HPV Vaccinations

Wednesday 19th July 2023 Westminster Hall

10:55

[Dame Maria Miller (in the Chair)]

As all parties are present, we will move seamlessly on to our next debate.

[Sir Paul Beresford (Mole Valley) (Con)]

I beg to move,

That this House has considered HPV vaccinations.

I am delighted to see you in the Chair, Dame Maria. I am also delighted to see the Minister. The subject of the debate is vaccination against the human papillomavirus. Unusually, both the Minister and I have seen HPV-related cancers, the destruction that the surgery to get rid of them does in providing a so-called cure, and how that often leaves patients. To be a little more positive, we have markedly moved our healthcare towards prevention. An increasingly vital arm of our preventive attack on various diseases must be vaccination. A vaccination strategy must focus not only on protection, but on elimination. For some diseases, we have been able to move towards elimination of the causative agent. That is the drive for me in this debate.

Vaccination has been around for a long time, ever since Dr Edward Jenner used the pus from a cowpox sore to inoculate an eight-year-old boy against smallpox in 1787—the first of thousands of people he and others inoculated and saved from smallpox that year. Millions upon millions have been inoculated since. I have no doubt that in this day and age, Dr Edward Jenner would have been up before the General Medical Council and struck off for recklessly endangering life, spreading disease and not following the guidance of the Joint Committee on Vaccination and Immunisation—I do not cross swords with it very often, but I have done so in the distant past. Since 1787, the development of vaccines has saved multiple millions of lives and stopped even more millions from various serious illnesses. The brilliant development and use of covid vaccines was a spectacular example of how far and how quickly we can progress.

I remember the mass inoculation programme against the polio epidemic from when I was a very small child. We saw polio spread through our community. If I remember correctly, the vaccination was a series of three injections in the upper arm using a syringe with a needle that was, in my view as a child, like a hollow 4-inch nail sharpened at the working end. It was plunged into my arm, reused after sterilisation and sharpened on a leather strop. It really hurt. Of course, the polio vaccine is now just a sugar cube carrying the vaccine, and kids love it. It has effectively wiped out polio in this country and most others. As we are all aware, there have been huge advances in the development, delivery and programming of vaccines, particularly for small children, who have been given huge protection against a variety of diseases. Over decades, vaccinators have had the chance to rid the world of some of these nasty diseases. Polio has been virtually eradicated. Apart from a few pockets in the world, yellow fever—a horrendous disease—has gone. Smallpox has gone. Measles went, but it has come back, because the vaccinations slipped.

I turn to HP viruses. They are a large family of viruses, at least two of which are downright dangerous to humans because they are causative agents of very many human cancers. They cause cervical, uterine and penile cancers and—in my professional area, which the Minister is aware of from her point of view—head and neck cancers. I point out my professional interest as a very part-time dentist. Head and neck cancers can be very hard to detect early and are frequently very destructive to treat. Surgery is frequently required. Such surgery commonly impairs normal living, such as eating, smiling and talking, and often physical appearance.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for securing this debate; he is right to have done so. I know that the Minister will respond in a very positive fashion, as she always does. Does the hon. Gentleman agree that the Government and the Minister must perhaps be clearer on why one dose is now needed, when parents in my constituency with a medical background tell me that one dose will not seal the vaccination? They are asking why covid boosters were essential, but this standard form of vaccination does not seem to be.

[Sir Paul Beresford]

As ever with the hon. Member’s interventions—which are frequent, as we have noticed, and press releases must result from them—he raises an interesting point. I will touch on it as I move on.

As I said, head and neck cancers can be hard to detect early. They are destructive to treat. However, we have had a vaccine for some time. For many years, there has been an initially very successful UK campaign to vaccinate teenage girls, targeting protection against cervical cancer. As the Minister will be aware, various colleagues and I, along with various groups, ran a campaign to make the vaccine available for teenage boys as well. The vaccine has been given to young teenage boys and girls and is not in the package received by infants. To be successful, we can and must drive the virus out. To do that, we must obtain herd immunity, with an overwhelming majority of teenagers inoculated—90% is the minimum target—but that is not happening. In 2021-22, only 9.8% of year 8 boys in this country were fully vaccinated. The figure for girls is better, but it is still only 67.3%.

With experience from the covid vaccine, we now have a real opportunity to rid the country of this deadly virus through an effective, concerted campaign, as we did with covid. The scientists have helped and, as has been mentioned, the HPV vaccination initially required two spaced injections, which have now been reduced to one. They use modern, fine, sharp needles, unlike the needles I was used to, meaning an essentially painless application.

