Should boys get it as well?

The idea of giving boys as well as girls the HPV vaccine is reasonable enough. It really just comes down to a cost benefit decision. How many lives would be saved by doing so against the cost of having done so? As long as the cost is under some £2 million per life saved – roughly what we think to be the statistical value of a life – then we should go ahead. If it doesn’t then we shouldn’t, instead deploying our scarce resources on saving lives in some other, cheaper, manner.

That isn’t, sadly, how the debate is currently going:

Health officials will come under increasing pressure to extend vaccination against the cancer-causing human papilloma virus to young men. Doctors say new figures, to be released in a few weeks, will show that rates of head and neck cancers in men are now rising so quickly that it is imperative the policy is reversed.

At present, in Britain, only young women are offered the HPV vaccine, which protects them against cervical cancer. Boys are not given the vaccine, even though the virus is known to cause cancers of the head and neck in men in later life. Health officials have argued that administering the vaccine to boys is not cost-effective.

OK, one side is arguing on cost effectiveness grounds, the other isn’t. For:

A vaccine that could prevent HPV infections was developed a decade ago, and from 2008 was used in the UK to inoculate schoolgirls against some cervical cancers.

OK, so, that’s girls who were likely to become sexually active soon after 2008. The vaccine is given at 12 or 14 or so, average age of first sex is 17 or so these days (yes, that late) and thus it’s the cohort entering young loveliness that is protected as of today. Given the preponderance of sex being heterosexual sex even today that means that whatever the effects of HPV are going to be it’ll take time for the protection to spread through the population. That’s the point being ignored:

By contrast, rates of head and neck cancers have continued to soar in men across the world. Its prevalence is three to four times greater than it was 20 years ago and in many nations it is now the fastest-increasing cancer.

As a result, many countries, including Australia and Canada, have decided to give the HPV vaccine to boys. “In total, 15 nations have now launched vaccination schemes for boys or have announced that they intend to launch one,” said Gillian Prue of Queen’s University Belfast.

By contrast, Britain has been slow to respond, although the Department of Health did recently announce that it was rolling out a programme in England later this year which would allow men who have sex with other men to be provided with the vaccine.

That last seems sensible enough although quite how to make sure that boys are vaccinated before they start to have sex is a toughie. Many to most experimenting a little before deciding.

But look at what is being called into evidence here. The incidence of male cancers among those whose female partners have not been protected by the vaccine. That’s not what we want to know at all, rather, we’re interested in what will be the incidence in the male population in 30 to 40 years’ time, among those men whose female partners were protected by the vaccine and thus not carrying nor spreading the virus. It’s simply the wrong evidence being used to support the argument:

It is too early to say how cervical cancer rates have been affected by the vaccine programme

Quite so. We don’t know – although we can make a pretty good guess – the effect of the vaccine upon the women who have had it. We also don’t know the effect of it upon the men who have sex with the women who have it. Thus that rise in those male cancers isn’t an argument in favour of men getting the vaccine, is it?

I’ve no particular dog in this fight, if it’s cost effective go ahead, if it ain’t don’t. But I would insist that we’ve got to be using the right evidence to make the decision – not something obviously true of the way the argument’s going so far, is it?

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  1. Cost-benefit is an easy decision but it is not the only criterion. HPV vaccine was a huge issue in Texas schools and it played a key role in wrecking the campaign of Michelle Bachman, who trotted out the hokey link between vaccines and autism during a Presidential debate.

    The effectiveness of the vaccine is undisputed. But many Texas parents view teenage promiscuity as wrong. Many view sex before marriage as wrong. It’s an affront to these parents for the schools to assume their offspring are or will be slutty. It also qualifies as yet another program, like a bowl of condoms in the guidance counselor’s office or free syringes, to ensure that kids can misbehave “safely,” an effective subsidy that reduces the cost of misbehaving. Disease is not a punishment that fits the crime, but parents would rather the schools educate than facilitate sex.

    Note that in no country is the vaccine administered door-to-door. The schools give the shots, another giant mandate-creep into ill-advised social policy.

  2. There appears to be a fundamental misunderstanding here. Tim is arguing that we only need to treat females as vectors of HPV and job done. This is not the way that viruses work. Immunising some or all of the population does not make the virus disappear. It is still there, present in every one of us, only we are immune to it. To acquire immunity, everyone has to be immunised.