The FDA recently approved the vaccine against human papillomavirus for use in boys and men to prevent genital warts. The vaccine has been used successfully in females to prevent cervical cancer, which is associated with the virus.
But should we recommend the vaccine for men?
Studies have concluded that the HPV vaccine was successful in reducing the incidence of genital warts in men, which is associated with cancers of the anus, penis, rectum, mouth and throat, diagnosed in about 8,600 men annually. Plus, preventing the spread of the virus to female partners can potentially reduce the incidence of cervical cancer.
But at what cost? Vaccinating girls against HPV made good economic sense — the same cannot be said for males, mainly due to a lower vaccine efficacy, which reduces the cost-benefit ratio – an important consideration when most cases of cervical cancer are in developing countries that can’t afford the vaccine.
The National Cancer Institute says targeting young women for vaccination, and screening older women for cervical cancer, will have a much bigger impact in reducing disease than widespread male vaccination. And the Harvard School of Public Health says a campaign to include boys for vaccination will cost seven times more than focusing on girls alone, and would be no more effective in reducing the incidence of HPV-related disease.
It’s best to wait for more data before considering using this vaccine on males.
I encourage you to listen and vote in this week’s poll, located both below, and in the upper right column of the blog.
Related posts:
- The HPV vaccine for the prevention of anal warts
- Going contrarian on Gardasil
- Gardasil: A "leap of faith"?
- Poll: How effective is the HIV vaccine, and will it affect public health?
- Why pregnant women should get the H1N1 flu vaccine
- Did the oral polio vaccine cause an outbreak in Nigeria?
- Poll: Doctors and nurses should get vaccinated against the seasonal flu and H1N1 influenza
{ 3 comments… read them below or add one }
My one vote changed the percentage split quite a bit. Would be interested to know how many votes have been recorded.
Also – I would be interested to see physicians asked this question two ways: would they recommend the vaccination as a public health policy, and would they recommend it for their patients or their own children?
The operative issue is that the vaccine appears to lessen the incidence of cancer of the anus, genitals, penis etc. in men. While I understand the cost/benefit analysis on a epidemiological level, the horrible suffering that occurs with cancers referenced above is enough to urge everyone to consider the vaccine for boys. Do we really want our sons to predecease us when this could be prevented?
HPV, Human Papilloma Virus, has clearly been demonstrated to increase the risk of a woman developing cervical cancer so it would seem to be a good idea to provide young woman, even as teenagers, with a vaccine that would guard against the virus and prevent the development invasive cervical cancers which would otherwise be produced by the virus.
Moreover, if vaccinating boys and young men would prevent transmission of the disease to young women, all the better.
In 2006 Merck Pharmaceuticals received the go ahead. The FDA approved the distribution of Gardasil and Merck promptly began the distribution of the vaccine.
Later in the same month the distribution began, the advisory committee on immunization practices recommended routine vaccination of girls 11 to 12 years old. Remarkably, these recommendations were issued before completion of the so-called phase III trials demonstrating whether advanced pre-cancerous lesions of the cervix are prevented by the use of the vaccine.
In fact, only two of the fifteen types of HPV known to have a cancer-producing potential have been shown to be affected by the vaccine.
Merck has seen to it that the public has been provided with a favorable view of the vaccine. In a report by Rothman and Rothman published in the Journal of the American Medical Association this year, Marketing HPV vaccine: implications for adolescent health and medical professionalism, JAMA 2009 Aug 19; 302(7):781-786 the author shows how Merck employed the assistance of various important medical associations by providing the associations with ready-made presentation slide sets, emails and letters to promote the product. All this publicity in favor of the use of the vaccine began before important trials had even been concluded.
Now, in the same issue of the Journal of the American Medical Association in which the report of Rothman and Rothman appears, there is an article from the U.S. Centers for Disease Control and Prevention and the U.S. Food and Drug Administration reporting adverse events occurring in the two and a half years following administration of Gardasil, Postlicensure Safety Surveillance for Quadrivalent Human Papillomavirus Recombinant Vaccine, Slade, B.A., Leidel, L.,Vellozzi, C.; et al. JAMA 2009 Aug 19; 302(7): 750-757. There were 752 adverse reports. 6.2% of the adverse reports involved serious adverse effects, including 32 reports of death but the system of depending on voluntary reports of adverse events risks underreporting and there is no real evidence that the adverse events reported resulted from the vaccine. Such adverse events reports are based solely on an event occurring after the administration of the vaccine and not because of any other evidence proving the vaccine caused the event.
So, we don’t really know the extent of any benefit a young woman will receive as a consequence of being vaccinated and we also don’t know the risk. We know even less regarding any benefit derived by young men and what magnitude of risk is justified to avoid gentital warts
What a nightmare for a parent with a decision to make about a teenager receiving Gardasil. Cervical cancer continues to kill thousands of women every year. If the leading cause of the cancer is a virus that can be prevented by vaccination, how does one decide to not offer the vaccination? If, as some have suggested, the chances are less than six adverse events per thousand doses distributed and only 6.2% of those represent serious adverse effects, that means that one serious adverse event would be associated with every three thousand doses distributed. But even with a risk this small, has there been a sufficient benefit demonstrated to justify that risk? And how does a parent justify a boy being subject to risk for the principle, though unstated purpose of preventing transmission of a disease to young women.
In a completely different context, many years ago Jonas Salk pointed out to me the importance of focusing on the numerator. If the chance is 1 in 10,000,000 and you are the one, it is little comfort that 9,999,999 other doses were administered safely.
Perhaps it was easier long ago when we knew little and simply did what we were told. If not better, perhaps it was just a lot simpler.