The main reason for this vaccine is to prevent CERVIX cancer. Boys don't have cervixes, so they don't need the vaccine.

Now it's true that it's not a bad idea to give it to boys to prevent future HPV related head and neck cancers, etc., but these are nowhere NEAR as common as women getting cervix cancer - which can affect women in their 30's and 40's, and not generally in the 60's like for men and women with head and neck cancer.

No one is saying you can NOT get your boy the vaccine, but boys don't have as much at stake, so from a public health perspective, covering girls is the most efficient use of our money. Also, if you DID recommend it for boys, sure as heck someone just like you would be writing articles complaining about the greedy vaccine makers trying to ram this hardly useful vaccine on every boy in America.

Terrible article, btw.

P.s. the vaccine doesn't prevent ALL hpv infection, it only covers some subtypes of hpv that are most likely to cover cancer, so saying it's to prevent hpv in the first place is also a non-starter

* "cover" = "cause" in p.s.

Whether or not the HPV vaccine is intended to prevent CERVICAL cancer only - and has gone through clinical trials to prove its effectiveness - it's pretty common for doctors to prescribe drugs for off-label uses. If the vaccine prevents HPV, of the kind that can lead to infant breathing problems and various other cancers, isn't it worth investigating whether it should be prescribed more widely?...rather than saying "Oh, but it's a GIRL drug! Cooties!"

Bondsman:

The main reason for this vaccine is to prevent CERVIX cancer. Boys don't have cervixes, so they don't need the vaccine.

Umm, vaccinating boys protects girls from cervical cancer as well. If a boy is vaccinated then he doesn't have to worry about later being an asymptomatic carrier of the virus if he has sex with someone who is unvaccinated.

Let me put it another way -- I get the seasonal flu vaccine not because I care very much about getting the flu (I'm in good health) but because I don't want to pass on the flu to unvaccinated people or even to vaccinated people (since vaccines are not always 100% effective). You can make a similar argument for vaccinating boys against HPV. The main argument against vaccinating boys on a widespread basis is cost. But the cost effectiveness depends strongly on the percentage of girls who get vaccinated.

You could protect girls from HPV by routinely vaccinating all boys just as easily as you could protect them by vaccinating all girls.

And in fact, given the (ridiculous) resistance to the vaccine by moral hazard types -- "my daughter will turn into a whore if she gets the vaccine!" -- I think making the vaccine routine for both boys and girls would increase the rate that girls get vaccinated. And for those poor girls who still don't get the vaccine, the more boys that have it the better for them too.

maracle:

You could protect girls from HPV by routinely vaccinating all boys just as easily as you could protect them by vaccinating all girls.

That is just flat wrong. If you vaccinate women, there will be many more guys with HPV than women, but it barely matters. Under a opposite system where more women than guys have HPV, women would still die from cervix cancer.

Ketone,

In my post I didn't say vaccinating boys was a BAD thing, but in a world where we don't have unlimited funds, would that be the best bang for our buck, as opposed to, say, making sure an equal amount of money was spent on poor boys getting their MMR series?

Health care resources are limited resources and must be rationed and used wisely.

If health care dollars are better spend elsewhere (i.e. more people would benefit if dollars spend on X instead of Y), than it is logical to target one gender and the gender that would get the most benefit for the general public.

Bondsman, jazzguitarman, the problem I have with your arguments is that they are not quantitative. Yes, if one can assume that 100% of girls get vaccinated and the vaccine is 100% effective, then it makes no sense to vaccinate boys. The study cited in Saletan's article essentially made those assumptions. My point is that if those assumptions aren't true -- and it is my impression that far less than 100% of the female population has been vaccinated against HPV -- then the cost effectiveness calculation changes. Bear in mind that the fraction of heterosexual women who end up with HPV infections is determined by two numbers that can be controlled by vaccination policy: the fraction of uninfected women who were vaccinated, and the incidence of HPV infections in men (which in turn is partly determined by the fraction of uninfected men who were vaccinated). The incidence of infections can be strongly nonlinear since promiscuous men can infect a lot of women.

