Abstract

Viral infections cause at least 15% of all cancers; one of the most important oncogenic viruses is the human papillomavirus (HPV) a causal agent in 5% of cancers in men and women. The identification of the major oncogenic HPV ’s HPV 16 and 18 by Harald zur Hausen was recognised in 2008 by the award to him of the Nobel Prize in Medicine. The unfolding of the HPV story started in the 1970’s and has resulted in the development of prophylactic vaccines using sophisticated recombinant molecular techniques and protein expression to prevent infection by HPV 16 and 18, the most prevalent oncogenic HPVs. These vaccines are licensed world wide and incorporated into national immunisation programmes in both developed and developing countries. In view of the overwhelming data on efficacy and the emerging data on the dramatic population effectiveness in vaccinated women, the questions about the current prophylactic vaccines are no longer about efficacy but rather about access and affordability. Two issues, reducing the dosage regimen from 3 doses to 2, or even 1 and gender neutral vaccination – extending the benefits of HPV vaccination to boys and men are intensely discussed. These discussions are complicated by the absence of an immune correlate and the observation that men make poor immune responses to HPV . .