Gender inequality in HPV protection

Government-funded vaccination policy ignores male population

Chris* was 16 when he was taken to the doctor and given a Gardasil vaccination. “Honestly, I didn’t choose anything. My mum signed me up to get the shot,” he said. Now a U3 History student at McGill, Chris doesn’t think about his inoculation much. “I really don’t know how many of my friends have it. I wouldn’t be surprised if some of my other guy friends had it, but I would be shocked if it was as prevalent as amongst my female friends. I think it’s somewhat stigmatized because it’s considered a disease that only affects females. That isn’t true, but I feel like that is the perception. Guys don’t want to get a shot for what they think of as a disease only women get.”

Human papillomavirus (HPV) is primarily conceptualized as a women’s ailment, with the majority believing that it is affiliated with cervical, vulvar, and vaginal cancers alone; however, it is also linked to penile, anal, and head and neck cancers, associating it with around 5 per cent of cancers worldwide. The vaccinations Gardasil and Cervarix can protect individuals if they are vaccinated prior to being exposed to the virus. Both vaccines protect against different strains of the virus, and while Gardasil has been approved for both females and males between the ages of 9 and 26, Cervarix is only available for females between 10 and 25.

In 2007, the first girls received HPV vaccines in Canada. By September 2008, all provinces in Canada had school-based vaccine programs targeting girls as young as nine. This is a cost measure, as at age nine a child will only need two injections, instead of three, to be immune. Depending on the province, girls have the option to begin the shots in Grade four or five, and have another opportunity in Grade nine, or seek the inoculation for free at a clinic or from their practitioner.

In April 2013, Prince Edward Island became the first province in Canada to include boys in their HPV vaccination campaigns. In September 2014, Alberta will follow suit. According to Alberta Health’s website, the government decided to extend coverage of the HPV vaccination to boys because it can “save lives, reduce disease and reduce future health care costs.” They estimate that the cost savings for the system from this policy change could amount to over $13.4 million.

If men can carry the disease and women can contract it from a male sexual partner, then not vaccinating men seems like it is ignoring a huge factor in the spread of HPV.

Quebec has chosen to not fund vaccination programs for boys, based on the assumption that inoculating females will indirectly protect males, and that if males want it, they will seek it on their own. Even though this inoculation policy does regard women as sexual beings, it assigns them a one-sided HPV burden in the responsibility and prevention paradigm. And while the shot is available for men, its high cost makes it inaccessible to many, with three doses of Gardasil costing $500. Furthermore, males are not educated about the virus to the same extent as females, and many men don’t even know that they are vulnerable, believing HPV to be responsible only for cervical cancer. NovaRogue**, a Political Science, Sociology, and Sexual Diversity McGill alumnus to whom I spoke via a thread on the McGill forum on Reddit, only found out that the vaccine was an option for him when he was advised by a nurse at age 21. He feels that men are “not at all” informed or advised to learn more about the vaccine in the same way women are.

In Chris’ understanding of vaccines, “maximum inoculation is when they are most effective. If men can carry the disease and women can contract it from a male sexual partner, then not vaccinating men seems like it is ignoring a huge factor in the spread of HPV.” According to Eduardo Franco, professor in the departments of Epidemiology and Biostatics, director of the division of Cancer Epidemiology, and chair of the Oncology department at McGill’s Faculty of Medicine, the Quebec government decided not to cover male vaccination because of the cost. “In Quebec they did a lot of evaluating; [the Quebec government] evaluated the cost and decided it was too much. They’ve done a good job covering women, and so did not adopt a publicly-available vaccine for boys. By covering women they are also indirectly covering men,” noted Franco.

This assumption also leaves the category of men who have sex with men at risk and wholly responsible for ensuring their safety in a way that women and men having sex with women are not. This subset of the population is in fact getting no publicly-funded protection. If men can be vectors of transmission, it seems ineffective not to vaccinate everyone. NovaRogue thinks that the current policy is discriminatory toward men who have sex with men (MSM), and calls the decision “short-sighted,” and “very possibly another example of institutionalized/systemic homophobia/heteronormativity.” Kristina Dahlstrom, postdoctoral fellow in the division of Cancer Epidemiology of the Oncology department, agrees, “By vaccinating only girls we are effectively not protecting MSM against HPV. MSM have a high prevalence of HPV and are at an increased risk of developing anal cancer.”

Franco says that as vaccines go down in cost, it is likely that more inclusive public coverage will happen. He hopes that his current study at McGill, the TRAP-HPV study, will shed light on opportunities for this. The TRAP-HPV study differs from other studies because it looks at non-genital sites, like oral and anal regions, and aims to determine whether unvaccinated partners of vaccinated individuals benefit in terms of protection from their partner’s HPV vaccination. Dahlstrom told the McGill Newsroom, “Increasing the knowledge about HPV transmission dynamics will benefit cost-effectiveness studies and have implications for decision-making when implementing population-level vaccination strategies.”

Andrew Doyle, an English Masters student at McGill, believes that, “In an ideal world, we would vaccinate everyone against everything, but in reality it costs too much. Me or my girlfriend might have it even though we’ve never had symptoms. [sic] I don’t really think about it differently than other STIs, but if there’s a vaccine for it, why not?”

*name was changed
**Reddit username