhere. Also in men. At Hamar Cathedral School, it is almost Russian time. Gabriel Skaare Hov (18) is Russian president and Aksel Asmundsson (18) is action manager during the Russian era at Hamar Cathedral School. Both say they would take a vaccine if offered. Photo: Viktoria Hellem-Hansen / news Hov is the Russian president and says they recently received a free vaccine against meningitis. Soon it may also happen that they can be offered another one as well, namely the HPV vaccine. In a new assessment from the Norwegian Institute of Public Health (FHI), which news has obtained access to, it is stated that they recommend a free vaccine to several people, including boys born in 2005. – I would have accepted if I had been offered a vaccine, says Aksel Asmundsson (18). What is HPV? Human papillomavirus (HPV) is a large group of viruses consisting of around 200 different types. About 40 of these become infected through sexual contact and infect mucous membranes. It is estimated that over 70 percent of the population will acquire a genital HPV infection during their sexually active life. Many people will not notice anything and the infection will go away on its own, but in some the HPV infection develops into cancer or genital warts. HPV 16 and HPV 18 together cause approx. 70 percent of all cases of cervical cancer. HPV 31, 33, 45, 52 and 58 together are responsible for around 20 per cent of cervical cancer cases. If cervical cancer is disregarded, it is estimated that around 200 cases of HPV-related cancer occur annually, of which approx. 100 cases in men. HPV infection is also a cause of genital warts. 90 percent of all genital warts are caused by HPV genotypes 6 and 11. These genotypes do not cause cancer. In Norway, the HPV vaccine that protects against HPV 6, 11, 16 and 18 was used until 2017. The one used today protects against HPV 16 and 18. Source: NHI and the Norwegian Medicines Agency 18-year-olds Gabriel Skaare Hov and Aksel Asmundsson think it is unfair that all young people have been offered a vaccine. Photo: Viktoria Hellem-Hansen / news More people may be offered the vaccine The first to be mentioned in the report are people who have an increased risk of HPV-related cancer. There are people with immunodeficiency conditions, HIV positive and consensual women. – We strongly recommend that they should get an offer of free HPV vaccine through the blue receptor trial, says department director of FHI, Are Stuwitz Berg and adds: – In addition, we think that the very youngest boys who did not manage to get it in the child vaccination programme, because they were a little too old when it was introduced, they should be offered a so-called catch-up vaccination. It is young men who were born in 2004 and 2005 who may be relevant in such a case, such as the two 18-year-olds. Are Stuwitz Berg is department director at the Institute of Public Health (FHI). Photo: Torstein Bøe Men who have sexual relations with men are also included as an option that can be considered. The reason is that they do not receive the same protection as men who have sex with vaccinated women. At the same time, there are several challenges with a separate program based on sexual orientation, he says. In addition, young men up to the age of 26 are included in the assessment, just as women were offered in 2016. – But then the vaccine has less effect, both because they have largely made their sexual debut and have probably been infected. They are quite well protected already, because women in the same age group have such high HPV vaccine coverage. These are the options FHI recommends. The options are abbreviated: Option 1 involves the offer of vaccination financed through the Blue Prescription Regulations for groups who, due to other illnesses, also have an increased risk of serious HPV-related illness: stem cell transplant recipients, HIV-positive women and women who have been diagnosed with HIV. Option 2 involves a separate vaccination offer for unvaccinated men who have sex with men, since this group has an increased risk of HPV-related cancer and vaccination can provide individual protection. A vaccination offer based on sexual orientation can be difficult to implement, compared to the experiences of other countries. Alternative 3 involves a catch-up program for men, in two different age groups. Alternative 3.1 involves an offer to young unvaccinated men born in 2004 and 2005, i.e. the last two cohorts that did not receive an offer through the childhood vaccination programme. FHI believes that the knowledge base is sufficient to recommend this measure, based on potential benefits for the vaccinated, but also possible positive effects at group level. Alternative 3.2 involves a 2-year catch-up program for all unvaccinated men up to the age of 26, which corresponds to the offer young women previously received. This will ensure that both sexes have equal access to the offer, even if the effects will be different, particularly due to the herd protection from the women. FHI believes that this alternative can be considered if one wishes to use this form of