Let’s Hear It From the Boys

Public health has a young male blind spot

Recently, on a podcast, someone asked me how public health should be communicating about vaccines to young adults, and I gave my usual answer, the one I believe and practice: lean into creative formats, meet people where they are, use data visualizations and storytelling on social media, have fun with content and lean into humor and human voice, and get out of the deficit model (the assumption that people reject science only because they lack facts). After the recording ended, I realized my answer was incomplete. By default, I had been picturing the largely female audience I am used to reaching. The boys had not entered the picture.

Plenty of young men get vaccinated, ask thoughtful questions, and take their health seriously. But the population-level trends suggest that whatever we are doing to reach them is not working at the scale it needs to, and the gap shows up most clearly in the audience public health communicators least often design for.

Most of our science communication infrastructure is built around the audiences who already show up: women, parents, and caregivers. They are the household decision-makers for vaccines, the ones reading the newsletters and watching the Instagram explainers, the ones who write in with questions about their kids, their pregnancies, and their aging parents. Young men, particularly those past pediatric care and not yet parents themselves, sit outside that frame, and the uptake data reflects it.

Take HPV. According to the most recent national data, from the 2022 NHIS, coverage among adults aged 18 to 26 was 57.2% for women and 37.3% for men. The gap has narrowed since the early years of the male recommendation, but it has not closed, and the overall rate has stagnated since 2019, well below the Healthy People 2030 goal of 80%. The HPV vaccine prevents cancers affecting both sexes, including the oropharyngeal cancers that disproportionately affect men, and yet the messaging around it has, for two decades, been overwhelmingly oriented toward girls and the people raising them.

The men’s flu vaccination data are harder to explain. A PLOS Global Public Health study, covered by CIDRAP last summer, found that self-reported flu vaccination among U.S. adult men dropped from 65% in May 2020 to 51% in October 2024, a 13-percentage-point decline, while uptake among women remained essentially flat. Within that four-year window, men went from above women to below them. The COVID-era data complicate the picture: early in the pandemic, men actually reported higher intent to vaccinate than women, even though actual uptake eventually skewed slightly higher among women. So the simple story, the one where men are uniformly more hesitant than women, does not really hold. But the openness men expressed in 2020 has not translated into sustained vaccination behavior, and somewhere between intent and follow-through, we are losing them.

Is this primarily a young man’s problem? Yes, but not exclusively. The dramatic sex gaps in flu and HPV vaccination are concentrated in adults under 65, and they widen among the youngest cohorts. After 65, the picture is more mixed. Flu vaccination rates are similar between men and women, though men trail women in pneumococcal vaccination. But the consistent, population-level pattern of men lagging behind is most evident among adults under 65.

That tracks with what we know about how young men move through the world. They have less routine contact with the health system. They are heavily targeted by the wellness-influencer economy. And compared to older men, they are at substantially lower direct risk of severe outcomes from the diseases these vaccines prevent, which leaves them more susceptible to the argument that the vaccine itself is the thing to worry about, not the disease. Older men get reminded of their actual risk in their actual bodies, often in the same conversation in which their doctor offers them the shot.

Psychologist Ryon McDermott at the University of South Alabama has spent years studying this directly, and his framing of the underlying question is the one we should be asking: how do we make vaccines manly? His research finds that men who endorse traditional masculinity norms are less likely to engage in preventive health behaviors because those behaviors get coded as feminine, deferential, or evidence of weakness, with the strongest correlates clustering in white, evangelical, and politically conservative populations. A 2024 systematic review and meta-analysis found the same pattern across 11 studies: stronger adherence to masculine norms correlated with lower uptake of COVID-protective behaviors, including vaccination. Recognizing this is not the same as mocking it or lecturing anyone out of it. It is the basic work of designing messaging around the people we are trying to reach.

