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Should Boys Get the HPV Vaccine?

The HPV vaccine offers the promise of reducing the incidence of cervical cancer. Vaccinating 60 girls will prevent one case of cervical cancer. Assuming the HPV vaccine is approved for male use, why would we give it to boys who cannot possibly develop cervical cancer? For starters, lowering HPV in men can lower the number of female infections and cancers. It is more cost- effective to vaccinate girls, but that doesn't mean we can cross boys completely off the list. Harvard researchers have estimated that the current cost of vaccinating boys is between $1,000 and $20,000 per year of female life saved (depending on the assumptions about sexual behavior). That is an attractive cost-effectiveness ratio, but a lot more than it costs to save a life by vaccinating girls. So if there are only a limited number of doses, we had better be sure we focus on girls.

However, the supply of HPV vaccine doses depends in part on public health policy. Phasing in male vaccination will encourage vaccine makers to increase production to meet supply needs for both sexes. Greater supply will reduce the price and make the vaccine affordable in poor countries. Although the HPV vaccine may help prevent future anal warts and anal cancer in boys, this may not be such a great selling point with conservative parents. It may be necessary to market this vaccine as a way for parents to protect their future daughters-in-law. Can parents be that altruistic?

David Bishai, MD, PhD, MPH, is an associate professor of Population, Family and Reproductive Health.

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