equal treatment as a basis. Such an offer will particularly have positive effects on an individual level among men who are not yet infected, but the size of this effect is limited given increasing age. Option 4 involves a 2-year gender-neutral catch-up program up to the age of 32. FHI, on the other hand, believes that there is little basis for considering this alternative. – Unfair gender discrimination Girls in the 7th grade have been offered a free vaccine since 2009 through the children’s vaccination programme. In 2022, there were zero cancer cases among young people who received the first HPV vaccine through the programme. A couple of years later, in 2016, women born in 1991 and until 1996 were also offered the vaccine. By then it was already too late for several women who had been infected by the virus. Nine years later, in 2018, boys in the 7th grade, boys born in 2006, were also offered the vaccine. This year they turn 18. No men born before have received the same offer. Ole-Erik Iversen says he has been publicly advocating for equality in HPV vaccination for 12 years. Photo: Haukeland University Hospital Professor emeritus and former chief physician, Ole-Erik Iversen, has long believed that more young men should be included in the vaccination. – There has been an ongoing offense and unjustified gender discrimination over several years, he says to news. He mentions again, as he did in a journal in 2020: – For every year that passes, there are 30,000 unvaccinated Norwegian boys and men who are deprived of the opportunity to prevent cancer. Do you think men up to the age of 26 should be vaccinated? Iversen says the assessment that FHI is now coming up with is reasonable, but still believes that all men up to the age of 26 should be offered catch-up vaccination, as women were. – Both sexes must be treated equally in accordance with Norwegian law, which prohibits discrimination, including on the basis of gender. Stuwitz Berg in FHI says he does not know whether Iversen has grounds to call it an offence. – Others must assess that. Read the full response from FHI regarding discrimination – The discrimination Iversen refers to is about several things. The vaccine was primarily approved to protect against cervical cancer, and it has taken time to gain the necessary knowledge about the effect against cancer, which can also affect boys, and thus the approval also came later. And for a long time there was a lack of vaccines in the world. And as I said, most younger men have herd protection due to high coverage among women, says department director at FHI, Are Stuwitz Beg to news. – In the years to come, the incidence of disease in women will decrease, while it will increase for many years in men. And we are already too late, says Iversen. Iversen believes that the vaccine can still have a protective effect, even though FHI says that more males have herd protection through females. – If you are infected with one type, there are still many other types that you are not necessarily infected with. Stuwitz Berg at FHI answers that the vaccine’s effect falls after sexual debut. – But it is true that Iversen says that some people can have some effect from the vaccine even later in their 20s. Will have costly consequences. It is the politicians who decide who to give the vaccine to. The Ministry of Health and Care said in January last year that they were waiting for FHI’s assessment. State Secretary Ole Henrik Krat Bjørkholt says in an e-mail that just before Christmas they received the assessment from the Institute of Public Health about introducing the HPV vaccine for men under 30. – Any introduction of this will have budgetary consequences, so treatment in the ministry is therefore part of the ordinary budget work. news does not get to see what it costs, because it is slanderous in the report. Costs for HPV vaccine outside of a program For those who want an HPV vaccine today, it costs almost NOK 3,000 for three doses of Cervarix. It is the vaccine given in the childhood vaccination programme, and protects against HPV18 and HPV16. Gardasil 9 protects against many more types, but costs almost NOK 5,000 if you buy it at the pharmacy, according to the joint catalogue. According to professor emeritus and former chief physician, Ole-Erik Iversen, the government gets a huge discount and a good purchase price in vaccination programmes, and it is therefore not as expensive. FHI confirms that you can get a good purchase price in vaccination programs since the vaccines here are bought in after a public tender. Source: Joint catalog Stuwitz Berg tells news that the question of which vaccine should possibly be offered to men over 20 has not been decided. Cervarix is the vaccine that was offered in 2016 to girls up to the age of 26, and it is the vaccine that is currently offered in the children’s vaccination programme. Photo: Junge, Heiko / NTB scanpix
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The Institute of Public Health (FHI) recommends free HPV vaccine for risk groups and young men – news Innlandet – Local news, TV and radio
