Expanding the case for gender-neutral human papillomavirus vaccination in South Africa: Emerging neonatal and ethical considerations.

Human papillomavirus (HPV) is widely recognised for its role in causing cervical cancer, prompting many countries, including South Africa, to prioritise girls in school-based vaccination programmes. This short report presents an exploratory case for expanding HPV vaccination to adolescent boys as well, drawing on emerging, but still limited evidence of maternal and paternal HPV transmission to neonates. Although current data on neonatal risks are preliminary, the possibility of vertical transmission and associations with respiratory papillomatosis, preterm birth and fertility issues warrant further investigation. Beyond neonatal outcomes, gender-neutral HPV vaccination offers ethical and public health benefits by promoting equitable protection, enhancing herd immunity and addressing transmission dynamics. Recent advances, including the World Health Organization-endorsed single-dose schedules and the availability of affordable vaccines, provide opportunities to revisit cost-effectiveness analyses. We recommend further context-specific research and modelling to quantify the long-term benefits of gender-neutral strategies in South Africa and similar settings.