Response

Roberto Leon

Thanks to Drs Jayabarathan and Batty for their comments. I understand their desire to press on for male vaccination against human papillomavirus (HPV); their arguments invoke the terrible conditions that HPV can inflict on men.

The reality is that, at present, the emphases of research protocols have been on the prevention of cervical intraepithelial neoplasia and cervical cancer. But there are ongoing studies in males and older women, and the results should be out soon.

Instead of passionate discussions about who should receive the vaccine, and when and why, we should formulate a long-term plan to combat HPV and the diseases it might inflict on its bearers, based on available data. My suggestion is a 25-year arrangement, divided into 4 areas:

Education of the general public

Examples of important topics include sex education at schools, steps to minimize the risk of acquiring the virus and other sexually transmitted diseases, and the beneficial effects of the vaccine as well as local availability.

Widespread vaccination

Commence the vaccination program without delay, based on available data in girls and women aged 9 to 26. Target the HPV-naïve population—mostly 11- and 12-year-old girls—for whom the vaccine is most effective. Add other target groups as new data become available.

Continue with research

Important missing data include the long-term effects of the vaccine and the effects of administering the vaccine in older women and men.

Improve detection of all cancers caused by HPV

Maintain the Papanicolaou smear screening program, which has been so successful in the detection and early treatment of cervical cancer and its precursors. At the same time, start a drive to improve the recruitment of women who avoid Pap smears, such as immigrant and aboriginal women. Formulate a plan for early detection of anal cancer and other diseases caused by HPV in men.

I hope that at the end of the 25 years HPV and its diseases will be at least contained, if not defeated.