One major positive is that the gender gap in vaccination rates continues to narrow, with 65% of girls receiving the first dose in 2016 compared with 56% of boys, according to the 2016 National Immunization Survey. The gap was 9 percentage points compared with 18 percentage points in 2014 and 13 percentage points in 2015.6
The low vaccination rate in males has largely been attributed to the common perception that HPV affects only girls. This makes sense given that the vaccine was initially advertised as a means to prevent cervical cancer. According to the Journal for Specialists in Pediatric Nursing, HPV infection is associated with 96% to 99% of cervical cancers compared with only 12% to 63% of oropharyngeal cancers and 36% to 40% of penile cancers.7 Cervical cancer is almost completely preventable with the HPV vaccine, whereas the cancers affecting men can be caused by other things, leading many to think of the vaccine as less important or effective in males. However, vaccinating boys and men aged 9 to 26 years against HPV can prevent more than 5 million cases of genital warts and 40,000 cancer-related deaths over the next century, while also saving $27,500 per quality-adjusted life year. In other words, the vaccine would not only prevent deaths but preserve people’s quality of life.
Many parents are hesitant to vaccinate their 11- or 12-year-old children against a sexually transmitted disease (STD) because they think that children cannot get an STD if they are not sexually active. However, the shot is not only most effective in younger kids because of their robust immune systems but specifically because they have not yet had sex. The CDC reports clinical trial data that show “no evidence of [vaccine] efficacy against disease caused by vaccine types with which participants were infected at the time of vaccination.”8 The idea is to get everyone vaccinated before they’ve actually been exposed. Making sure that most children are immunized also ensures that those who are unable to be immunized will still be partially protected through herd immunity.
Boys and girls should be equally informed
Another major issue is that boys simply don’t know that they should be getting vaccinated for HPV. Doctors appear to be far more encouraging of their female patients than their male patients, leading males to be less aware of vaccine benefits and less likely to seek out the vaccine. Last year, the American Journal of Managed Care reported that 1 in 5 parents of boys said the main reason for not vaccinating sons for HPV was because the parent didn’t receive a physician’s recommendation, compared with 1 in 10 parents of girls.9
Many parents assume that any necessary vaccine will be recommended to them by their doctor. The problem with HPV is that the vaccine is still relatively new, especially for boys, and some doctors still don’t explicitly recommend HPV vaccine to their male patients. This ultimately puts the responsibility on boys and boys’ parents to be proactive. The main takeaway is that HPV is about a lot more than sex and gender. Boys and girls should get vaccinated to protect themselves and to protect their future sexual partners and the community as a whole. Because HPV is a largely asymptomatic infection with reduction but not elimination of transmission with condom use, the importance of vaccination against HPV cannot be overstated.
Barriers to access
According to the Kaiser Family Foundation, 25 states and the District of Columbia have laws that either require HPV vaccination for school entry, provide funding to cover the costs of the vaccines, or support public education about HPV and the vaccine.10 In the other states, people with a lower socioeconomic status are much less likely to get the vaccine due to lack of awareness and/or cost. There are also small differences in state-specific regulations that allow for major differences in implementation.
For example, Washington, DC, and Virginia require the vaccine for girls to enter 6th grade but allow parents to opt out of the requirements for medical, moral, or religious reasons.10 Girls can easily opt out of getting the vaccine, despite the fact that it’s technically required by the state, and boys and their parents are not held accountable at all. Rhode Island is the only state that requires all 7th-grade students to be vaccinated.
It isn’t enough to simply label something as a requirement if there are so many exceptions to the rule. Federal regulations in addition to state regulations need to be in place to bridge the gap between the 29% of adolescents being up-to-date with HPV vaccination in Mississippi and the 78% being up-to-date in Washington, DC.10
1. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): HPV fact sheet. Available at: https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Reviewed November 16, 2017. Accessed August 5, 2019.
2. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): About HPV. Available at: https://www.cdc.gov/hpv/parents/about-hpv.html. Reviewed April 29, 2019. Accessed August 5, 2019.
3. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV) Questions and answers. Available at: https://www.cdc.gov/hpv/parents/questions-answers.html. Reviewed August 23, 2018. Accessed August 5, 2019.
4. Immunization Action Coalition. Ask the Experts. Human papillomavirus (HPV). Available at: http://www.immunize.org/askexperts/experts_hpv.asp. Accessed August 5, 2019.
5. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): HPV coverage data. Available at: https://www.cdc.gov/hpv/hcp/vacc-coverage/index.html. Reviewed August 23, 2018. Accessed August 5, 2019.
6. American Cancer Society. HPV vaccination rates are rising among American teens. Available at: https://www.cancer.org/latest-news/hpv-vaccination-rates-are-rising-among-american-teens.html. Published August 14, 2017. Accessed August 5, 2019.
7. Thomas TL, Snell S. Ask the expert: Vaccinate boys with the HPV vaccine? Really? J Spec Pediatr Nurs. 2013;18(2):165-169. Erratum in: J Spec Pediatr Nurs. 2014;19(1):101.
8. Centers for Disease Control and Prevention (CDC). Chapter 11: Human papillomavirus. In: The Pink Book. Epidemiology and Prevention of Vaccine Preventable Diseases. Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html. Reviewed May 16, 2018. Accessed August 5, 2019.
9. American Journal of Managed Care (AJMC) 2006-2019 Clinical Care Targeted Communications Group, LLC. Dr. Anna Beavis discusses gender differences in HPV vaccination. Presented at: Society of Gynecologic Oncology (SGO) 2018 Annual Meeting on Women’s Cancer; March 24-27, 2018; New Orleans, LA. Available at: https://www.ajmc.com/conferences/sgo-2018/dr-anna-beavis-discusses-gender-differences-in-hpv-vaccination. Published March 25, 2018. Accessed August 5, 2019.
10. Kaiser Family Foundation. The HPV vaccine: Access and use in the US. Available at: https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in/. Published October 9, 2018. Accessed August 5, 2019.
11. Centers for Disease Control and Prevention (CDC). CDC Newsroom: Many adolescents still not getting HPV vaccine. Available at: https://www.cdc.gov/media/releases/2015/p0730-hpv.html. Reviewed July 30, 2015. Accessed August 5, 2019.