There are some hurdles. This is being given to young teenagers, preferably both boys and girls, but an isolated vaccination is unfortunately not part of the package of early year vaccinations. Because early HPV vaccinations were promoted as preventing cervical cancer, some groups wrongly saw them as promoting promiscuity. That could not be further from the truth. For that reason, in our next campaign we should tend to slant the promotion more to the prevention of death and disfiguration from head and neck cancers, as well as cervical and penile cancer.

The NHS developed IT systems on a personal, individual level over the covid campaign. Someone on the campaign list would get constant reminders to get the covid boosters; those reminders kept coming until they had got the boosters. The same could be applied to HPV, especially as teenagers’ lives are generally dominated by their phones. A vigorous campaign in schools would help, and pushing in GP practices so that parents got involved.

As someone born in New Zealand, it pains me to say that the Australians are driving for an HPV-free nation, and I have heard that the New Zealanders are following suit. The Aussies appear to be winning against the virus. They are on the edge of being below four cervical cancer cases per 100,000 annually. If the Australians can do it, we can darn well do it.

The consequences of removing this virus are enormous: saving lives, saving thousands from disfiguring and often debilitating surgery and, most importantly, saving vast sums from our precious health budget. Minister, let’s get on with it.

11:05

[The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)]

It is a pleasure to serve under your chairmanship, Dame Maria. I thank my hon. Friend the Member for Mole Valley (Sir Paul Beresford) for bringing this important issue to the Chamber today. I know that he has done a great deal of campaigning on this, particularly vaccination for boys, and that he has clinical experience. We have discussed this, as we have both seen at first hand the horrific effects of head, neck and oral cancers on individuals and the difficult treatments they have to undergo, including surgery and radiotherapy. People are often not aware that HPV vaccination relates to head and neck cancers as well as cervical cancer.

HPV causes about 99% of all cervical cancers, but thanks to our world-leading vaccination programme that protects girls and boys, we have seen an 87% reduction in cervical cancers in vaccinated women compared with previous generations. Our ambition is to work to eliminate cervical cancer, and the HPV vaccination programme is a key part of that, but we are also looking at the data on the impact on rates of head and neck cancers as well as other cancers. Vaccination is a game changer in preventing some cancers caused by HPV.

The UK was one of the first countries in the world to introduce an HPV vaccination programme, back in 2008. Since then, millions of vaccines have been delivered, stopping the transmission of HPV, protecting individuals and saving lives. The programme has been evolving and we have made a number of significant changes, including introducing more effective vaccines, reducing the number of injections required and making the programme universal; in 2019, it was offered to boys as well as girls. Those changes have further strengthened what was already a very successful programme, and it is a key priority for the Government to increase uptake rates of the vaccine to at least pre-pandemic levels. That is a good place to get to, but of course we want to go further if we can.

Although we are not back to pre-pandemic levels yet, we are seeing encouraging recovery among older school-age children, as those who missed their vaccination during the pandemic are being caught up with. The vaccine is mainly delivered by school-based vaccination teams, and this delivery model, in combination with alternative vaccination sites for those who are not in mainstream education, has been very successful in getting our uptake rates pretty high.

Pre-pandemic levels of vaccination were consistently high across the board. To try to get back to those levels, anyone who missed their immunisation for whatever reason will remain eligible until their 25th birthday. They can catch up via their schools, alternative sites such as community centres, and GP practices, so there is a range of routes through which a young person who missed their vaccination can still access it until they are 25.

There is a separate HPV programme for gay and bisexual men, who are also at risk from HPV. The JCVI advises that they are at an increased risk of the virus and its effects on particular cancers. That is why there is a separate programme available through specialist sexual health services and HIV clinics, and the vaccine can be accessed until a man’s 46th birthday. There are two separate programmes, with multiple ways in which people can get the vaccination, and we encourage them to do so.

We have raised the eligibility age over the course of the programme and offered the vaccine to boys as well as girls. Using recent evidence, we are able to compare pre-covid vaccination rates of girls, but we are not able to with boys, because they have only been offered the vaccine since 2019. We are looking at the data, which will take years to develop, on the effect of vaccinating boys on preventing cervical cancer in future partners and on other types of cancer caused by HPV.

