A pair of ‘Head-to-Head’ articles in the BMJ discusses whether human papilloma virus (HPV) vaccination should be extended to boys.

The author of the ‘Yes’ article comments that HPV is responsible for a range of other diseases in addition to cervical cancer, and suggests that to reduce overall morbidity from these it is necessary to vaccinate boys as well as girls. This would increase herd immunity and facilitate the eradication of HPV. He quotes a US cost-effectiveness study that calculated a cost per QALY of just over $90,000 for including boys in the vaccination programme under some circumstances. Another model quoted suggests that vaccinating the whole sexually active population would be cost-effective. Finally, he asserts that in situations where uptake in women may be low, it is more cost effective to vaccinate males than hard-to-reach females.

In contrast, the author of the ‘No’ response states that the many of the non-cervical cancers in which HPV is involved also have other causes: anal cancer, that most attributable to HPV, has only about a tenth the incidence of cervical cancer, occurs more frequently in women, and for men would be better dealt with by suitable screening. She notes that the US cost-effectiveness analysis concluded that with current knowledge, including boys in the vaccination programme was not cost-effective under most scenarios. She comments that effective vaccination coverage of females will in itself reduce the risk of male exposure, and over time will reduce overall infection rates significantly. In summary, she concludes that on current knowledge, the priority should be to vaccinate as many young girls as possible.