I have always wondered whether the HPV vaccine would be such a hot political issue if it were primarily for boys rather than girls. Let’s face it, we have a double standard when it comes to adolescents and sex. Politicians like Michele Bachmann are able to push parents’ buttons by evoking images of innocent 11-year-old girls (pigtails included), reminding them that HPV is related to sex, and warning them of the impending promiscuity that will inevitably come with the shot. With boys though, that fear is harder to summon.  After all, we don’t expect our young boys to be innocent and we don’t fear that they’ll turn into sluts—boys will be boys. 

So, will offering the HPV vaccine to young boys cause a similarly bitter political and media controversy to the one we saw last month around Rick Perry’s mandate that all girls in his state be vaccinated?  Well, we are about to find out because, today, a Centers for Disease Control and Prevention (CDC) advisory committee voted to recommend that the vaccine become standard for boys ages 11 and 12.

Human papillomavirus is the most common sexually transmitted disease (STD) in the United States.  In fact it is estimated that 50 percent of all sexually active people will get it at some point in their lives.  This is partly because HPV is easily spread from infected skin to uninfected skin.  And, while transmission can be prevented by condoms, the infected skin can be in areas that are not covered by a condom, such as on a man’s scrotum.  Most people who have HPV (an estimated 20 million in the United State) will have no symptoms or adverse health effects and may never even know they had it.  Some people, however, will get genital warts, which may go away on their own or may need to be removed by a health care provider.  Certain strains of the virus, if left untreated, can lead to cervical cancer as well as cancer of the penis and the rectum.  Recent research also suggests that HPV is the cause of a new rise in cancers of the neck and throat. HPV infections cause about 15,000 cancers in women and 7,000 cancers in men each year.

In 2006, the Federal Drug Administration (FDA) approved Gardasil, the first of two vaccines that are currently available to protect against certain strains of HPV, for use in women ages 9 to 26. The second vaccine, Cervarix, was approved for use in the same group in 2009. In 2009, the FDA also approved the vaccines for use in boys and young men. Both vaccines are given as a series of three shots. 

While the FDA approves vaccines, the CDC advisory committee helps decide which vaccines are recommended as part of the routine medical care that young people receive.  Up until now, the HPV vaccine was available for young men ages 9 to 26 but was not a recommended part of their routine health care. 

Today, the Advisory Committee on Immunization Practice voted that boys ages 11 and 12 should be vaccinated and that those between the ages of 13 and 21 should get “catch-up” vaccines if they haven’t already been vaccinated. Vaccinations may be given to boys as young as 9 and to men between the ages of 22 and 26 as well.

The committee’s recommendation is not a mandate that parents get their children vaccinated—we all know that many parents today refuse all vaccines.  However, these recommendations are important as they inform what pediatricians suggest to parents and are routinely used by private insurers to determine which vaccines they will cover.  Moreover, the health reform legislation of 2010 requires insurers that participate in health exchanges to offer vaccines that are routinely recommended by the committee.

Only about 1 percent of boys have been vaccinated so far.  Public health professionals hope that vaccinating more young men will not only protect them from cancers linked to HPV but also help prevent them from spreading HPV to their female partners. 

This decision may turn out to be controversial, after all, not because it involves boys and sex but because it involves boys and oral and anal sex.  As the New York Times points out, the burden of the disease among men “is far higher in homosexuals.”  Of course, since the vaccine is most effective when given before a young person becomes sexually active it would not be possible nor would it be wise to single out young men who identify as homosexual.  The Times suggests “Parents of boys face some uncomfortable realities when choosing whether to have their child vaccinated. The burden of disease in males results mostly from oral or anal sex, but vaccinating boys will also benefit female partners since cervical cancer in women results mostly from vaginal sex with infected males.”

While public and political reactions remain to be seen, the nation is once again talking about HPV, which I always think is a good thing.  I only hope that cooler heads prevail and people remember (or are frequently reminded) that in the end this is a vaccine that has been proven safe and prevents cancer (CANCER) and that can only be a good thing.