We are now evolving how many doses we give. When the programme started, people were offered three doses. That has since been brought down to two doses, and from September this year, a single dose will be sufficient to vaccinate fully against HPV. The hon. Member for Strangford (Jim Shannon) asked how we can be sure that a single dose will be effective. The JCVI looked at the evidence and recommends a single dose. We know from vaccination rates that young people often come for one dose, but may not return for the second. If we are happy that a single dose is effective, that will get our vaccination rates up. My hon. Friend the Member for Mole Valley highlighted the example of Australia, where a single-dose vaccine is used, with good success rates. The JCVI, the World Health Organisation and the Scientific Advisory Group for Emergencies all recommend moving to a single dose, because the clinical evidence is that it is just as effective as two doses.

Moving to a single dose will allow our vaccination teams to focus on catching up with those who have not turned up for any vaccines. That is our key priority: reaching out to those groups that have not come forward, because of the implications of trying to prevent cancer in an individual and, as my hon. Friend the Member for Mole Valley said, trying to capture the herd immunity effect. There may be some people who cannot have the vaccine for some reason. Getting as many people vaccinated as possible means we are reducing the risk of cancer when they are older.

I can reassure the hon. Member for Strangford that these changes are based on scientific review and advice from independent experts and the JCVI. They all aim to strengthen the programme further and ensure that more people have access to effective vaccines to prevent HPV infection and future cancers.

[Jim Shannon]

First, I welcome the Minister’s response, which is very positive. I mentioned people in my constituency who are medically qualified in their particular sector. They may not have all the evidence that the Minister referred to. Would the Minister please email me to let me know when that information will be available? Thank you.

[Maria Caulfield]

Absolutely, we can send the hon. Gentleman the information provided by the JCVI on its recommendations. I think the hon. Gentleman also asked why it is a one-off and not a regular dose. The evidence and studies show that, when someone is vaccinated against HPV, the protection lasts for at least 12 years. It could well be longer but, because the programme is not that old, we have only that level of data. There is certainly at least 12 years of protection from that initial vaccination. We will send him that information; we quite rightly want people to be able to ask questions and be reassured by the evidence we are able to provide.

HPV vaccination is one of the most cost-effective ways to protect people from both the infection and related cancers. We are keen to ensure that vaccination levels are as high as possible. Pre-pandemic, the programme reached 80% coverage for two doses. Those were good levels of protection that we would like to get back to, and then go higher. Covid-19 disrupted the roll-out, because young people were not able to go to school, and the vaccination teams were not able to roll out those programmes. Despite catch-up work and teams working extremely hard, we are seeing a decrease in uptake in vaccination. That is of concern because of the future implications.

We are committed to recovering the HPV programme back to pre-pandemic levels. We have seen some recovery when we have done catch-up work. To put it in context, HPV vaccine coverage decreased by 7% in year 8 girls, and 8.7% in year 8 boys. That is quite a significant drop. We have figures only for girls pre-pandemic, but these rates are about 18% lower than pre-pandemic coverage. That shows that my hon. Friend the Member for Mole Valley is quite right to raise this issue, and that there is work to do. I am happy to commit to meeting with my counterpart in the Department for Education, the Minister for Schools, to see how much further we can go to support schools and make the vaccination roll-out more effective.

I will also meet with the screening team to see how we can drive up those rates further and whether we need better communication, for both young people and parents, about what a difference vaccination can make to a young person’s life. To a young person at school, cervical cancer or head and neck cancer seem a long way off, but vaccination is so important for the future, not just for them but for future partners. I commit to my hon. Friend the Member for Mole Valley that we will do more to get those rates back up, because it is in the interests of young people.

I thank my hon. Friend for raising the debate. I encourage him to keep holding our feet to the fire on this issue, because it is important that it does not drop off the radar. He was quite right to raise the issue of the covid vaccination. We have been extremely successful as a country, particularly in the initial roll-outs, in vaccinating the whole country at 12-weekly intervals and then with ongoing booster programmes for vulnerable people in the community. We do well with our flu vaccine roll- outs as well. We need to put this programme on a par with other vaccination programmes and I am keen to make progress.

I commit to working with my DFE counterparts and raising the profile of how important the HPV vaccination programme is. I commend my hon. Friend for all his work in this area, particularly his clinical work. He has picked up head and neck cancers at an early stage, and people will have benefited from his clinical expertise. The ideal is for them not to develop that cancer in the first place, and that is where we all want to get to. We are committed to increasing the uptake of the vaccination across all eligible groups, and I will keep the House updated on our progress.

Question put and agreed to.

11:16

Sitting suspended.