Yesterday, we finally took a step forward to better protecting the nation’s health through the introduction of a potentially life-saving Human Papilloma Virus (HPV) routine vaccination programme for gay and bisexual men from April 2018.
This brings England in line with Scotland and Wales where such a scheme has been up and running since mid-2017. The rollout will go some way towards protecting gay and bisexual men from preventable cancers caused by HPV, including anal, penile and neck cancers, as well as genital warts. Terrence Higgins Trust, alongside other sexual health charities have long called for parity of access to the vaccine in line with other parts of the UK.
The decision by NHS England and Public Health England follows an England-wide pilot of the vaccine for gay and bisexual men. In its assessment of the pilot, Public Health England reported that of those offered the vaccine, less than 4% of people declined. And, nearly one in ten people attended a sexual health clinic for the first time to get the vaccine. This is good news as getting more people through the doors of clinics is hugely important to not only address HPV but to also reduce new HIV infections and make sure all of us have the information and services they need to ensure good sexual health.
However, this decision still leaves a significant part of the population at risk of HPV. In the UK, each year HPV causes more than 1,400 cases of head and neck cancer and nearly 50,000 cases of genital warts. It’s estimated that four out of five people will contract HPV at some point in their lives, with 10% of cases leading to serious health conditions. Moreover, incidence of anal cancer among gay men is about five times higher than the rate observed in the general population, with even higher rates among HIV-positive gay men. These statistics speak for themselves.
It requires attendance at a sexual health clinic which is not always practical or accessible. We have seen huge cuts to sexual health services across the country, with one NHS Foundation Trust in London turning away over 11,400 people between April and September 2017. This new vaccination programme could see already oversubscribed services under increased pressure. Therefore, any additional cost of implementing this new vaccination programme needs to be quickly identified and most importantly, fully covered, in order to make it a success.
We know that the efficacy of the vaccine is significantly increased when administered before someone is sexually active. Hence the new MSM programme will protect some people, but this will not provide the coverage that is needed. Since 2008, all teenage girls in England have been offered the HPV vaccine through school. This reduces the incidence of cervical cancer, caused by high-risk strains of HPV, and other related conditions. The rationale for not vaccinating boys is that they will be protected due to the high uptake of the vaccine by girls, but around 15% of girls are not receiving both doses of the vaccination. Offering the vaccine to gay and bisexual men only within sexual health clinics also relies upon universal uptake of sexual health services among this population, which isn’t happening.
There is a simple solution to this.
Terrence Higgins Trust believes the HPV vaccine should be provided through a gender-neutral school-based vaccination programme, in line with the current programme for girls. This would mean every child, regardless of gender or sexuality, can enter the adult world with their risk of HPV significantly reduced. Failure to implement this change could result in devastating consequences.
The power to extend the HPV vaccine to boys lies with the Joint Committee on Vaccination and Immunisation (JCVI), which advises the Department for Health and Social Care on vaccines. JCVI has shamefully delayed a decision to extend the programme to boys no less than two times. At present, we still do not know when a decision will be made, with every delay putting the health of more boys at greater risk. We have been campaigning alongside other health charities as part of the HPV Action coalition and last year launched the Jabs for the Boys website which provides information about HPV and why it must be extended to all adolescent boys.
The evidence is clear: the tools are there to protect both girls and boys from the impact of HPV. It’s time real leadership was shown to make this a reality.