But age isn’t always a reliable measure of sexual activity, particularly for those who, say, married young and are getting a divorce and re-entering the dating scene. “If you vaccinate a 45-year-old woman who hasn’t had a cervical HPV, the vaccine will work for her as well,” says Aimée R. Kreimer of the National Cancer Institute. One study shows the vaccines, which guard against multiple varieties of the virus, can be effective in older women who have not been previously exposed to all of the targeted strains. Another study even suggests that the vaccine prevents further HPV outbreaks among women who have already been treated for cervical infection. “Our findings clearly show that those who have the disease can be protected from new disease and dispels the myth that only young and virgin girls can benefit from the vaccine,” says Elmar A. Joura of the Medical University of Vienna and an author of a study published last year in the British Medical Journal. “The earlier you vaccinate the better, but the benefit never really stops. It prevents new infections for sure, independent of age.”
Unfortunately, the decision about whether to get vaccinated or not isn’t a simple one. Gardasil and Cervarix have no therapeutic properties, and once someone has caught one of the strains, the vaccine is no longer protective against that particular infection. There is no reliable blood test to show which HPV strains someone has been exposed to, so it is always possible that the vaccine could be beneficial—or not. But overall, the longer someone has been sexually active, the less likely the vaccine will be of use, which is why public health campaigns focus on the young.
Most nations with universal health care also have rigorous cost-control measures and do not cover the HPV vaccine for people in their 20s. The exact age varies: In the United Kingdom vaccinations are free for those 11 to 17 years old. In Canada, where vaccination programs are run by the provinces, free shots are chiefly available to school-aged women. The same is true in most European nations. Studies like Joura’s have inspired many countries to raise their age recommendations beyond America’s 9 to 26 years old—Canada suggests the vaccine for women up to the age of 45—but those who aren’t covered by the public vaccination programs have to pay for it themselves. “This [hypothetical older] woman is probably not cost-effective in a vaccination program, but when she is looking for the personal benefit she clearly gets it,” Joura says.
America’s patchwork of private and public providers are often more generous with free vaccinations than are health care systems in other developed nations. Many insurance companies will cover the cost of the shots for those up to the age of 26, as will many publicly funded programs for children, and in some states adults, without private insurance.
The FDA’s age-licensing limitations or the CDC’s age recommendations do not mean that it is a bad idea for those older than 26 to get the HPV vaccine. But the cost of the vaccine in most cases has to be paid out of pocket, to the tune of about $390 to $500. Is it worth it? That’s a personal judgment call. The fewer sexual partners you’ve had, the less likely it is that you’ve already been exposed to the HPV strains the vaccine defends against. If you anticipate having new partners (potentially with new virus strains you haven’t been exposed to before), you may well still benefit from the vaccine.
For people who haven’t encountered all of the HPV strains in the vaccine, says Alex Ferenczy of McGill University, “the efficacy of the vaccine is still outstanding for those remaining virus types to which they were not exposed before the vaccination."
One more reason to consider the vaccine is that it is unclear whether antibodies, either induced by an actual HPV infection or the vaccine, have a half-life. That means protection may not last forever. This is true of other antibodies: The immunity conferred by a childhood brush with chickenpox may not last to protect us from shingles, which is caused by the same virus, later in life. It is known that vaccine-induced antibodies or those produced naturally in reaction to an HPV infection last 10 years. But they have not been proven to last a lifetime. If they don’t last, this is another possible reason why the vaccine could be effective in women in their 40s, but there is not enough research to prove or disprove this premise.
The vaccine is most useful for young people who are least likely to have been exposed. But by this measure, America is failing. Due to our long history of anti-vaccine hysteria, and some conservative politicians’ perennial efforts to politicize anything remotely related to sex, HPV vaccination rates in the United States are terribly low. Only 32 percent of girls ages 13 to 17 have received the full three-shot regimen, which is significantly less than in Canada, Great Britain, and some regions of Mexico (although much of the European Union has similarly dismal rates). Like most health issues in the United States, HPV’s worst consequences are unequally distributed, with cervical, anal, and penile cancer rates all higher among lower-income populations who tend to be poorly covered by insurance programs and have less access to health care.
For those who are under 26, getting vaccinated will likely be free. Since it is impossible to know how effective the vaccine may be in your case, it’s worth getting—it won’t hurt you or your wallet. For those over 26, vaccination can be an expensive decision, but it may well be worth it, particularly if you haven’t had many sexual partners or are expecting new ones. But to get the most bang for our public health buck, America needs to muster the political will to establish HPV vaccination programs for schoolchildren, both boys and girls. We already require vaccination of children against another sexually transmitted infection before they enter school: hepatitis B. HPV vaccination is an easy and safe way to spare kids a lot of pain and fear later in life.