The health department should explain when boys will be considered for HPV vaccination
South Africa’s framework has left the door open to vaccinating boys in its public human papillomavirus vaccination programme. (Photo: Unsplash)South Africa’s health department should assess the inclusion of boys in its public human papillomavirus vaccination programme. This assessment, argues Professor Colleen Aldous, should account for the protection boys could gain, the cost of delivering it, and the work still required to reach girls who miss vaccination and women who need cervical screening and treatment.
The human papillomavirus (HPV) is usually discussed in relation to cervical cancer. Persistent infection with cancer-associated HPV strains can also cause anal, penile and oropharyngeal cancers, the latter affecting parts of the throat. Boys therefore have a direct interest in protection.
A recent development gives that discussion a timely opening. The HPV gender-neutral vaccine Cervavac obtained prequalification status by the World Health Organization (WHO), a regulatory step which means that it can be procured by United Nations agencies. This recombinant quadrivalent HPV vaccine for girls and boys aged 9 through 26 years targets HPV types 6, 11, 16 and 18. It is administered for the prevention of diseases caused by the four HPV types. This includes the prevention of anal cancer in boys and young men, and cervical, vulvar, vaginal, and anal cancers in girls and young women.
While WHO prequalification does not mean that South Africa has registered or purchased the vaccine, changed its vaccination schedule or agreed to include boys, the arrival of another product should, however, prompt scrutiny of what South Africa can procure and whom its programme should protect. The national cervical cancer elimination framework for 2026–2030 already recognises the possibility of extending vaccination to boys when feasible. The government should now explain how feasibility will be assessed and what evidence would justify a change. (See Spotlight’s detailed guide to childhood vaccines for details on all of them.)
Recognising progress
South Africa’s HPV vaccination programme launched in 2014. Today it includes girls in public, private and independent schools. With some 3.6 million girls vaccinated it has been a resounding success. Public health researchers evaluating the programme have found that infections with HPV types 16 and 18 was 83% lower in a post-vaccine group than in a similar pre-vaccine group.
With that being established, protection through a girls-only programme depends partly on vaccination coverage and patterns of sexual contact. Its indirect benefits will not reach everyone equally, including men who have sex with men. A policy assessment should examine these differences rather than take for granted that vaccinating girls provides sufficient protection for all boys.
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Vaccine choice is important. Cervavac covers HPV types 16 and 18, which cause most cervical cancers, and types 6 and 11, which cause most genital warts. Other vaccines offer different coverage. For instance, the HPV vaccine procured by government and provided through the national HPV vaccination campaign is GlaxoSmithKline’s Cervarix. It protects against HPV types 16 and 18.
South Africa needs to compare the protection each product offers with the price it can negotiate and the number of people it can reliably reach.
Including boys could also help establish HPV vaccination as an ordinary part of adolescent healthcare. That is a reasonable aim, although a change in eligibility would still need consent procedures, school access, trained teams of healthcare workers, and of course proper funding.
The gaps that remain
As mentioned, there has been measurable progress in vaccinating girls. In a parliamentary reply dated 16 July 2026, Health Minister Dr Aaron Motsoaledi reported that 428 395 girls had received a dose during the February–March campaign, against a target of 472 658 in public and special schools. That represents 90.6% of the campaign target. It should not be presented though as coverage of all eligible girls nationally since the same reply noted the scheduling of catch-up vaccination and vaccination in private and independent schools for August and September. Those months have now passed. Publishing the results would help establish which girls were reached and where further outreach is needed.
The minister also said existing grant funding was sufficient for Grade 5 girls across public, private and independent schools, while the cost of broader catch-up vaccination was being assessed. This distinction is important to note. A funded routine programme does not automatically provide the resources to find and vaccinate everyone who missed earlier rounds.
Girls who are absent on vaccination day, no longer attend school or fail to return a consent form, need another opportunity. Arguably, a programme should also be judged partly by how effectively it recovers these missed opportunities. School-based delivery needs a clearly communicated route to vaccination for those it does not reach.
Women still need reliable care
The national framework records more than 11 000 new cervical cancer cases and nearly 6 000 deaths in 2022. It reports cervical screening coverage of 38.7% in 2024. These dated figures show why the discussion about boys must proceed alongside improvements in women’s care.
Vaccination prevents new HPV infections, it does not treat an established infection or an existing cancer. Screening and treatment therefore remain essential. A screening test should yield a result that the woman can understand and act on, followed by assessment and care when required.
Counting tests alone cannot tell us whether that happens. Services should also report how many women with abnormal results complete the assessment, how long they wait and how many receive the treatment they need. A woman lost between a positive test and a referral remains at risk despite having appeared in the screening statistics.
Women living with HIV face a higher risk of cervical cancer. Integrating cervical care into HIV services could reduce the need for separate appointments and referral journeys. Implementation should make use of existing contact with healthcare services while ensuring that an abnormal result receives appropriate follow-up.
Boys belong in the discussion
The economic assessment of adding boys should include cancers in males and genital warts, as well as effects on cervical cancer. It should show the vaccine price, delivery costs, expected uptake and assumptions about how long protection lasts. It should also examine the consequences of improving girls’ coverage and catch-up services within the same budget.
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The final policy decision rests with the National Department of Health. The National Advisory Group on Immunisation (NAGI) advises the minister and the department on vaccine evidence, schedules and new vaccine introductions, but it does not itself set or fund national policy.
The decision also exposes a wider institutional gap. South Africa uses health technology assessment in parts of the health system and is developing a more formal national approach, but it does not yet have a single established, independent body equivalent to the United Kingdom’s NICE that routinely and publicly assesses clinical benefit, cost-effectiveness, budget impact, equity and feasibility across health technologies. A decision on vaccinating boys would benefit from such a transparent process, with NAGI’s vaccine expertise informing the broader assessment.
South Africa’s framework has left the door open to vaccinating boys. The next step should be a published assessment with a timetable for a decision. If inclusion is supported, it will need a funded delivery plan and measurable milestones. Progress should be evident in the boys protected, the girls reached after a missed school visit, and the women who receive timely care after an abnormal screening result.
*Aldous is a healthcare scientist and professor at the University of KwaZulu-Natal, working across clinical research, researcher development and evidence-based medicine.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
Disclosure: Cervavac was in part developed with support from the Gates Foundation. Spotlight receives funding from the Gates Foundation, but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.