Public health value of universal HPV vaccination.
BACKGROUND
The story of Human Papillomavirus vaccination demands reflection not only for its public health impact on the prophylactic management of HPV disease, but also for its relevant economic and social outcomes. Greater than ever data confirm the efficacy and support the urge for effective vaccination plans for both genders before sexual debut.


METHODS
A review of previous experience in gender-restricted vaccination programs has demonstrated a lower effectiveness. Limiting vaccination to women might increase the psychological burden on women by confirming a perceived inequality between genders; and even if all women were immunized, the HPV chain of transmission would still be maintained through men.


RESULTS
The cost-effectiveness of including boys into HPV vaccination programs should be re-assessed in view of the progressive drop of the economic burden of HPV-related diseases in men and women due to universal vaccination. The cost of the remarkable increase in anal and oropharyngeal HPV driven cancers in both sexes has been grossly underestimated or ignored.


CONCLUSIONS
Steps must be taken by relevant bodies to achieve the target of universal vaccination. The analysis of HPV vaccination's clinical effectiveness vs. economic efficacy are supportive of the economic sustainability of vaccination programs both in women and men. In Europe, these achievements demand urgent attention to the social equity for both genders in healthcare. There is sufficient ethical, scientific, strategic and economic evidence to urge the European Community to develop and implement a coordinated and comprehensive strategy aimed at both genders and geographically balanced, to eradicate cervical cancer and other diseases caused by HPV in Europe. Policymakers must take into consideration effective vaccination programs in the prevention of cancers.
University of Liverpool, St. Helens Teaching Hospital, St. Helens, UK. Electronic address: raudisio@doctors.org.uk.
Riccardo A
RA
Audisio
Department of Health Sciences, Hygiene Unit, IRCCS AOU San Martino, IST University of Genoa, Genoa, Italy. Electronic address: icardi@unige.it.
Giancarlo
G
Icardi
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. Electronic address: andrea.isidori@uniroma1.it.
Andrea M
AM
Isidori
Department of Mother and Infant Sciences, Gynecologic Oncology Unit, University of Milan, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy. Electronic address: dr.carlo.liverani@gmail.com.
Carlo A
CA
Liverani
Scientific and Medical Consultant, Fondazione Giovanni Lorenzini, Milan, Italy and Houston, TX, USA. Electronic address: alberto.lombardi@lorenzinifoundation.org.
Alberto
A
Lombardi
Department of Gynecologic Oncology, HPV Unit, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: luciorm55@gmail.com.
Luciano
L
Mariani
Faculty of Economics, University of Rome Tor Vergata, Faculty of Statistics, University of Rome La Sapienza, Kingston University, London, UK. Electronic address: f.mennini@uniroma2.it.
Francesco Saverio
FS
Mennini
Bradford Teaching Hospitals NHS Foundation Trust, St. Lukes Hospital, Bradford, UK. Electronic address: david.mitchell2@bthft.nhs.uk.
David A
DA
Mitchell
Fondazione Giovanni Lorenzini Medical Science Foundation, Milan, Italy and Houston, TX, USA. Electronic address: andrea.peracino@lorenzinifoundation.org.
Andrea
A
Peracino
University of Brescia, Brescia, Italy. Electronic address: sergiopecos@gmail.com.
Sergio
S
Pecorelli
Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy. Electronic address: giovanni.rezza@iss.it.
Giovanni
G
Rezza
Department S.Bi.Bi.T., Unit of Public Health, University of Parma, Parma, Italy. Electronic address: carlo.signorelli@unipr.it.
Carlo
C
Signorelli
Italian Pediatricians Federation (FIMP), Florence, Italy. Electronic address: giovannivitalirosati@gmail.com.
Giovanni Vitali
GV
Rosati
Department of Pediatrics, Biomedical and Clinical Science Department, University of Milan, Milan, Italy. Electronic address: gianvincenzo.zuccotti@unimi.it.
Gian Vincenzo
GV
Zuccotti
D003362:Cost-Benefit Analysis; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D030361:Papillomavirus Infections / Q000517:prevention & control*; D053918:Papillomavirus Vaccines / Q000191:economics*; D011634:Public Health / Q000191:economics / Q000379:methods; D002583:Uterine Cervical Neoplasms / Q000517:prevention & control / Q000821:virology; D014611:Vaccination / Q000191:economics*
D053918:Papillomavirus Vaccines
Boys; Cancer prevention; HPV; Herd immunity; Vaccination