Riccardo A Audisio1, Giancarlo Icardi2, Andrea M Isidori3, Carlo A Liverani4, Alberto Lombardi5, Luciano Mariani6, Francesco Saverio Mennini7, David A Mitchell8, Andrea Peracino9, Sergio Pecorelli10, Giovanni Rezza11, Carlo Signorelli12, Giovanni Vitali Rosati13, Gian Vincenzo Zuccotti14. 1. University of Liverpool, St. Helens Teaching Hospital, St. Helens, UK. Electronic address: raudisio@doctors.org.uk. 2. Department of Health Sciences, Hygiene Unit, IRCCS AOU San Martino, IST University of Genoa, Genoa, Italy. Electronic address: icardi@unige.it. 3. Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy. Electronic address: andrea.isidori@uniroma1.it. 4. 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. 5. Scientific and Medical Consultant, Fondazione Giovanni Lorenzini, Milan, Italy and Houston, TX, USA. Electronic address: alberto.lombardi@lorenzinifoundation.org. 6. Department of Gynecologic Oncology, HPV Unit, "Regina Elena" National Cancer Institute, Rome, Italy. Electronic address: luciorm55@gmail.com. 7. 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. 8. Bradford Teaching Hospitals NHS Foundation Trust, St. Lukes Hospital, Bradford, UK. Electronic address: david.mitchell2@bthft.nhs.uk. 9. Fondazione Giovanni Lorenzini Medical Science Foundation, Milan, Italy and Houston, TX, USA. Electronic address: andrea.peracino@lorenzinifoundation.org. 10. University of Brescia, Brescia, Italy. Electronic address: sergiopecos@gmail.com. 11. Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy. Electronic address: giovanni.rezza@iss.it. 12. Department S.Bi.Bi.T., Unit of Public Health, University of Parma, Parma, Italy. Electronic address: carlo.signorelli@unipr.it. 13. Italian Pediatricians Federation (FIMP), Florence, Italy. Electronic address: giovannivitalirosati@gmail.com. 14. Department of Pediatrics, Biomedical and Clinical Science Department, University of Milan, Milan, Italy. Electronic address: gianvincenzo.zuccotti@unimi.it.
Abstract
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.
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.
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