Back in September, Amplify blogger michellemysistahs reported that an FDA panel recommended the use of the HPV vaccine in boys and men.  On October 16th, the FDA approved the use of the HPV vaccine in boys/men.  Then, on October 21st the Advisory Committee on Immunization Practices for the U.S. Center for Disease Control “stopped short of recommending the vaccine for boys as part of the approved childhood immunization schedule”

Questions still remain: why would boys and men want to be vaccinated from HPV?  Will the HPV vaccine become accessible to men/boys?  Should men/boys get the vaccine?

Why would boys and men want to get the HPV vaccine

If you ask the FDA panel that recommended the use of the HPV vaccine for use in boys and men they would tell you that it prevents genital warts.  In her post HPV Vaccine for Men, Too!, michellemysistahs points out that the vaccine helps prevent certain cancers in men: those being penile, anal, and oral cancers.

If you ask the Advisory Committee on Immunization Practices for the CDC, they echo the findings of a study lead by Jane Kim, an assistant professor of health decision science: “including boys in an HPV vaccination program generally exceeds what the U.S. typically considers good value for money”. Given that HPV is a sexually transmitted disease, all people who have sex can potentially spread HPV.  So vaccinating boys/men also helps prevent HPV-linked cancers in women: those being cervical, anal, and oral cancers.  Cervical cancer is treatable and preventable and a leading cause of death in women worldwide.  Some public health officials are talking about this. What is not being talked about is how boys and men may want to get the HPV vaccine to prevent cervical cancer. 



Transmen are particularly at risk for cervical cancer.  And, according to a report by Trans Care Project, a joint effort of Transcend Transgender Support & Education Society and Vancouver Coastal Health’s Transgender Health Program, some transwomen are also susceptible.

Will the HPV vaccine become accessible to everyone

 Maybe I’m being cynical, but I’d say the outlook does not look good.  Before this most recent FDA decision, boys and men were definitely not able to get the HPV vaccine.  And trans folks could maybe get the vaccine – if their doctors and insurance companies had them identified as “women”.  As the New York Times points out:

The new recommendation means, in effect, that doctors and clinics may now administer the vaccine at their discretion to boys and men ages 9 to 26, but they are not expected to offer it. Parents may consider the vaccine as an option for their sons, but some health insurers may choose not to cover the shots.

What this means to me is that (1) insurers probably won’t cover it for boys and men, and (2) many doctors won’t offer it either.  This does not sound like accessibility to me. Should boys and men get the HPV vaccine The real question is should anyone (or everyone?) get the HPV vaccine.  And in general, I think that is a very personal decision.  From a public health view point, however, if the goal is to curb the spread of HPV which can lead to uncomfortable and sometimes costly conditions such as genital warts, and it can lead to potentially life-threatening cancers (cervical, anal, and oral) – then I think yes, anyone and everyone should get the HPV vaccine. The HPV vaccine is a very new one, however.  Given that it is only a few years in the testing, the longevity of the vaccine’s effectiveness is still unknown.  If I get the HPV today, will it still prevent me from getting HPV in 10 years?  in 20 years?  The jury is still out.  There are also some reports that the HPV vaccine causes more adverse side effects than other vaccines.

 

And the HPV controversy continues

If you google HPV controversy one of the first things that comes up is a fear that the vaccine will encourage promiscuity.  I think that’s simply ridiculous.  What I am troubled by, however, is how media coverage about the HPV (especially when it first came out) focuses almost exclusively on cancer prevention instead of talking about how the vaccine could be part of a comprehensive approach to STI prevention.

I'm also troubled by the power differentials of who has been required to get the vaccine.  Given the questions that remain about the safety and efficacy of the HPV vaccine, I find huge fault with states that have required all girls of a certain age to get the vaccine.  Why were girls made the mandatory test group while officials thought nothing (until recently) of vaccinating boys?  Additionally if you think about who mandated vaccinations affect most you’ll realize that marginalized people (low income, people of color, etc.) are it.  People with more money, education, and flexible time can use all these things to find out whether they want their families to get the vaccine and then work to get exceptions if they decide that they don’t want it.  As if all this wasn’t enough, the U.S. Citizenship and Immigration Services added the HPV vaccine to the list of requirements for immigrant women.  What this did was make immigrant women a mandatory test group for the vaccine and also increase barriers for women worldwide who seek U.S. citizenship – because the HPV vaccine doesn’t grow on trees.  The HPV vaccine became a way for the U.S. to further xenophobia and bar low-income women from entering the U.S.

I think approving the HPV vaccine for boys and men was a good step.  But questions about the safety and accessibility of the HPV vaccine (and comprehensive information) for low income people and trans people still go unanswered.