Take One for the Team?

Why boys are unlikely to take HPV shots for girls

Trish HallEditor of the Op-Ed Page

''You do a public service by getting your child vaccinated,'' said Jane Kim, an assistant professor at Harvard School of Public Health. But as a mother of two young boys herself, she said, she is not inclined to weigh the benefits to their future sex partners: ''Whether or not this vaccine can benefit my boys directly is probably my biggest concern.''

From Rabin (2011):

Private benefits to boys

Spillover benefits to girls

Giving boys the HPV vaccine:

Human papillomavirus (HPV) is a virus that most people catch at one time or another, mostly being a nuisance that their immune systems corral, bang up a little and throw out. For some, HPV hangs around, creating embarrassing and painful herpes lesions on the lips and genitals. For an unlucky few, it ignites changes in cells that lead to cancers of reproductive organs, anus, mouth and throat. These cancers kill…

“The virus causes about 19,000 cancers in women every year, and 8,000 in men, according to the C.D.C. Women most commonly get cervical cancer as a result of the virus, while men are most likely to get throat cancer.” (Tavernise, 2013)

According to the CDC, HPV causes about 19 thousand cancers in women each year and 8 thousand in men, the most common being cervical cancer in women and throat cancer in men.

Human papillomavirus (HPV) is a virus that most people catch at one time or another, mostly being a nuisance that their immune systems corral, bang up a little and throw out. For some, HPV hangs around, creating embarrassing and painful genital warts. For an unlucky few, it ignites changes in cells that lead to cancers of reproductive organs, anus, mouth and throat. From the millions of infections each year, HPV causes about 9 thousand cases of cancers in women, mostly of the cervix, and 8 thousand in men, mostly of the throat.fn

fn. http://www.cdc.gov/media/releases/2013/p0619-hpv-vaccinations.html

According to the CDC, HPV causes about 19 thousand cancers in women each year and 8 thousand in men, the most common being cervical cancer in women and throat cancer in men.

In 1992, the National Cancer Institute gave a small grant to researchers who wanted to explore the possibility of developing a vaccine that would protect people against HPV. Fourteen years later, in the summer of 2006, the government approved Gardasil for girls over the age of 9 and women younger than 26. Gardasil protects them against the four strains of HPV that cause most of the cancers and almost all the genital warts. Three years later, the government approved another HPV vaccine, Cervarix, which only protects people against the two strains causing cancer.

In October, 2009, the government announced that boys could be given Gardasil. The rationale was that it protected boys from genital warts and prevented them from giving HPV to women in the future. The idea was that parents would give their young boys three painful shots, costing hundreds of dollars, for what most physicians argued was a minor health benefit for boys and a major health benefit for girls. Would parents really give their boys these shots given that most of the benefits spillover to others, which are what economists call external benefits?

Boys could be given Gardasil beginning in October, 2009. The government’s rationale was that Gardasil protected boys from genital warts and, more importantly, prevented them from giving HPV to women in the future. Preventing warts is a private benefit to the boys; protecting women is a spillover benefit, or what economists call an external benefit. Is it realistic that parents would give their young sons three painful shots, costing hundreds of dollars, principally to achieve external benefits, ones that are not directly enjoyed by the parents or their sons?

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The Market for HPV Vaccine

''You do a public service by getting your child vaccinated,'' said Jane Kim, an assistant professor at Harvard School of Public Health. But as a mother of two young boys herself, she said, she is not inclined to weigh the benefits to their future sex partners: ''Whether or not this vaccine can benefit my boys directly is probably my biggest concern.''

According to The New York Times, a federal advisory committee recommended on October 26, 2011 that “boys and young men should be vaccinated against human papillomavirus, or HPV, to protect against anal and throat cancers that can result from sexual activity.”

A few days later, the New York Times ran an editorial entitled, “For their Own Good…”

2008 2009 2010 2011 201205

1015202530354045Figure 1. Immunized with the HPV Vaccine, 13-17 Year OldsVacc

inated(%)

Fe-males

Males

Tucked between the Advisory’s recommendation and the New York Times editorial was an article entitled “Will You Give Your Son the HPV Vaccine?” that ended with

79 percent of the 87 parents who responded said that they would vaccinate their boys.

John from New York: One father with two boys said that if they were girls, he would get them the shot. But that he wasn’t going to get them vaccinated because there were “virtually no benefits to them” and the only reason that the government was recommending that boys get the shots was because 70 percent of parents with girls were choosing not to have them vaccinated.

The parents who said that they would have their sons vaccinated fell into three groups:

1. Didn’t explain their decision: HHC from Austin, Texas, said only that “Heck yes! And my daughter too!”

2. Among those who explained why they would have their boys vaccinated, 40 percent said that their decision was influenced by spillover benefits. “Resilient” from Saint Paul, Minnesota, says “it’s the right thing to do.” “Andrea” from Madison, WI says she told her son, “It’s not all about you.”

3. More than half of the parents who said they would focused only on the benefits to their sons of avoiding throat and anal cancer, and protecting their future wives. Only one parent mentioned genital warts…

Patricia from Kansas City says, “Even if boys don't get some sort of cancer, you are also vaccinating them against genital warts. Who wants genital warts? I would happily get vaccinated (if I could) against my cold sores, which I've had since childhood. They won't kill me but do disrupt my life.”

“Only two in 1,000 men get a new diagnosis of genital warts each year.” Shield article

A lot of the parents who say that they plan to have their son(s) receive the shot say that they will give it to their daughters or that daughters have already received it.

Year Female Male

2012 40.0 17.3

2011 38.5 6.6

2010 35.7 1.9

2009 36.9 0.0

2008 30.0 0.0