When it hit the market in 2006, the vaccine against human papillomavirus was marketed to parents of girls as a way to prevent cervical cancer. Merck’s TV commercials for Gardasil, at the time a series of three vaccines, featured young women proclaiming they wanted to be “One Less” victim. But for years the marketing ignored a population of people who could benefit from it: boys and men, particularly gay men, who are at risk of other preventable types of cancer that HPV can lead to.
Christopher Wheldon, assistant professor of social and behavioral sciences, has examined the implications of this medical treatment being aimed at one group of people over another. His work exploring awareness of the HPV vaccine’s ability to prevent non-cervical cancers among men and older adults has been published in several recent papers. Among his findings: most adults who were aware of HPV didn’t know it could cause other cancers.
“We have a vaccine that can protect against these other cancers, but most people still think it's just a cervical cancer vaccine,” says Wheldon, whose research focuses on cancer education and care for underserved and vulnerable populations.
HPV infection can cause cervical, vaginal, and vulvar cancer in women, penile cancer in men, and anal cancer and oral cancer in both sexes. From 2008 to 2012, an average of more than 30,000 cancers per year attributable to HPV were diagnosed in the U.S., around 38 percent in males, according to the Centers for Disease Control and Prevention. The incidence of oral cancer, which the vaccine seems to inhibit, is increasing and exceeds the incidence of cervical cancer, Wheldon says. The FDA approved Gardasil for males in 2009, and in 2011 it was indicated for use in the prevention of anal cancer. But for years the girl-centered marketing carried on, skirting around an uncomfortable yet important fact: HPV spreads as the most common sexually transmitted infection.
“Parents were very uncomfortable with the idea of vaccinating their kids against an STI. So what they did instead was frame it as a cervical cancer prevention,” Wheldon explains. That approach contributed to the climate where males becoming sexually active may have been less aware of its benefit and more vulnerable to HPV-associated cancers. “The way the vaccine was initially licensed, combined with how it was marketed, has created a persistent public perception that HPV is a female health issue.”
In 2018, Merck received approval for Gardasil 9, a new version of the vaccine protecting against nine types of HPV that are responsible for the majority of HPV-related cancers. The guidelines still recommend the vaccine for individuals up to age 26 but have added that adults up to age 45 may consider the vaccine based on a shared decision with their healthcare provider. It’s not always useful for older adults, because the vaccine is more effective when taken before any sexual activity or potential exposure to HPV, but it may be appropriate for some.
Wheldon’s team had already surveyed male sexual minorities (MSM), asking those over 26 how likely they would be to get the HPV vaccine if the recommendation were changed to include men older than 26. “The take-home was that, when presented with information about HPV as a prevention for anal cancer, gay and bisexual men are very interested in getting the vaccine,” he says. Those respondents indicated they would be less concerned about side effects than parents of children might be and would be happy to feel protected.
Wheldon and co-author Sarah Maness of the University of Oklahoma reported their findings in “An Assessment of Cancer Education Needs to Promote Mid-Adult HPV Vaccination Among Male Sexual Minorities,” published in Journal of Cancer Education in November.
More recently, Wheldon teamed with researchers including Erica Thompson of the University of North Texas Health Science Center to dig into national health survey data to quantify HPV vaccine awareness among American adults ages 27 to 45. The findings, reported in the February 2020 edition of the journal Vaccine, were that although there was widespread knowledge of HPV as a cause of cervical cancer (79.6%), a minority of respondents (36.1%) knew about HPV as a cause of non-cervical cancers.
More recent advertising for Gardisil 9 features boys as well as girls. Still, Wheldon’s work suggests that underserved populations can be left behind by popular marketing and its power to disseminate information. “For gay and bisexual men, I think that's really important,” he says. “They're not going to get cervical cancer, but they're much more likely to get anal cancer, and for the most part they’re not aware there's a vaccine that can actually prevent the majority of cases of it.”