HPV vaccines to be rolled out to gay community as girls-only approach ‘leaves gay men at risk’
The government has confirmed that it will introduce a nationwide HPV vaccination programme for men who have sex with men.
A vaccination programme began in 2008 among school-age girls in the UK to tackle the human papilloma virus, which spreads through genital or oral contact and can cause a number of cancers.
Only girls are vaccinated on the grounds that men who only have sex with women are also protected from transmission through ‘herd immunity’.
However, the initial ‘herd immunity’ plan left gay men vulnerable. As unvaccinated men have sex with other unvaccinated men, they are effectively left without any protection – leaving HPV to spread through the gay community.
Campaigners have long called for change to protect gay and bisexual men – and after a pilot programme, it was announced this week that NHS England and Public Health England (PHE) will roll out a vaccination programme from via sexual health (GUM) clinics and HIV clinics in England.
The programme will start from April 2018.
Public Health England said that the earlier “vaccination pilot was a success”, and that “a phased nationwide rollout to protect men who have sex with men from some cancers caused by HPV as well as genital warts, will now go ahead”.
Given the phased approach to the rollout, patients should not contact their clinics to request the vaccine.
If the vaccine is available patients will be offered it as part of their routine sexual health check-up.
Dr Michael Edelstein, Consultant Epidemiologist at PHE, said: “Our evidence shows that men who have sex with men are welcoming an HPV vaccination programme, and it can be delivered successfully through sexual health services.
“MSM are a group who receive little indirect protection from the adolescent girls’ vaccination programme. We expect the new programme to reduce the number of cancers that are directly caused by HPV.”
The news has been welcomed by sexual health campaigners – though they say it does not go far enough.
Liam Beattie, HPV policy lead at Terrence Higgins Trust, says: “We welcome the introduction of an HPV vaccination programme for gay and bisexual men in England from April 2018 to bring the country in line with what’s already happening in Scotland and Wales.
“The rollout will go someway towards protecting gay and bisexual men from preventable cancers caused by HPV, including anal, penile and neck cancers, as well as genital warts.
“This announcement is a welcome step forward and one that Terrence Higgins Trust and other sexual health charities have been campaigning for.
“However, we know that the efficacy of the vaccine is significantly increased when administered before someone is sexually active. Therefore we maintain our call for a gender-neutral school-based HPV vaccination programme with the HPV vaccine being rolled out to all adolescent boys in line with the current programme for all girls.
“We look forward to learning more about the planned phased roll-out of the vaccine with the hope it can be done in a swift and timely manner.”
One alternative proposal that would have seen teenage boys routinely vaccinated as well as girls was ruled out by the Joint Committee on Vaccination and Immunisation on grounds of cost.
Ian Green, Chief Executive of Terrence Higgins Trust, said in a statement at the time: “We are deeply disappointed by this short-sighted recommendation to deny teenage boys the potentially life-saving HPV vaccine. Girls aged 12 and 13 have been given the vaccine since 2008, but boys have had no protection.
“A gender neutral policy on HPV vaccination is long overdue and would protect boys from cancers caused by untreated HPV, including penile, anal and some types of head and neck cancer. It is shameful that this is still being denied to them.
“To eradicate HPV and protect people from related cancers, we need protection for boys and girls before they become sexually active. While this is ‘interim’ advice, it is a worrying sign.
“Before a final decision is taken, we strongly urge the government to listen to the campaigners, experts, charities, parents and young people who have campaigned so passionately for equal access to the vaccine, and to do the right thing.”
The JCVI recommendation says: “The Committee is mindful that the argument for gender equality has been put forward to justify the need for a gender neutral programme.
“Ultimately JCVI’s role is to consider the scientific, clinical and economic evidence when formulating its advice.
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“Much of this indicates that while there is a disparity between males and females in terms of protection from HPV, the strong herd effects of the programme provide substantial benefit to males.
“The Committee has recognised that MSM are disproportionately affected by HPV infection and disease compared to other men and as a result has advised a targeted programme for MSM which is already being piloted.”
The JCVI added: “The additional benefits gained from extending the programme to adolescent boys would be small, relative to the impact of the girls programme.
“The findings of both cost-effectiveness analyses provided specifically to the committee predict that extending the HPV programme to adolescent boys would not be a cost-effective use of health service resources in the UK setting.”
It noted that there would be “while it is clear that a programme to vaccinate adolescent males would provide those vaccinated with direct protection against HPV infection, and associated disease, all the evidence suggests that the risk of infection in males has already been dramatically reduced by the girls programme and that these herd effects will continue to have a substantial impact.”