for approximately 82 % of oropharyngeal cancers , of which 72 % are most likely caused by HPV . 10 Furthermore , the most recent data on cancer incidence rates reported a steady increase of oropharyngeal cancers in males , pointing to an urgency to promote the HPV vaccine to help prevent these cancers . 11 Ultimately , as men bear a significant burden of disease associated with HPV , the information disseminated regarding the benefits of HPV vaccination in males should center on this theme .
In light of the evidence that HPV related cancers are not limited to the female urogenital system , this paper focuses on a novel approach to advocate for HPV vaccination in adolescent males that targets self-preservation instead of altruism , which in this case is defined as vaccination for the purposes of protecting others .
Vaccine Hesitancy :
Despite the known benefits , there still exists hesitancy surrounding the HPV vaccine . 12 , 13 The SAGE Working Group on Vaccine Hesitancy defines vaccine hesitancy as the “ delay in acceptance or refusal of vaccination despite availability of vaccination services .” 14 Additionally , the group noted that vaccine hesitancy is “ complex and context specific , varying across time , place , and vaccines ” and “ is influenced by factors such as complacency , convenience , and confidence ,” which compose the “ 3 Cs ” model of vaccine hesitancy . 14
The “ 3 Cs ” contribute to the vast continuum of attitudes surrounding vaccination . 14 Complacency is defined by low perceived risk of disease and thus necessity of the vaccine . Confidence focuses on trust in vaccine efficacy and safety , the system that delivers vaccines , and the motivations of policymakers . 14 Lastly , convenience centers around physical availability , the ability to understand , and affordability . 14 For example , a physician ’ s recommendation can help increase convenience , especially if the vaccination takes place during an existing appointment , while also facilitating confidence in the vaccine by disseminating relevant information . 5 , 15 Notably , the “ 3 C ’ s ” remain prevalent across vaccinations , including influenza , 16 COVID-19 17 and more .
HPV Vaccine and Physician Hesitancy :
Hesitancy surrounding the HPV vaccine comprises each of the “ 3 Cs ”, and it is also present in a variety of individuals , from health care providers to the parents of young children . Research has shown that
12 , 18 – 21 physicians ’ recommendations are crucial for vaccine uptake , thus health care providers ’ attitudes toward HPV vaccination should also be examined . Health care providers ’ hesitancy to vaccinate patients is not uncommon and can be due to a lack of knowledge about the vaccine , perceived higher risk of disease of cancer in girls versus boys , or perception of the patient ’ s sexual activity . 12 As many view the HPV vaccine as associated with the onset of sexual activity , this problematic approach leads to physician preference
5 , 12 , 22 for vaccinating older adolescents instead of younger children . Concerns or discomfort in discussing sexual activity with young patients can be an additional barrier to physician advocacy of the HPV vaccine . Prior to the approval of the HPV vaccine , Daley et al . sampled the attitudes of pediatricians regarding the recommended age of administration to female patients . 5 In this study , many pediatricians reported that they would recommend the HPV vaccine to female adolescents over the age of 13 . 5 However , vaccinating patients at 11-12-years old is critical to the vaccine ’ s success , as it arms the immune system before any potential exposures . 4 It ’ s also critical that health care providers be willing to initiate these discussions to effectively advocate for HPV vaccination of their pre-teen patients .
The tendency to provide the HPV vaccine to females more often than males is driven by the well-known association between HPV and cervical cancer , whereas providers may be less aware of the other associated cancers , such as anal , penile and oropharyngeal cancers . 12 , 20 , 22 , 23 Perkins and Clark noted that only two of the 31 providers surveyed were aware of the cancer prevention benefits of HPV vaccination in males , with several other providers also describing that altruism might not be enough to convince parents to get their sons vaccinated . 20 Research surrounding the effects of altruism is in its early stages , but evidence suggests that altruism , or vaccination for the purpose of protecting others , can positively impact vaccine uptake , specifically considering the influenza vaccine . 24 , 25 HPV vaccine advocacy has centered on cancer prevention in females and successfully brought awareness , and this effective strategy now must be applied to males in light of the increasing rate of HPV related cancer in males . 11 , 20 As physicians represent the point of contact between parents of young children and potential vaccination , it is vital that these health care providers are well educated about the benefits of HPV vaccination for boys as well as girls . Increasing physicians ’ knowledge of the HPV associated cancers that affect both sexes will prove important for increasing the rate of HPV vaccination in males . 20
When considering the attitudes of general practitioners who advise patients with their vaccine recommendations , the difference in physician recommendations to their patients and practices for themselves and their children can potentially reduce their ability to be vaccine advocates . 18 In one study , it was found that this divergence was highest for the newest and most controversial vaccines like HPV , which had a divergence rate of 11.8 %. 18 This data suggests a percentage of general practitioners are recommending the HPV vaccine to their patients but are not practicing what they preach , likely due to low perceived risk of infection and concerns about safety and increased sexual promiscuity for their own children . 18 It is important to note that this study centered around vaccination attitudes toward their daughters , and so general practitioners ’ at-
( continued on page 22 )
November 2022 21