The information environment that has grown up around this audience makes the problem far worse. The health education of a 22-year-old man in 2026 does not come from his pediatrician. It comes from Joe Rogan, the most listened-to podcaster in the country, who co-founded the supplement company Onnit and platforms guests ranging from credentialed scientists to alpha-male wellness entrepreneurs. It comes from Andrew Huberman, whose Stanford credentials and “protocol” framing lend scientific gloss to a podcast that, in his episode on colds and flu, told listeners he does not get the flu vaccine. It comes from a constellation of carnivore-diet evangelists, peptide stackers, biohackers, and testosterone optimizers whose commercial model depends on selling the premise that the right combination of supplements, sleep protocols, sauna sessions, and cold exposure can render external medical interventions unnecessary or even suspect.

And increasingly, it comes from the federal government. In February, RFK Jr. posted a 90-second workout video with Kid Rock, the two of them shirtless on exercise bikes, doing push-ups in a sauna, plunging into cold pools, playing pickleball, and toasting glasses of whole milk under the caption GET ACTIVE + EAT REAL FOOD. The video is bro-coded to a degree that would be funny if the man producing it did not also run the federal apparatus responsible for the country’s vaccine policy. Conspicuously absent from his prescription for American health: any mention of vaccines.

This manosphere-meets-biohacking ecosystem is not anti-health, exactly. It is voraciously pro-health, just a parallel version of health that runs on different premises. The men public health is failing to reach are spending hundreds of dollars a month on AG1 (formerly Athletic Greens), creatine, and continuous glucose monitors, tracking their HRV (heart rate variability), and reading study abstracts in pursuit of what they understand as optimization. In that universe, vaccines are conspicuously absent from the protocol, sometimes treated as actively suspect, and almost always framed as something the speaker has personally opted out of in favor of a more sophisticated approach.

Threading through much of this content is a particular nostalgia for the primal: eat as our ancestors did, sleep as our ancestors did, lift heavy things, walk barefoot, and expose yourself to the elements like our ancestors did. (Extreme versions of this include drinking your own urine and sunning your perineum. Trust me, do not Google it.) It is a worldview built around the idea that modern life has corrupted us and that the way back to health runs through pre-modern practice. The fact that those ancestors died young, frequently from the exact infectious diseases we now prevent with vaccines, does not appear to factor into the protocol.

The values underneath this worldview, that you are the steward of your own body and that institutions should earn rather than assume your trust, are not on their face unreasonable. They are also not unique to young men or to libertarian politics, though young men and libertarians are heavily represented among those who embrace them. The problem is that vaccines, as currently framed by public health, hit none of the notes this audience responds to. They are often presented as community responsibility rather than individual benefit, when in fact they are both. They are framed as routine and parental rather than as something a young man might actively choose to maximize his long-term odds against a preventable cancer or a season of lost training time.

What would taking this seriously look like?

• Recruiting credible male voices in their twenties and thirties into evidence-based science communication, because almost every trusted public-facing vaccine voice in the country right now is a woman.

• Meeting young men in the formats they actually consume, which are long-form podcasts and video, where vaccine skeptics currently do the talking.

• Using sovereignty-compatible framing where it is honest, because protecting a man’s future fertility, his future children, his performance, and his time are good reasons to vaccinate that are often absent from the conversation.

• Dropping the assumption that what we are seeing in the data is a hesitancy problem when much of it is a reach problem.

So, who gets to be that voice? I would love it to be me. But as an aging millennial mom whose recent Google history runs heavily to vaginal estradiol and elementary school PTA threads, I am almost certainly not the right match. Like listens to like, and as much as I tried in my youth to figure out how young men think, I am no closer to that answer at forty than I was at seventeen. What I can do, and what I think many of us in this field can do, is support the people who are willing to venture into that space. Arm them with the science, the communication strategies, the receipts. Help them anticipate the bad-faith arguments. Make it easier for them to show up well, in formats their audiences actually trust, in language those audiences actually use. The boys are listening, all the time, to whoever is willing to talk to them in language that respects how they think about their bodies. The least the rest of us can do is build the runway.

Stay Curious,

Unbiased Science