Health: Human Papilloma Virus

Baroness Wheeler Excerpts

Tuesday 20th January 2015 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I, too, am very grateful to my noble friend Lord Patel for securing this debate and providing the opportunity to address this important issue. I also pay tribute to his contribution and work as chair of the All-Party Parliamentary Group on Men’s Health and to his dogged and persistent campaigning on the need to give teenage boys the HPV vaccine to prevent men getting cancers. Indeed, we have been very fortunate today to have the expert contributions from other strong campaigners on this and other key sexual health issues.

As we have heard, there is certainly a compelling case for challenging the Joint Committee’s 2008 conclusion that evidence did not support applying the universal programme of HPV vaccination for girls to boys. We have heard today how the contention that for boys such a programme would provide little additional benefit or be cost effective—because vaccine efficacy was high, and high coverage in girls would provide herd protection for boys—is increasingly difficult to sustain.

HPV Action, which leads the campaign for a gender-neutral HPV vaccination programme, is an authoritative voice on this issue and an umbrella body whose members include a wide range of leading public health, cancer, oral health, sexual health and men’s health organisations. The BMA, the Royal College of Physicians, the Royal Society for Public Health, and the charities Cancer Research and others, such as Jo’s Cervical Cancer Trust, all strongly support the campaign for the vaccine and the vaccination itself. The latter stresses that vaccinating both girls and boys at a young age may be the best way to achieve the greatest protection for females against the risk of cervical cancer, and that extending the vaccine to boys would provide universal protection to both sexes from many other HPV-related cancers. The BMA points to “overwhelming evidence” supporting extending the HPV vaccine to all boys as well as girls before they start having sex. Indeed, there is growing consensus in the UK and internationally that extending the HPV vaccination to boys represents the only effective, equitable solution to ensure that all are protected.

We can also acknowledge that the JCVI’s recent recommendation for men who have sex with men—MSM—to be offered HPV vaccinations when they attend sexual health clinics is an important step forward. However, we have heard today the strong concerns that this is not enough to protect MSM, and that the reality is that most MSM will remain unvaccinated. The most effective protection for MSM and heterosexual men is to vaccinate all adolescent boys before they become sexually active. The JCVI consultation on MSM ended this month. Does the Minister have any update on the level of response and do the Government have an estimated date for receiving the JCVI’s final advice?

There is also strong evidence that vaccinating boys will also help to protect women. The Royal Society for Public Health says:

“While the vaccination for girls does offer herd immunity for boys, this doesn’t take account of transient populations and presumes that males remain within the herd. Men may still contract HPV elsewhere (e.g. travelling abroad) or from females in the UK who have had the vaccination”.

On HPV vaccine for adolescent boys, the JCVI, in its November 2014 MSM interim statement, expresses disappointment that the modelling work on the impact and cost-effectiveness of the programme by Public Health England is not able to begin until this year, when, as we have heard, it had originally been expected to have taken place so that recommendations could come through this year. The JCVI is right to stress that it would be inadvisable to take shortcuts in the process of modelling which might undermine the validity of the results, but I hope that the Minister acknowledges the widespread concern that the delay and the revised estimated date for the recommendations of early 2017 is causing. I hope that he can shed some further insight on the reasons for the PHE delay and on what action the Government will be able to take to help the JCVI bring this date forward. The HPV action estimate is that every year that passes leaves 400,000 boys unvaccinated and unprotected. That is a worrying figure indeed. The noble Baroness, Lady Hollins, expressed particular concern about the position of boys with learning difficulties. I look forward to hearing the Minister’s response to that because it is obviously a very important issue.

Obviously, the JCVI work on the impact and cost-effectiveness of vaccinating adolescent boys is crucial, balancing the cost of the vaccination programme with the cost of treating HPV-related diseases, which is considerably more. My noble friend Lady Gould spelt out the costs involved in that. The RSPH’s call to action on extending the vaccine programme to all 12 to 13 year-old boys calls for the negotiation of a cost-effective HPV vaccine based on the Australian Government’s experience, which managed to secure a reduced cost per dosage of the vaccine for boys. My noble friend Lady Gould also referred to the changes last year in the vaccination programme for girls from three doses to two. The savings involved in that could have the potential to be invested in extending the programme to boys.

Finally, I underline the RSPH’s call for the need for a major campaign to increase public awareness of the risk of transmitting or contracting the HPV virus, and the potential impact that HPV can have on everyone. This is especially important in schools as a key part of the PSHE schools programme. Labour is strongly committed to, and in favour of, sex and relationship education being compulsory in all publicly funded schools in an age-appropriate way. The Minister will know that we tabled key amendments on this during the course of the then Children and Families Bill, but there was strong resistance from the then Education Secretary, Michael Gove. We also underlined the need to update the statutory sex and relationship guidance issued by the education department to schools, which has not been updated since 2000. In the spirit of joined-up government, I conclude by asking the Minister if the Department of Health will lead the way on this. Is it undertaking any work on this, and will he ensure that HPV awareness forms part of this work?