Summary
HPV vaccination in females makes sense from a moral and medical point of view, and may even be cost-effective in the long run. HPV vaccination in males is none of these.
Analysis
A new article in the Washington Post chronicles the newest application by Merck for its Gardasil vaccine: seeking approval for use in boys and young men.
Gardasil for females, approved in 2006, made medical and possibly economic sense: the rate of deaths and high-cost treatment for cervical cancer was predicted to drop steeply and uptake of vaccine increased over time. After the first 5-10 years of routine plus catch-up vaccination, the annual birth cohort of females (roughly 2,000,000 females who turn age 11) per year receiving the vaccination would cost $180 per recipient or 360 million dollars per year; preventing 10,000 cases of cervical cancer and 3,700 deaths (after pain and suffering, not to mention also after treatment costs).
Gardasil for males, however, is an entirely different story: vaccinating the same birth cohort of about 2 million boys turning 11 per year would cost the same 360 million dollars but prevent at most 1,000 deaths. I say at most because once all females are routinely getting the vaccine, transmission in males should be mostly interrupted, with remaining HPV transmission only from male to male. This effectively makes the vaccine somewhere between 4 and 40 times more expensive from a death-prevention point of view.
Of course, one could make the same argument for vaccination males only. Great! In fact, arguably this would be more effective, as male to male transmission of HPV is more common than female to female transmission. The fact is, vaccinating all of one gender would pretty much interrupt the cycle for half the cost of vaccinating everyone.
