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University of Miami pediatrician, Judith L. Schaechter, M.D., gives an HPV vaccination to a 13-year-old girl in her office at the Miller School of Medicine on September 21, 2011 in Miami, Florida.
The controversy surrounding the vaccination of teenage girls for HPV is well known but now a federal panel of experts is recommending 11 and 12-year-old boys be vaccinated, too.
Human papillomavirus (HPV) is a cancer-causing virus that is transmitted from sexual activity. Researchers estimate that 75 to 80 percent of American men and women will be infected with HPV in their lifetime. While many will be asymptomatic, some will lead to abnormal cell growth, leading to cervical and vaginal cancers in women and anal cancer in men. New evidence also links HPV to mouth and throat cancers from oral sex, which is becoming more prevalent among young people. However, some argue against the risk assessment and cost-effectiveness of vaccinating for HPV; it would cost $140 million to vaccinate boys ages 11 and 12, for one year alone.
Lawrence Ross is a physician specializing in pediatric infectious disease at Children's Hospital Los Angeles and serves on the speaker’s bureau for Merck, the drug manufacturer of a brand of HPV vaccine called Gardasil. He said he supports the recommendation because the vaccine can prevent infection in both men and women. The vaccine will also help to decrease the rate of transmission. Ross says that even heterosexual males should consider being vaccinated. “All males are at risk, gay males may be more likely to be involved in so-called ‘high-risk’ sexual behaviors but even heterosexuals are at risk,” Ross says.
Diane Harper, professor of medicine at the University of Missouri-Kansas City and HPV vaccine researcher is skeptical of the benefits of the vaccine for heterosexual men. Harper says evidence suggests the only cancer the vaccine protects against is anal. She says anal cancer is significantly less common in heterosexual males compared to gay men. Harper says the vaccine may potentially prevent precursors to this type of cancer in the gay population.
Harper also argues that the effectiveness of the vaccine is up for debate. “To have anal cancer protection provided by Gardasil is a hoax,” she says, “We know that the antibody titers that men generate from Gardasil go away two to three years faster than they do in women.” Harper says there is no evidence to support the claim that providing the vaccine to men will prevent transmission to women.
Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, favors the recommendation because, he says not enough women get vaccinated. The vaccine is administered in three doses over a period of a year but most women never complete the series. He says that vaccinating men will help but even better would be a concerted effort to push more young women to get vaccinated.
Caplan says HPV is a public health issue, “If you add in genital warts, if you add in that you can transmit it to babies, there are about a thousand babies that get horrible infections in their throats and face from this thing. Then I think you got the case that makes it worthwhile to really try harder to get women to take it.”
Would state or federal healthcare dollars pay for that? Will insurance cover it now that it’s been recommended? Because most men contract HPV through homosexual sex, would it be appropriate to only vaccinate gay boys? And should vaccination for both girls and boys be mandatory?
Lawrence Ross, MD, pediatric infectious disease specialist at Children's Hospital Los Angeles; he also is part of the speakers bureau for Merck, which manufactures the HPV vaccine Gardasil
Arthur Caplan, director, Center for Bioethics at the University of Pennsylvania
Diane Harper, professor of medicine, University of Missouri-Kansas City, School of Medicine; HPV vaccine researcher for past 20 years