None of you have done the math to determine the cost effectiveness of vaccination under varying assumptions about the percent of the population that gets vaccinated or about the vaccine effectiveness. What we can say is this: vaccinating both boys and girls should be about twice as expensive as vaccinating just girls alone, assuming that the male and female populations are about equal and that boys and girls will receive the vaccines at about the same rates (which may not actually be true). What none of us has calculated is how much extra protection the female population would get from vaccinating both boys and girls using real data regarding vaccination rates. If the protection factor moved from 70% to 99% (for example), would that be worth twice the cost?

Ketone,

At any one time, about 20 million people in the U.S. have hpv, with about 5-6 million new infections per year.

There are about 17 thousand hpv associated carcinomas in women yearly (mostly cervix) and about 7 thousand male hpv related cancers, and again, these cervical cancers take more life-years, seeing how they can strike 20-30 years earlier.

So what do you think? If you are only going to spend X amount of money vaccinating people, and assuming the country is NOT going to spend enough to vaccinate everyone (the cost of Gardasil is about 120$ per dose, and 3 doses are required, so it's 360$ per person) ... where would you put your money? vaccinating all the girls you can, or vaccinating 1/2 boys and 1/2 girls, just boys, what?

Personally, *I* think vaccinating as many girls as possible is very reasonable. It may be reasonable to vaccinate anyone with multiple sexual partners, but then it may be too late for them. What do YOU think would be most appropriate to do with the money and vaccine we have right now?

Part of the answer depends on who's paying for the vaccinations. They're obviously going to be making more vaccine, since every year more kids reach the age to be injected.

There are two problems with those numbers. First, sexually active women are more likely to get screened for HPV because of the pressure to have yearly pap smears. I'm not aware of men getting the same kind of pressure for yearly exams (sex is only dirty and damaging for women apparently) and I don't think yearly physicals include screening for carrying the virus. So those numbers are going to reflect the disparate diagnosis prevalence in the two communities.

Second, those are incidence numbers for the guys at least. And the issue is partly protecting men from these cancers but mostly protecting women. And if we don't know how many men are passing on HPV, then Ketone is correct that we can't make any reasonable cost/benefit analysis as to equal vaccination by both sexes.

Additionally, I agree with Saletan's point about the gender bias in sexual politics. Rape counseling is almost entirely aimed at women. Well, men get raped too. And maybe fewer women would get raped if we put some of that money into programs aimed at convincing men to stop sexual violence. We don't make sexually active men have yearly exams and yet we force women to have yearly pap smears that have no health benefit (after three years of no problems the likelihood that a woman will have an abnormal pap smear is tiny-- so much so that they don't do them yearly in other countries, often places where contraception is over-the-counter). We have to stop the thinking that lets men off the hook for negative aspects of sex. It's everybody or nobody-- let's see men be forced to go to the doctor once a year if they buy condoms.

So who's forcing you to have an annual pap smear, and what's the penalty if you don't?

Bondsman:

So what do you think? If you are only going to spend X amount of money vaccinating people, and assuming the country is NOT going to spend enough to vaccinate everyone (the cost of Gardasil is about 120$ per dose, and 3 doses are required, so it's 360$ per person) ... where would you put your money? vaccinating all the girls you can, or vaccinating 1/2 boys and 1/2 girls, just boys, what?

I would say that you need an actual quantitative data-based model to determine that and you can't choose a strategy simply by waving your hands. You need to have the data and you need to compare a few alternative vaccination strategies, their estimated costs, and estimated effectiveness. Once you've done that you can start to think about opportunity cost. But the key is to have data -- without resonable assumptions about actual vaccination rates (not just objective rates) and a well-parameterized disease transmission model, how could you possibly tell whether it's more effective to vaccinate "all the girls you can" (percentage unknown?) or 1/2 boys and 1/2 girls? Maybe infections are dominated by promiscuous men and it would actually be more effective to vaccinate boys instead of girls because you'd have a higher chance of knocking out the main disease vectors. I don't think it's at all straightforward to make these estimates since it's a nonlinear problem.