Let the boys in.
That is the blunt message the Federation of Medical Women of Canada has delivered to public health officials who have limited HPV school-based vaccination programs to girls and young women.
"Vaccinating females alone is not enough," said Vivien Brown, a Toronto family physician and FMWC board member.
She said that because human papillomavirus is easily transmitted from one partner to another during sex, regardless of gender, it is short sighted and ineffective to focus only on females.
HPV, a family of viruses, is the principal cause of cervical cancer and genital warts.
The vaccine, first approved in 2006, has been touted as an effective way to prevent cervical cancer and that's why there has been a focus on immunizing girls.
But in a new position statement, published on Tuesday, the FMWC argues that boys and men play an important role in the transmission of HPV and that they also suffer from a significant number of HPV-related cancers.
In addition to female gynecological cancers such as cancer of the cervix and vulva, HPV is the main cause of penile and anal cancer, and it is the principal cause of throat cancers in women and men alike.
All told, the annual incidence of cancers related to HPV is 14 per 100,000 population in women and seven per 100,000 population in men, according to the FMWC analysis.
In addition, HPV is one of the most common sexually transmitted infections in both females and males.
"Vaccinating males is a more equitable public-health policy and recognizes that both genders contribute to the transmission of HPV and both develop HPV-related diseases," Dr. Brown said.
In Canada, every province and territory offers school-based vaccination exclusively to girls. The age group targeted varies tremendously by jurisdiction, from Grade 4 in Quebec through to Grade 8 in Ontario.
There are two HPV vaccines on the market. Gardasil, a product of Merck Frosst Canada Ltd., protects against infection with HPV types 6, 11, 16 and 18, meaning its offers protection against genital warts as well as cervical cancer.
Cervarix, a product of GlaxoSmithKline Inc., protects against infection with HPV types 16 and 18, which cause about 90 per cent of cervical cancer.
The principal reason that HPV is administered almost exclusively to girls and women is that research focused on females and there was a lack of data about males. But, earlier this year, Health Canada approved the vaccine for use in boys and men.
The HPV vaccine is also costly – about $400 in total for the three doses – so to get the best bang for the buck public health officials have focused on cervical cancer prevention.
Dr. Brown said concerns about cost are understandable and they arise whenever a new vaccine comes along but, over time, immunization has always proven to be the cheapest, most effective public health initiative. Besides, having one gender receive the vaccine free of charge and the other pay out of pocket is inherently unfair, she added.
"By immunizing both sexes we will have less HPV disease including cervical cancer, anal cancer, throat cancers and so on. The FMWC feels that there should be a school-based program so that all people in that age group have equal access to this vaccine … it should not be available only to those who can afford this cancer prevention," Dr. Brown said.
To date, Prince Edward Island is the only province that has said it is seriously considering extending the school-based HPV vaccination program to boys.