HPV Vaccination for Boys

John Howell Excerpts

Wednesday 2nd May 2018 Westminster Hall

[Sir Roger Gale]

My hon. Friend the Minister indicates that he knows the problem only too well. My hon. Friend the Member for Finchley and Golders Green has done a significant amount of work in achieving the provision of human papillomavirus vaccine for gay men—a small but significant step in the direction in which I hope we may travel further this morning.

Until a relatively few weeks ago, I knew very little about this issue. I concede that entirely. Unlike one of my colleagues who was here in this Chamber yesterday morning while I was in the Chair listening to the debate, who had a relative who had died of bowel cancer, I have no personal experience. However, when I met Professor Nutting and Peter Baker, I was astonished at the speed with which they convinced me of the argument—and I am not a pushover when it comes to spending taxpayers’ money. I think it is a no-brainer, and I hope to persuade my hon. Friend the Minister, and others, on this cause.

The human papillomavirus causes, among other things, cervical cancer, throat cancer, anal and penile cancers, and cancer of the back of the tongue. The virus is carried by about 80% of the population, which means somebody in this room is a carrier; it is not uncommon. I would like everybody to take that on board. Go on the tube in the morning and there will be dozens of people carrying the virus—most of it dormant, and a lot of it non-malignant. It is contracted in sexually active youth and, for men, usually in their teens or 20s.

The point is that it is a slow-burn issue. Its effects are not experienced overnight. A condition contracted as a teenager or at university may not rear its head for 30 years. We are talking about men now in their 50s and 60s, who some of the eminent people sitting behind me in the Public Gallery are treating, waiting that length of time without realising that they have anything wrong with them at all, because there is no screening process for men, unlike the screening process for cervical cancer.

I spoke yesterday to two people, Jamie Rae and Stephen Bergman—both sufferers, and both in their mid-50s—who described their experiences to me. I will not go into too much of the gory detail. I heard again this morning of another experience: somebody’s colleague, himself an eminent surgeon, who had throat cancer and suffered many months out of work, which was a loss to the health service, damage to his family and, of course, the treatment. The treatment involves chemotherapy and radiotherapy; it may involve a tracheostomy; and it inevitably damages the saliva glands in the mouth, leaving the patient who survives with permanent dryness, considerable pain and ongoing discomfort. As I have indicated, there is also the social damage. Both Jamie Rae and Stephen Bergman described to me in graphic detail the processes they have been through and the discomfort—I use that word very modestly indeed—they have experienced. They described themselves as the lucky ones, because both those gentlemen have come through it relatively unharmed, but of course there are many others who do not.

The HPV vaccine has been available to adolescent girls since 2008. A pubescent girl of 12 or 13 is offered the opportunity to be vaccinated in school. The parents, quite properly, have a right to refuse that vaccine. Just in case anybody has any doubt, I am aware that there are a small number of cases where parents believe that things have gone wrong and that children have suffered as a result of the vaccination. That is medically unproven, but we have to recognise that the parents believe it. Parental choice is vital, and in the case of pubescent girls there is parental choice.

The process ties in directly with the Department of Health and Social Care’s cancer strategy, which of course is about prevention. The Department has done significant work on preventing or seeking to prevent other prominent cancers. Lung cancer is the obvious one, and the anti-smoking campaign is highly relevant in this context. Melanoma is another; something that people of a certain age, such as myself, probably did not bother with at all has suddenly become prominent as the realisation of the damage that the sun’s rays can do to the skin and the cancers that can arise from that has dawned on the population. Any responsible parent or grandparent now takes the trouble to ensure that their children have appropriate sunscreens at all times when enjoying the sun. HPV vaccine falls directly into that category. It is usable for prevention and, used properly, it works. That is proven. As I said, this has been available to adolescent girls since 2008.

We now come to the hard bit of the argument, because up until now I think everybody would probably agree that we are on a winner in using HPV vaccine, but of course there is the question of cost and efficacy. The argument has been deployed that herd immunity, to use the colloquial phrase, will mean it is not necessary to vaccinate boys, because if we eliminate the infection in girls, boys will not catch it from the girls. That is nice in theory, but wrong in practice.

I am told by those who know better than I do that the average young male has at least 10 sexual partners. The Minister might find that surprising; I did myself, but it is so. It depends whom we believe, but in the United Kingdom the vaccine has an uptake of between 70% and 83%, although in some parts of the country it is as low as 50%. A young man embarking on an exciting night out with his girlfriend therefore has a very high risk of contracting HPV from a girl who has not been vaccinated, and that is just in the UK. We overlay on that the foreign travel that many young people are now happily able to enjoy. Sometimes, with sun, sea and sand goes sex, and the risk of exposure to HPV in those circumstances can be even greater. Therefore, the idea that herd immunity will in time address the problem is fallacious, and this is where I have to accuse those who are responsible for taking the decisions—that is not the Minister—of short-termism.

