Letters HPV vaccination

Human papillomavirus (HPV) is not an equitable virus

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5207 (Published 19 August 2014) Cite this as: BMJ 2014;349:g5207
  1. David Isaacs, paediatrician1
  1. 1Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
  1. david.isaacs{at}health.nsw.gov.au

An editorial1 and previous letter2 discuss human papillomavirus (HPV) vaccination in boys in terms of inequity, and the authors point out that in Australia the vaccine is given routinely to boys as well as girls. The authors say the decision is not about science, purely about finances. The trouble is HPV is not an equitable virus: it causes more severe disease in women than men.

In 2007, the Australian government agreed to pay for HPV vaccine in girls because the vaccine was effective, and it was also estimated to be cost effective—it was not proposed for boys then. In 2013, when a vaccine company applied for boys to receive HPV vaccine, they offered the vaccine at a much lower price because of lower health gains being bought—anal and possibly oropharyngeal cancer and herd immunity—and the greater uncertainty. After some negotiation on price, the Australian government agreed to pay for boys because HPV vaccine was cost effective at the price offered. Cost effectiveness is an important concept that if ignored will result in governments spending money that could be better used on other healthcare interventions.


Cite this as: BMJ 2014;349:g5207


  • Competing interests: None declared.


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