HPV vaccine for men

Boy getting his shot

CDC Advisory Committee To Weigh Whether To Recommend Vaccinating Boys Against HPV

“October 21, 2009 — The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices on Wednesday is scheduled to consider whether to recommend vaccination of boys with Merck's human papillomavirus vaccine Gardasil, NPR's "All Things Considered" reports. Both men and women can be infected by HPV, which can lead to genital warts, cervical cancer in women and other genital cancers in both sexes (Wilson, "All Things Considered," NPR, 10/20).

Since 2006, Gardasil has been approved for use in girls and women to prevent two strains of HPV -- types 16 and 18 -- that cause about 70% of cervical cancer. Gardasil also protects against two other strains of HPV that cause 90% of genital warts. Last week, FDA approved GlaxoSmithKline's Cervarix for use in girls and women ages 10 through 25 to prevent cervical cancer, and it expanded approval of Gardasil to include boys and men ages nine through 26 for protection against genital warts. Cervarix does not protect against genital warts, though there is evidence showing it protects against another HPV strain closely related to types 16 and 18 (Women's Health Policy Report, 10/19).

On Wednesday, the advisory panel will focus on whether it is cost effective to vaccinate boys against HPV. Neal Halsey, a professor at the Johns Hopkins Bloomberg School of Public Health, said the best way to control transmission of HPV "would be to immunize both men and women, boys and girls." He added that the "right thing to do -- from a scientific standpoint, ethical standpoint, in terms of shared responsibility -- is to immunize all boys, all girls."

However, a recent Harvard University study found that vaccinating boys is not cost effective if most women are vaccinated. The cost savings associated with vaccination of boys and men are affected by how many girls receive all three doses of Gardasil, which is priced at about $130 per dose. Vaccinating boys would do more to help curb the spread of HPV if very few girls are vaccinated. CDC surveys show that 37% of U.S. girls ages 12 through 17 have received one dose of Gardasil. In comparison, nearly 80% of girls in the United Kingdom have received the HPV vaccine, and there is no intent to immunize boys.

Merck's Erik Dasbach said that vaccinating boys would be cost effective based on current vaccination rates among U.S. girls. However, the figure used to determine the vaccine's cost effectiveness in the U.S. also "accounts for the vaccine, and for screening cervical cancer, compared to all the cost that would be avoided by preventing HPV diseases," Dasbach said, adding that vaccinating boys would not be cost effective when examined through that model.

"All Things Considered" reports that many analysts had wanted Merck to delay seeking approval for Gardasil for girls in 2006 because it was still being tested in boys. This would have allowed Merck to offer the vaccine universally for boys and girls at a lower price, which analysts say would have been cost effective ("All Things Considered," NPR, 10/20).”

Personal comment: For the last two years our clinic has been vaccinating all young men screened for STIs as candidates for Escort training and as partners for St Lucy’s girls. There are no exceptions. Men applying for drilling rights through our screening program are required to have all their shots in minimum time. I think the cost effectiveness question for boys will resolve itself when Glaxo Smith Kline’s competing vaccine, Cervarix, comes on the market in a few months. It doesn’t make sense to pinch pennies when we are responsible for the sexual health of young socially prominent women.