ACIP: No HPV vaccine preference for females, no recommendation for Gardasil in males

News from the meeting of the Advisory Committee on Immunization Practices underway today in Atlanta:

In their morning session, the committee voted to expand its recommendation for HPV vaccination to include the newly-licensed Cervarix, making minor modifications reflecting technical differences regarding the administration of each vaccine.

More importantly, the ACIP expressed no preference between the two vaccines, instead simply noting that both Cervarix and Gardasil are recommended for cervical cancer prevention, while only Gardasil is recommended for prevention of both cervical cancer and genital warts.

By ACIP standards, in which most decisions are largely resolved by working groups prior to public meetings of the full committee, the decision not to express a preference generated significant discussion. Several members questioned the decision not to express preference for Gardasil, with one suggesting it may be perceived as suggesting that the ACIP did not view genital warts as important.

The majority opinion, voiced by ACIP chair Carol Baker, held that cervical cancer prevention was the primary goal of HPV vaccination. This goal would be best served by having two vaccines available, particularly in case of shortages, a common occurrence for vaccines with a single manufacturer. (The implication being that a preferential recommendation could jeopardize the market for and viability of the non-preferred vaccine.) In the end, only one member voted against the recommendation expressing no preference, an action that followed ACIP precedent when two similar vaccines are available against the same disease.

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Later this morning, the ACIP approved only a 'permissive statement' regarding vaccination of males against HPV with Gardasil, essentially stating that males may be vaccinated but stopping far short of the routine, universal recommendation common for most vaccines (including HPV vaccination in females). Despite endorsements for a routine recommendation from several liaison groups participating in the meeting, cost effectiveness data for male vaccination and concerns over the use of limited public health resources appeared to steer the committee away from a broad endorsement of male HPV vaccination.

The 'permissive statement' means that private insurers will be less likely to provide coverage of HPV vaccination for males, according to a representative from America's Health Insurance Plans (AHIP) in attendance at the meeting. Male vaccination will still be included in the Vaccines for Children program for uninsured and underinsured children, however. Historically, vaccines lacking a routine recommendation from the ACIP -- as is now the case for Gardasil in boys and men -- have had significant difficulty gaining widespread use.

We'll add links to coverage of today's developments as they're posted online.