Why Aren’t More Boys Getting HPV Vaccines?

When his nine-year-old son went to a routine doctor’s appointment a few years ago, Nosayaba Osazuwa-Peters, Ph.D., expected that he would receive a vaccine for human papillomavirus (HPV). The vaccine, which protects against multiple forms of cancer caused by HPV, is recommended for pre-teen boys and girls. And can be given beginning at age nine.

Osazuwa-Peters, an associate professor of global health who studies some of the cancers caused by HPV, saw no reason to delay. But he was surprised when his son’s doctor said the vaccine could wait, since he was at low risk for HPV infection.

“I couldn’t wait for my son to receive the vaccine,” says Osazuwa-Peters, who is also in the Department of Head and Neck Surgery and Communication Sciences in the Duke School of Medicine. “And for him not to, I wasn’t happy about that.”

The encounter may also point to a larger issue – a lack of urgency in encouraging men and boys to be immunized against HPV. According to a March 2024 study co-authored by Osazuwa-Peters, adult women in the U.S. are three times as likely to have received at least one dose of the HPV vaccine as men. The gender gap also exists among demographic groups that have lower overall HPV vaccination rates, including some racial groups and adults with lower levels of education.

A significant factor in that gap, says Osazuwa-Peters, is the “feminization” of HPV as a public health issue. When HPV vaccines became available in 2006, they were initially only approved for girls. Even when vaccines were offered to boys in 2009, much of the messaging around HPV continued to focus on risks to women and girls, such as protection against cervical cancer. It’s one reason that today awareness of the benefits of HPV vaccines tend to be significantly higher among women than among men, Osazuwa-Peters and co-authors note. 

While men have plenty of reasons to get the vaccine, including protecting their partners from cancer risks, Osazuwa-Peters’ is studying whether more direct appeals to the health benefits for men may help close the gender gap in HPV vaccinations. 

“A lot of men object to the HPV vaccine and will say, ‘Why should I get this when it is for girls?’” he says. “It’s frustrating how the vaccine was marketed because it has contributed a lot to the negative perception of it.”

As the fourth leading cause of cancer among women, cervical cancer remains a significant threat, especially in low-income settings where access to HPV prevention and treatment is uneven. But untreated HPV infections, which are spread through sexual activity, can cause many forms of cancer that affect both men and women. For example, oral transmission of HPV can cause oropharyngeal cancer, which occurs in the mouth and throat. Incidence of this cancer has been rising in recent years, with three-quarters of cases in men, Osazuwa-Peters notes.

Osazuwa-Peters became interested in HPV prevention after seeing patients with oral cancers while practicing as a dentist in Nigeria more than a decade ago. He is now seeking funding to launch projects aimed at expanding HPV vaccine awareness and access among boys and men. He would like to see the vaccine offered not just in primary care offices, but through specialists such as ear, nose and throat doctors who can speak to the cancer risks of going unprotected.

But primary-care doctors also need to do more to dispel misconceptions about HPV vaccination, he says. The best time to receive an HPV vaccine is before a child becomes sexually active, he notes, adding that research shows there is no link between a child receiving the vaccine at an early age and becoming sexually active earlier.

“We know more about HPV now,” he says. “That’s why it’s important to increase awareness amongst providers. When they have a positive outlook on a vaccine, it won’t be a missed opportunity with patients.”