For nearly a decade, HPV vaccination in Korea was largely framed as a cervical cancer prevention measure for girls, leaving boys outside the national program despite evidence that the virus also causes diseases in men, including oropharyngeal cancer, anal cancer and genital warts.
Professor Kim Dong-hyun of Inha University Hospital speaks at an MSD Korea media session in Seoul on Wednesday, emphasizing the need to expand HPV prevention awareness from a girls-only cervical cancer vaccine to vaccination for both boys and girls. (Credit: MSD Korea)
That perception is now being challenged after Korea began providing free HPV vaccination to 12-year-old boys under the National Immunization Program, or NIP, on May 6. At a media session in Seoul on Wednesday, MSD Korea and medical experts said the policy change should be used to correct the long-standing view that HPV vaccination is mainly for girls and to build broader prevention awareness for both sexes.
Under the expanded NIP, 12-year-old boys are now eligible for free HPV vaccination. The previous program covered girls aged 12 to 17 and low-income women aged 18 to 26. The NIP currently uses the quadrivalent HPV vaccine.
Cho Jae-yong, executive business unit director of vaccines at MSD Korea, said awareness of male HPV vaccination has remained low even though HPV can infect both men and women and cause related diseases in both sexes.
“HPV is a virus that infects both men and women and causes related diseases, but social awareness of male vaccination has tended to remain low,” Cho said. “With the meaningful introduction of HPV national vaccination for boys this year, we will continue to make various efforts to help male adolescent vaccination take root smoothly by promoting the importance of vaccination for both men and women.”
Professor Kim Dong-hyun of the Department of Pediatrics at Inha University Hospital, said HPV vaccination should no longer be understood only as a cervical cancer vaccine.
Kim described HPV as a “silent virus,” noting that infection does not immediately cause symptoms or cancer but may lead to disease years later. While the virus often clears naturally, persistent infection can cause cervical cancer, vulvar cancer, vaginal cancer, anal cancer, oropharyngeal cancer and genital warts.
“The HPV vaccine has often been explained to parents as a cervical cancer vaccine to make it easier to understand, but it is not a vaccine that prevents only cervical cancer,” Kim said. “Oropharyngeal cancer, which is a major concern among men, is also related to HPV and should be viewed as a vaccine-preventable disease.”
The burden of HPV infection among Korean men has also been increasing. According to the Korea Disease Control and Prevention Agency (KDCA), the number of reported HPV cases in Korea rose 32.8 percent over the past four years, from 10,945 in 2020 to 14,534 in 2024. Among men, reported cases increased 82.9 percent, from 117 to 214 during the same period.
A Korean study of 44,065 men conducted from March 2014 to February 2022 found that 59 percent tested positive for HPV DNA. Genital warts, which are mainly caused by HPV infection, were reported far more frequently in men than in women, with 48,017 male patients in 2024 compared with 9,600 female patients.
Kim said male vaccination is particularly important because men do not have a routine screening system comparable to cervical cancer screening for women. Unlike women, whose HPV infection rates tend to decline with age, men continue to show infection rates of about 40 to 50 percent from their 20s to 40s, suggesting continued exposure to new HPV infections.
“Because the virus can be carried and transmitted without symptoms, HPV vaccination for male adolescents is important from both individual and community prevention perspectives,” Kim said.
Despite the growing disease burden, male adolescent vaccination remains extremely low in Korea. As of 2024, the HPV vaccination rate among boys born in 2011 was only 0.2 percent. Kim said the start of government-supported vaccination for boys should therefore be used as an opportunity to raise coverage and narrow the prevention gap between boys and girls.
The timing of vaccination is also important. Experts generally recommend HPV vaccination at ages 11 to 12 because protection should be established before first sexual exposure. Under the NIP, the quadrivalent HPV vaccine is given in two doses for children aged 9 to 13, with the second dose administered six to 12 months after the first.
Studies have shown that two doses administered between ages 9 and 13 generate immune responses against HPV types 16 and 18 that are non-inferior to those seen after three doses in women aged 16 to 26.
“The purpose of the vaccine is to establish immunity before first sexual experience, and that is when the effect is greatest,” Kim said. “Rather than morally judging the age of first sexual experience, we need to propose the most appropriate medical prevention strategy based on reality.”
Kim said early vaccination also has practical advantages, as children aged 9 to 14 need only two doses, while those who begin vaccination after their 15th birthday generally require three doses.
Age 12 is also a key point in Korea’s routine immunization schedule, as children are expected to complete several essential vaccinations before graduating from elementary school, including the sixth dose of Tdap and the fifth dose of inactivated Japanese encephalitis vaccine.
“Age 12 is when secondary sexual characteristics begin in boys, and it is also a time when parents should check normal growth and development while paying attention to disease prevention through essential vaccinations before elementary school graduation,” Kim said. “HPV vaccination should also be guided actively in clinical practice so that it can be completed during this period.”
The session also addressed Korea’s use of the quadrivalent HPV vaccine under the NIP. Kim said the quadrivalent vaccine provides clear cancer prevention benefits because it covers about 70 percent of HPV-related cancer risk. However, he said Korea should eventually discuss switching to the 9-valent HPV vaccine, which could expand cancer prevention coverage to about 90 percent by including additional high-risk HPV types.
“The quadrivalent vaccine also has the advantage of covering about 70 percent of cancers. Seventy percent is by no means a small figure, and the prevention benefit is clear,” Kim said. “If the 9-valent vaccine can be used, the coverage could be increased by another 20 percentage points.”
Kim said the introduction of HPV vaccination for boys should now be followed by public education, active guidance from healthcare professionals and further policy discussions on how to improve HPV prevention.
“The introduction of HPV NIP for boys is important, but the more important task is helping the program settle in clinical practice and society,” Kim said. “Government and medical community efforts should continue so that HPV prevention can move beyond the past perception of a girls-only vaccine and become a prevention strategy for both boys and girls.”
Lee Han-soo
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