"Protecting boys as well as girls by vaccinating against human papillomavirus may cut the incidence of genital warts and several cancers among both sexes," says Dr Prue. "HPV related disease in men causes a considerable burden; therefore, vaccinating boys is likely to produce more health and economic benefits than those from a girls-only programme.
"The current girls-only vaccination programme leaves MSM [men who have sex with men] at particular risk of infection because they do not benefit from any herd protection ... As for men who have sex with women, the extent to which they benefit from a girls-only vaccination programme even with a high uptake may also be limited. For example, in Denmark HPV vaccination has significantly reduced the incidence of genital warts among women but not among men.
"The suffering caused by HPV related diseases is self evident. The economic costs are also considerable: a study of treating nine major HPV related diseases in Italy produced an estimate of almost €530m (£420m; $714m) a year. And the cost of treating genital warts was almost £17m in England in 2008."
Dr Prue concludes: "Ultimately, any decision about whether to vaccinate boys should not be based solely on cost effectiveness. Public health, equity, and the human costs of HPV related disease for both sexes must be the main considerations."
Even more significantly, the BMJ has also published an editorial which supports Dr Prue's argument.
The editorial says: "It is easy to see why the vaccination programme was initially targeted at young women, who will benefit from a substantial reduction in cervical cancer and similar reductions in all forms of cervical dyskaryosis. This should lead to more a streamlined cervical screening programme and much less colposcopy and invasive treatment. However, the evidence is now conclusive that HPV also causes oropharyngeal cancers, with most cases caused by HPV-16 and HPV-18, and this has the fastest rising incidence of any cancer (15% a year).
"An estimated 90% of cases of anal cancer in the UK are also linked to HPV infection. According to new figures published by Cancer Research UK, anal cancer rates in the UK have increased by nearly 300% in the past 40 years ... Roughly six people now die every week from the disease in the UK. In gay men who are infected with HIV, the incidence of anal cancer is even more alarming; rates of 107/100 000 have been reported in the US.
"The only sensible answer to these dilemmas is a gender neutral vaccination strategy in schools that gives two doses of the vaccine to all 12-13 year old boys and girls. Anything else is discriminatory, inequitable, less effective, and difficult to explain. Can the UK afford to do it? If the price is right, we can’t afford not to."