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hpv vaccine coverage for boys
HPV Vaccine Coverage for Boys

Now that public coverage of the HPV vaccine for all boys is on the way in BC, here's the facts!

Why Vaccinate All Boys

Because there's a Link between HPV and Cancer

  • The Canadian Cancer Society reports that three of every 4 Canadians will be infected with HPV at some point in their lifetime. HPV is an infection that can lead to cancer in both men and women. Among cancers affecting men, HPV infection is associated with anal, penile, oropharyngeal (OPC) and oral cavity cancers. Rates of HPV-associated oral cancers are rising in BC, especially among males. Currently, men are 2-4 times more likely to be diagnosed with an HPV-related OPC than women. In the US it is projected that OPC will become the most common HPV-related cancer by 2020, exceeding even cervical cancer. Additionally, anogenital warts (AGW) represent a considerable public health issue with respect to quality of life and economic burden for both males and females with rates that have shown to be consistently higher in Canadian males than females.[1]
  • The HPV vaccine effectively reduces infection associated with HPV-related cancers among both males and females. In BC, the HPV vaccination rate for females has stagnated with rates ranging from 50-70%, which are insufficient for optimizing herd immunity. A recent systematic review and meta-analysis provides evidence that while boys can receive some protection from female HPV vaccination, it is to a lesser extent than females. For example, in countries with coverage rates of at least 50%, AGW decreased by 61% in females compared to only 34% in males. Still, males are left at risk if they engage in sexual activity with individuals in jurisdictions with low vaccination rates or no vaccine at all[2].

Please click here to see a recent article on including males in HPV program - from the Canadian Medical Association Journal.

No Evidence of Herd Immunity

  • Although there have been assumptions that boys are protected from HPV infections by girls through herd immunity, a recent study from Ontario suggests this is not the case.  The study concluded, "A significant impact of the Ontario HPV vaccination program on Anogenital Wart rates in young adult females, but no evidence of herd effects on males."[3] 

Equality

  • In regards to inequality, the HPV vaccine prevents infections best when given before exposure, which means:
    • the current (publicly funded) program requires boys to identify as being gay at a very young age to receive the maximum protection,
    • a vaccine program that singles out gay children is discriminatory. Can you imagine if access to other preventative health care services required patients to identify as gay or "at-risk" at such a young age?,
    • the decision to include some "at-risk males" is a half-measure with numerous pitfalls. Boys under government care or in juvenile detention already face enough obstacles and stress and will not benefit from being singled out for a vaccine that should be administered to all children - regardless of gender, sexual identity, or guardianship status, and
    • HPV is not simply a women's issue. Males are at risk of acquiring and suffering from HPV-related diseases such as genital warts and cancers of the anus, penis, tonsils, larynx, and tongue. Also, HPV-related throat cancer in men is on the rise

Please click here to see what our partner, the Canadian Cancer Society, thinks about the HPV vaccine for girls - and for boys.

Cost and Cost Effectiveness

  • BC Health's Minister, the Honourable Terry Lake, says the price will have to go down to make this a cost effective vaccine. According to the Provincial Finance Committee, the cost is estimated to be $4 million to vaccinate all boys. The Committee recommends the HPV vaccine be covered.[4]
  • This vaccine started out as a three dose, although beginning in October 2014 is a two dose. This has resulted in savings that could offset the additional cost to give two doses to all boys in Grade 6, as is currently available to girls.

What Do Other Provinces Cover?
And What Made them Choose that Option?

  • Just two provinces provide the vaccine to only girls: Newfoundland and Labrador (Gr 6) and New Brunswick (Gr 7).
  • Saskatchewan only covers girls (Gr 6) and HIV infected boys.
  • As of September 2016, six provinces (Alberta, Manitoba, Nova Scotia, Ontario, Quebec, and PEI) will immunize both boys and girls under publicly funded programs.
  • This ranges between Gr 4 (Quebec), Gr 5 (Alberta), Gr 6 (Manitoba, PEI) and Gr 7 (Ontario, Nova Scotia).  
  • In Ontario, the Health Minister cited a Princess Margaret Cost-Effectiveness study, which looked at head and neck cancers and predicted a cost of $28 M therefore validating the additional cost of providing the vaccine for all boys.
  • In PEI, the influence of boys in reducing HPV transmission overall and protection for males was cited as the reasons and noted that the cost wasn't a major factor.
  • In Alberta, the Health Minister noted possible cost savings based on a provincial cost-effectiveness analysis of $13.4M in savings.
  • In Quebec, the Public Health Minister noted the goal of adding males was to protect them directly (versus indirectly through females) as they are affected by more HPV-related cancers than previously thought.

What are the current NACI (National Advisory Committee on Immunization) Recommendations?

Gardasil and Cervarix have been approved by Health Canada and are recommended by Canada's NACI[5]. Gardasil is recommended for boys and young men to prevent anal cancer, its precancerous condition and anogenital warts. The vaccine is most effective when given to males before they become sexually active. Therefore, NACI recommends that Gardasil be used for:

  • Males between 9 and 26 years of age, and
  • Males 9 years of age and older who have sex with other males.

[1] PHAC website: http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/12vol38/acs-dcc-1/index-eng.php
[2] Cancer Society letter to Minister of Health, the Honourable Terry Lake (June 2, 2016)
[3] Early Impact of Ontario's human papillomavirus (HPV) vaccination program on anogenital warts (AGWs): A population based assessment: FM Guerra et all.  Vaccine (in press) 2016.
[4] https://www.leg.bc.ca/parliamentary-business/committees-reports/14 - The Committee heard support from a number of organizations for the Province's human papillomavirus (HPV) vaccination program as an effective means to reduce incidence of certain cancers, including a growing number of oral cancers of the throat and tongue. Presentations addressing HPV vaccination programs by the Living Positive Resource Centre and the YouthCo HIV and Hep C Society were united in recommending that the program, currently aimed at young women and ‘at-risk' men, be extended to include all young people. Merck Canada also voiced support for an expanded HPV vaccination program, pointing out that comprehensive vaccination programs support health care budget sustainability through prevention of future costs.
[5] http://www.cancer.ca/en/cancer-information/cancer-101/what-is-a-risk-factor/viruses-bacteria-and-other-infectious-agents/hpv-vaccines/?region=mb#NACI, accessed August 2, 2016

© 2016 BC Pediatric Society