Health: Human Papilloma Virus

Baroness Hollins Excerpts

Tuesday 20th January 2015 Lords Chamber

[Baroness Hollins (CB)]

My Lords, I thank the noble Lord, Lord Patel of Bradford, for initiating this important debate. It comes at a time of growing consensus within the medical community that now is the right point to extend HPV vaccination to all boys. It is the only effective and equitable solution to protect against HPV infection. I want to focus my remarks during this debate on the role of HPV in a range of cancers affecting men and the growing evidence that the best way to target HPV in boys is to vaccinate them in school. I shall also raise concerns about a group which is often overlooked in discussion: men with learning disabilities. I ask the Minister to remember this group of men in his response.

There is no doubt that incidences of cancers associated with HPV are going up. The UK has seen a recent rise in the incidence of HPV-related oropharyngeal carcinoma among men, and I understand from the research of Professor Margaret Stanley, who has already been mentioned in this debate, that this has the fastest rising incidence of any cancer—15% a year. Over the past four decades, rates of anal cancer in both men and women in the UK have risen steadily. It is estimated that 90% of anal cancer in men is related to HPV infection, and roughly six people die every week in the UK from this cancer. Infection with HPV is also responsible for nearly all cases of genital warts.

Men who have sex with men are especially at risk of exposure to HPV infection because they are completely outside the vaccinated herd. Reflecting on the comments of the noble Lord, Lord Patel, I presume that if only 80% of girls are vaccinated, since girls are only half the population, that must reduce the effectiveness of the herd to 40%. Does it? The incidence of anal cancer in this group is estimated to be similar to that of cervical cancer in an unscreened population of women.

A not insignificant number of boys will be sexually abused before reaching adulthood, including boys with learning disabilities, who are at much higher risk of abuse and are less likely to have received sex education or to know how to report abuse. Although some improvements have been made, the sexual health needs of those with learning disabilities have, for the most part, been overlooked. This is particularly worrying as evidence suggests that men with learning disabilities who have sex with men are less likely to identify themselves as gay and therefore are less likely to have access to formal or informal sexual education, which places them at even greater risk of getting STIs or even HIV.

It is against this backdrop that HPV Action has been formed. It is a coalition of organisations that support gender-neutral vaccination. It includes the British Dental Association, the Royal College of Obstetricians and Gynaecologists, the Royal Society for Public Health and the Faculty of Public Health, among others. All agree that the case for vaccinating both sexes against HPV is growing stronger. The House will wish to be reminded that my interests include being chair of the board of science of the British Medical Association. The British Medical Association, which represents doctors, has also said that it now believes that there is an overwhelming case for expanding the school-based HPV vaccination programme to include boys. This was debated at the 2014 annual representatives’ meeting, and members voted to accept this evidence and advocate for equity in the vaccination programme.

It is clear that scientific and medical opinion now largely believes that HPV vaccination will prevent many cases of head, neck and penile cancer, and an increasing number of clinicians and public health organisations in the UK recommend HPV vaccination for boys. There is also a growing consensus that the most effective approach to providing this protection to boys would be to provide vaccination in school. To ensure that vaccine recipients are protected, they must receive the immunisation prior to the initiation of sexual activity. As such, there are concerns that providing immunisation only at GUM clinics would not do this effectively. It is not practical to offer HPV vaccination only to men who have sex with men because, to be most effective, boys should receive the vaccine prior to the age of sexual activity. The optimum age for this would be 12 or 13. It is clear that 12 or 13 year-old boys would not attend GUM clinics. We have already heard that the median age for first attendance is around 28 or 29. Boys of 12 or 13 may be unaware of their sexual orientation.

In the existing school-based vaccination programme, we already have an appropriate mechanism for vaccine delivery. From September last year, the HPV vaccination schedule was reduced to two doses. This reduction now provides capacity—this is an important point—to extend the school-based HPV vaccination programme to include boys. I believe that this presents us with a real opportunity, and providing HPV vaccination to all boys in schools will guarantee that high vaccine coverage rates are achieved. If we were to take this step, we would not be the first. Australia, Canada and the USA already offer HPV vaccination to boys.

The introduction of HPV vaccination to protect women against cervical cancer has made a significant contribution to reducing incidences of HPV infection among young women in the UK. This undoubtedly represents a significant health gain. However, there is now overwhelming evidence—and consensus—that there is a case for expanding the school-based HPV vaccination programme to include boys.