Health: Human Papilloma Virus

Baroness Gould of Potternewton Excerpts

Tuesday 20th January 2015 Lords Chamber

[Baroness Gould of Potternewton (Lab)]

My Lords, I, too, congratulate my noble friend Lord Patel of Bradford on securing this important and rather urgent debate. It is urgent because there are more than 100 different types of HPV being passed from one person to another, not only by sexual contact but by skin-to-skin transmission and through non-sexual routes of HIV transmission, which include vertical transmission from mother to newborn baby. As my noble friend said, HPV is very easily acquired. It is reckoned that most women and men will acquire it at some time during their lives.

This discussion on vaccination for boys takes me back to the early 2000s, when we made similar requests for HPV vaccination for girls, when I was chair of the Independent Advisory Group on Sexual Health and HIV. We need only look at the success of that campaign. It is now the norm for secondary schoolgirls aged 11 to 13 to be routinely offered the vaccination as prevention against cervical cancer. Boys were not included at the time, although our campaign argued strongly that Gardasil should be the chosen vaccine so that they could be vaccinated against genital warts. Not to include boys was a mistake, which we are now trying to rectify.

Since then, the non-vaccination of boys has been a growing issue and concern, as it has become evident that in fact it has serious public health consequences. As a result, as has been said, the BMA reports that there is a growing consensus in the UK that extending vaccination to all boys represents the only effective answer to the question of how to ensure that all are protected against HPV infection. To add to the list of organisations that we have already heard, that is also supported by Cancer Research UK and Jo’s Cervical Cancer Trust and a large number of organisations that work in the field of men’s health.

As has been said, there is increasing evidence of the association between HPV and the many types of cancer and precancerous lesions caused by HPV. A reduction of precancerous lesions would help to reduce the rate of penile and anal cancer in men, as confirmed by Cancer Research UK. As it says, 90% of anal cancer in men is related to HPV infection. A recent statement by the Royal College of Surgeons makes it clear that scientific evidence suggests that the vaccination of boys could help to prevent anal cancer and cancer of the oropharynx and tonsils. The college goes on to say that those types of cancer are increasing. Data from 2012 showed that while there were 2,483 cases of cervical cancer and decreasing, there were also many cases of oropharyngeal cancer and tonsil cancer, which is fast growing.

On getting throat cancer, the actor Michael Douglas got a great deal of publicity—as though it was something unique—when he spoke out about the link between the virus and throat cancer. That view is supported by the Throat Cancer Foundation, which also firmly believes that schoolboys should receive the HPV vaccine to protect against throat cancer. James Rae, head of the foundation, has called the disease a “ticking timebomb”, because boys are routinely exposed to a virus that can cause loss of life. Nor should we ignore in that list of cancers, as has been said, the possibility of head and neck cancers occurring because of HPV.

The importance of the vaccine Gardasil is that it is a protection against genital warts. HPV is responsible for nearly all cases of genital warts. Genital warts are not only a source of infection but can be a source of sexual shame and embarrassment. The medical treatment can be long, often requiring multiple visits for treatments from which there is, unfortunately, no absolute cure. Clinical trials in Australia have shown that the vaccine is 89% effective in preventing genital warts but less effective in those who have already been exposed to HPV. That outcome surely illustrates and identifies not only the need but also the sense of early intervention well before boys become sexually active and are potentially exposed to the virus. To roll out the vaccine to boys would also help to reduce incidence of cervical cancer in women. Equally, at the appropriate age we should also give children information about the risks and about the protection that condoms and dental dams provide. However, they will not absolutely remove transmission; the greater guarantee has to be a vaccine.

At the start of the review in 2013 the JCVI set up a sub-committee to assess whether the programme should be extended to adolescent boys, men who have sex with men or both. As has been said, the review was due to report in 2015. The JCVI concluded that men who have sex with men should be offered the HPV vaccine, and of course that is welcome. However, that will not protect the majority of men who have sex with men because, as has been said, they attend GUM clinics at a rather later age, by which time they may have had multiple sexual partners and so be at risk before they attend a sexual health clinic.

The question that has to be asked, as other noble Lords have asked, is: why the two-year delay to 2017? That delay seems to focus on the model being developed by Public Health England. Maybe the Minister can tell the House if representation has been made to Public Health England, which I spoke to this evening, so that the Government can honour their original and welcome commitment.

I will make two final points. The cost of a jab of vaccine is £45. If that is multiplied by the nearly 400,000 boys who should be vaccinated, the total cost would be around £23 million per annum. We might say that that is a lot of money, but if that figure is set alongside the cost of the treatments for the consequences of HPV, there would be savings, be it in the treatment of the various cancers or of genital warts. To take just two instances, it is estimated that the treatment for throat cancer costs the NHS £45,000 per patient. The cases are not all caused by HPV, but the number that is caused by it is growing, so there could still be substantial savings. Add to that the cost of treating genital warts of the figure we just heard—£52 million each year—and add the cost of treatment for anal and penile cancers and head and neck cancers. Put it all together and it is clear that over a period there would be savings to the NHS. Can the Minister say whether that exercise has been undertaken, so that we can show that in fact there is a financial case for implementing the vaccination of boys against the HPV virus? In addition, the fact that the HPV vaccination schedule has been reduced to two doses should mean that there is the capacity within the existing school-based programme to extend that vaccination programme to include boys.

My second and last point relates to the question of equity. Withholding a health intervention from any group at risk of easily preventable diseases is inequitable and discriminatory. Not vaccinating boys may be, as has been said, in breach of the Equality Act—I think it is—because it discriminates against boys who are at risk because of the withholding of a particular health intervention. Vaccinating girls is not sufficient; men will continue to have sexual contact with unvaccinated women, whether in this country, where according to Public Health England the critical 80% threshold for girls is not being met in many parts of the UK, or they may have sexual partners outside the UK. It might also be said that providing vaccination to gay men only discriminates against heterosexual men. Therefore, this question of discrimination should be looked at.

The human cost of HPV-related diseases has to be the primary consideration, and this is a genuine opportunity to make progress in the fight against cancer by a simple jab at a cost of £45. Lives can be saved each year if boys are given the same vaccination that protects girls from developing cancer. Other countries have been named, such as Canada, Australia and the United States, but one country has not been mentioned: South Korea, which has vaccinated boys and shown the efficiency of the vaccine. I therefore ask the Minister why we have to wait another two years for a decision, or even longer before the programme starts. The answer has to be prevention—a programme of prevention that provides for a gender-neutral vaccination strategy in schools for all 11, 12 and 13 year-old boys and girls.