I can see the attraction of the argument that extending vaccination would not be cost-effective and that herd immunity is coming downstream. Yes, the cases coming through now are historical, in the sense that the disease was contracted 20 or 30 years ago, so well before any immunisation. If we want to save money and damage health at the same time, that is quite a good way of going about it. I am seeking to persuade the Minister of the real value of having the courage—he is not lacking in courage—to take a long-term decision now.

The cost of immunising every adolescent boy within the relevant range in the UK is estimated to be, at the top end—this includes the purchase of the vaccine, which of course has to be negotiated by the health service, and its application—about £22 million a year. That is a lot of money, but in health service terms it is almost a bagatelle. Set against that, I am told by those with real experience, some of whom are sitting behind me in the Public Gallery, that there are about 2,000 patients a year—men in their 50s and 60s—who have developed throat, penile or anal cancers. The cost of treating those is about £21 million a year. Of course, that takes no account of the social costs and the other damage that can be done. In the case described to me this morning, of a surgeon who was taken out of play for a considerable time, the cost of treatment—of a replacement jaw, as well as the chemotherapy, radiotherapy, hospitalisation and everything else that goes with it—is looking like being somewhere between £50,000 and £100,000, and that is just one case.

[John Howell (Henley) (Con)]

My hon. Friend mentions the 2,000 people. Does he have an estimate of the total number of people who might be spared the effects of the virus if the actions that he proposes are taken?

[Sir Roger Gale]

I am afraid that I do not. The figure that I have is 2,000 people a year, so one has to assume that it is that—but it is growing.

The reason the condition is becoming more prominent, not less, is the change in sexual attitudes from the 1960s onwards, when practices that were previously unacceptable became acceptable. Oral sex, for example, became relatively commonplace. We can therefore expect, certainly within the next 10, 15 or 20 years, a significant rise in the number of cases. The discussion has to be about what happens after that and whether the herd immunity actually works. I am arguing that it will not, for the reasons I have given.

I have talked about the slow burn, the 20 or 30-year wait, and the costs to the health service, on which the view seems to be, “Okay, fine. Let’s kick that into the long grass. It’s not our problem.” There will be 15 Ministers between the present one, sadly, and the time when people are developing diseases. However, the condition of genital warts, which is also caused by HPV, takes only three, four or five years to incubate, and the cost of that annually is £50 million, so do the maths. The economics of this are unassailable, and on those grounds I defy anyone to challenge my argument. The argument comes down to herd immunity. Will vaccinating girls do the job or not? I have made it clear that I believe it will not, and I think that the time has come for the Department to take a further long, hard look at the issue.

Up to now, the Joint Committee on Vaccination and Immunisation has indubitably taken a short-term approach to this: “Does it work? Well, yes, the vaccine works. Is it worth it? Well, not if we are vaccinating girls. Let’s see what happens—kick it down the line and save £20 million a year today,” even if that means that in 10, 15 or 20 years’ time we will be spending not £20 million but £200 million a year, which will be in addition to all the social costs. I understand that the JCVI will meet in the first week of June. We were promised that a decision on extending vaccination would be taken in 2015. That was deferred until 2017 and has now been deferred without a date being set for the final result.

Before I conclude with a request to the Minister, I want to say this. Chris Curtis, chairman of The Swallows head and neck cancer charity, sent me a video this morning. It was compelling, because he has been a sufferer himself and he described his own circumstances. I want to say something to the JCVI, to each and every member of that august body, who are of course medically qualified in a way that I am not. What I want to say on behalf of all the people who have been treated and have approached me is what Chris Curtis said at the end of his video. Friends, when you are thinking of kicking this into the long grass because it is not going to affect many people for a very long time and we do not have to concern ourselves with tomorrow, remember what Chris Curtis said, very starkly: “Tomorrow comes very quickly.”

I will not ask the Minister to second-guess the JCVI—that would not be right. I do not believe that this is his decision to make, in the sense that I suspect he is little more medically qualified than I am. Neither of us has the expertise to make this judgment. Will he please convey that sense of urgency about tomorrow to the JCVI, with the firm and genuine request that he wants them to take a long-term view, and to make the decision on the balance of long-term cost, not savings tomorrow?

--- Later in debate ---

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Sir Henry. There is not much more that I can add to the presentations that have been made by my colleagues, but I want to make a couple of points. First, this is not simply about the sexual relationships of gay people. It affects all of us. My colleagues made that point firmly, but we need to make it again. Secondly, this virus is horrible. It is a disgraceful virus—to anthropomorphise a virus. We have heard the descriptions of the cancers that are induced by it.

I want to concentrate on the preventive powers of this vaccination for genital warts. There is a strong case for that. They may appear to be insignificant, but I do not believe that they are; they are much more widely distributed among the population than the cancers induced by the virus. My hon. Friends the Members for North Thanet (Sir Roger Gale) and for Worthing West (Sir Peter Bottomley) have made a compelling case for the immunisation of boys, which I fully support.