THE BLOG

Is the NHS Unfairly Excluding Men?

13/08/2014 15:38 BST | Updated 12/10/2014 10:59 BST

If you are a woman who finished high school before 2008, it is unlikely you were able to benefit from the introduction of a free vaccination against the human papilloma virus, otherwise known as HPV. If you are a man, it wasn't for you anyway - or was that a serious mistake?'

In 2008, the HPV vaccination became available on the NHS to all girls aged 12 to 13 years old. The vaccination primarily protects against the two types of HPV responsible for more than 70% of cervical cancers in the UK.

If you were lucky, as I was, and still within the education system in 2008 and born on or after 1st September 1990, you would have had the chance to receive the vaccination as part of the 'catch-up' programme.

Cervical cancer is the second most common cancer in women under the age of 35. Every year, just under 3,000 women are diagnosed with cervical cancer. To put that in perspective, that's eight women being diagnosed every day.

Remember Jade Goody, the reality television celebrity, who died from cervical cancer in 2009 aged just 29? As a result of her death, a campaign was launched to reduce the age of screening women from 25 to 20 in England. Ms Goody's death was a brutal reminder that cancer will and can take the life of anyone at any age. Cervical cancer is no exception. It made the introduction of the vaccine in 2008 all the more poignant.

And so, it is only common sense to vaccinate girls to try and reduce the numbers of those affected by this cancer. The virus is spread through sexual activity and though most girls don't start having sex until they're 15/16, it is important to get protection as early as possible.

Nonetheless, an article last month in the British Medical Journal (BMJ) suggests that boys too should be vaccinated.

"Boys and men don't have a cervix!", I hear you cry in confusion. An accurate and indeed a correct observation.

What many don't realise, however, is that HPV does not just give rise to cervical cancer. Types 6 and 11 of the virus gives genital warts which affects both genders. Types 16 and 18 can lead to neck and anal cancer, specifically penile cancer in men.

Only a few years ago, the Hollywood actor Michael Douglas gave publicity to throat cancer, allegedly claiming his cancer had been caused by HPV. There has been a significant rise in oral cancers in the UK: 4,000 diagnosed in 2002 increased to 6,200 in 2012, according to Cancer Research UK.

While Australia, the USA, two Canadian provinces and Austria currently offer the vaccine to both boys and girls, in the UK boys can only get the vaccination, called Gardasil, privately. This costs around £150 per dose.

Is the NHS unfairly excluding males from a very beneficial vaccine? Is it just that girls should get it free while boys have to pay if they want to protect their health?

Unfortunately, perhaps predictably, considerations of cost are involved. Would it be cost effective to vaccinate boys as well? Does the cost of treating these STD's and cancers cost more than the vaccination? This remains to be one of the key questions. In 2008, it was estimated genital warts alone cost the UK £17 million.

According to the review in the BMJ, if uptake of the vaccine becomes low amongst girls (currently it's generally high), vaccinating boys would prove both cost and health efficient. There are patchy coverage rates for girls across the UK, with BME groups less likely to be vaccinated. Further, areas within London with the number of vaccinated girls varies widely.

By vaccinating boys, therefore, it would help protect the unvaccinated girls by reducing transmission rates, whilst simultaneously protecting the boys themselves.

This is all very well and fits neatly when considering heterosexual relationships. But what about men who have sex with men (MSM)? Herein lies a problem.

MSM are particularly at risk from catching many strains of the virus. These men do not benefit, at all, from the current female vaccination programme. Unintentionally, it would seem the NHS has further ousted a group that has struggled for health equality and is at high risk of other sexually transmitted diseases.

But what to do? Should men and boys receive the vaccine on the NHS? Or just MSM?

Of course, the availability of the vaccine is not solely based on economic factors. Public health, equity and the human cost of HPV are all important. Think back to the introduction of rubella (German measles) vaccine in 1969; initially just girls were vaccinated but a vaccination programme including boys has been offered since...

For now, we can be thankful we have access to any sort of vaccine against HPV, even if its access is limited. We can only hope that in the near future this vaccine will become free for all and not just for some.