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Why Do Only Girls Get the HPV Vaccine?

Experts say it’s time to vaccinate all boys in Canada against the virus.
A girl is vaccinated against HPV. Image: ASCOM Prefeitura de Votuporanga/Flickr

Ontario just announced that, starting in September, boys in the province will get the HPV vaccine, a cancer-fighting shot that's been publicly funded and available to girls in the province since 2007. Across Canada, girls have been getting HPV shots for years, but in most places, boys still aren't vaccinated. In fact, just three provinces include boys in their school-based programs: Alberta, PEI, and Nova Scotia. Manitoba and Quebec are going to start vaccinating boys soon, too.

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But even then, there will be four provinces, and two territories, where only girls get a publicly funded HPV shot. In those places, most boys won't get vaccinated. The human papillomavirus is the most common sexually transmitted infection in Canada, and around the world. So why is it still seen as a female problem?

In a new article in the Canadian Medical Association Journal, published April 25, experts argue that it's time to systematically vaccinate all boys in Canada against HPV, just like girls. It's time to stop thinking of HPV as a female virus, and on depending on females getting immunized to protect the whole population.

Pretty much everyone who has sex will get an HPV infection at some point in their lives, according to the US Centers for Disease Control, and most infections will clear on their own. But the virus is still worth protecting against. It's associated with anogenital warts, cancers of the penis, anus, oral cavity, vulva, vagina, and oropharynx. According to the CMAJ paper, men are now reporting more HPV-associated cancers, like anal and oral ones. It says, "some argue that the risk of HPV-related cancer is similar in both sexes."

So it's strange that it's taken so long to agree that men should get vaccinated, too. Lots of experts agree that it's bad policy not to vaccinate both genders. The Canadian National Advisory Committee on Immunization, for one, has said that both males and females should be vaccinated against HPV. (Typically, it's for ages 9 to 26.) The CDC recommends it for both groups, too.

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The HPV shot been seen as "a woman's vaccine," the CMAJ paper says, partly because it's been promoted that way: first and foremost, as protection against cervical cancer.

More than half of Canadian parents didn't even know that males could get an HPV vaccine

"HPV was first associated with cervical cancer," McGill University researcher and study author Gilla Shapiro told Motherboard, so the vaccine was promoted as protection against that. Shapiro's paper points to Merck's "One Less" campaign as an example—one less woman who'll die of cervical cancer, because of their vaccine, Gardasil. We haven't seen similar messaging around boys and the HPV shot.

The idea is that female-only vaccination confers a "herd immunity," protecting boys and men who don't get vaccinated. In a 2015 review, the CMAJ says, female vaccination in high-income countries did lead to lower instances of anogenital warts in men. But it isn't good policy to just rely on one gender to keep both covered.

For one thing, straight men who aren't vaccinated pose a risk to women who haven't gotten the shot, either. And men who have sex with men still are at high risk of developing HPV and related disease, the study says. Then there's men who travel abroad, to places like Japan, where vaccination against HPV is uncommon. They won't be protected by the herd immunity that women confer back home in Canada.

In a 2014 survey, the CMAJ paper says, more than half of Canadian parents didn't even know that males could get an HPV vaccine. And if they decided they wanted their boys vaccinated, and were in a province that didn't cover it, they'd have to track down a doctor to do it (instead of relying on a school-based program) and there's a good chance they'd have to pay for it out of pocket, too..

Typically, "it's $100 a dose," Shapiro said. "And two to three doses are recommended." That alone would be enough to turn some parents away, if they thought it wasn't really necessary to get their sons vaccinated in any case.

"Including boys in HPV vaccine programs is important for equity," and to protect them against HPV-associated diseases, Shapiro said.

It's time to extend the vaccine to boys across the country.