Many doctors in Germany stick very closely to the recommendations of the Stiko (standing committee on vaccinations) and take a lot of convincing to vaccinate more, or they outright refuse. It's really annoying.

My health insure only covers HPV vaccines for 26 year olds and younger: https://www.sbk.org/beratung-leistungen/vorsorge-und-praeven...

Depends on your health insurance. My previous insurance company paid back the full cost when I was 30 years old. I can recommend checking https://www.entschiedengegenkrebs.de/vorbeugen/kostenerstatt... (and then also confirming that with the insurance company over text, just to be safe)

Sort of similar in most EU countries. I could get it in Austria but it's prohibitively expensive.

Can you pay for it?

In Denmark you can. I was in my mid thirties when I went to my doctor to ask them to prescribe it. Before each shot I would go to the pharmacy and buy one dose and go to the doctor to have them administer it for me (if I wanted to). At that time I think it was free for teenage girls, now it's free for teenage boys as well.

The evolution of who gets HPV vaccines is really interesting. At first it was young women, as vaccinating young men had a very marginal decrease in cervical cancer rates via indirect protection (which itself is a function of how many young women are vaccinated). Then as HPV infection was linked to more cancers, vaccinating young men crossed the cost-effectiveness thresholds many governments use.

Vaccinating older populations is similarly just a less clear-cut case, but it's a cost-effectiveness argument, not one purely driven by if the vaccine offers protection.

Seriously. My memories of this vaccine are so foggy because I distinctly remember being told "its not effective for men" and that it would be an expensive out of pocket cost. Yet, the whole point would always have been to prevent the spread.

But from a personal POV it is very cost-effective! Even if it is not so at the population at as large group.

Do you mean from the POV of a particular high risk (or high income) person or from the POV of every individual?

it's not just the cost of the vaccine roll-out though, you need test on your target demo and since these are healthy people the bar is very high. If the demographic (like males over 45) shows very little involvement in the infection vectors then testing might fail the cost-effectiveness, not the delivery of the vaccine.

Indeed. Generally for HPV, there were modeling studies showing this was probably a good idea before trials started.

Generally yes. I asked my primary care physician and would have been able to get the vaccine dose from the pharmacy (paying for it myself) and she would have administered it.