HPV Vaccinations for MSM

John Nicolson Excerpts

Tuesday 7th June 2016 Westminster Hall

[John Nicolson (East Dunbartonshire) (SNP)]

I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing the debate. Vaccinations against HPV were introduced in the UK primarily to target cervical cancer. The HPV vaccination programme for girls aged between 11 and 13 has been in place since 2008, and last year the uptake of the vaccination was 89.5% across the UK. It has therefore been a huge success.

However, there are more than 100 types of HPV and it is one of the most common sexually transmitted infections in the UK. HPV infections are highly contagious, as they are spread mainly by skin-to-skin contact, and nearly all sexually active people get infected at some point in their lives. Some HPV infections clear up with no treatment necessary; others will develop into treatable conditions, such as genital warts; and some will go on to cause cancer. Despite the fact that HPV vaccinations in schools are available only to girls, to target cervical cancer, not only women can be infected. As we have heard, among men, 80% to 85% of anal cancers and almost 50% of penile cancers are associated with the infection. Evidence that has emerged since the original HPV vaccination programme was introduced has shown that immunisation is likely to provide protection against a wide range of HPV-related diseases, including those cancers.

The widespread vaccination of girls was intended to create wholescale community immunity and prevent the spread of HPV to unvaccinated male sexual partners. In Australia, research has shown that to have been a success, with a 90% reduction in genital warts in heterosexual men and women under 21 years of age. However, the vaccination programme ignored a significant section of society, which is left defenceless against the dangers of HPV: men who have sex with men, for whom the burden of HPV-related diseases is significantly increased compared with heterosexual men. In particular, they experience a higher risk of suffering from HPV 16-associated anal cancers, with rates 15 times higher in men who have sex with men.

The Joint Committee on Vaccination and Immunisation’s recommendation that a vaccination programme should be introduced for men up to 45 years of age who have sex with men is therefore welcome. In March, the Scottish Government announced their intention to introduce a targeted vaccination programme as soon as possible, and this month NHS England will begin a pilot vaccination programme at selected sexual health clinics to test delivery in those settings. However, the decision to implement a pilot has been described as “unnecessary” and “a cynical stalling tactic” by the Terrence Higgins Trust, which has pointed out that the London North West Healthcare NHS Trust already provides vaccinations to men who have sex with men, with impressive take-up and results. The Terrence Higgins Trust rightly does not want to see delayed a full national programme that could prevent serious illnesses and save lives. Its fears can possibly be traced back to NHS England’s decision not to commission PrEP, a preventive medication for those at risk of HIV, after an 18-month investigation. Instead, NHS England opted to run a number of test sites over two years to research how that treatment could be introduced in the most clinical and cost-effective way. That decision was described as “shameful” by the Terrence Higgins Trust and “astonishing” by the National AIDS Trust.

The pilot HPV vaccination programme is intended to immunise 40,000 people and be followed by a review of its impact. That is a welcome first step, but it is clear that immunisation will need to go beyond sexual health clinics. Those who do not attend such clinics will not be immunised and many may mistakenly believe that they do not need to be vaccinated if they use condoms. Significantly, the optimum age for men to receive the vaccine is as 12 to 13-year-old boys—in other words, at school, at the same time as their female classmates. That is the logical next step.

The Joint Committee on Vaccination and Immunisation is currently considering this issue along with Public Health England and the University of Warwick, although it will not be in a position to provide its final advice until 2017. The Terrence Higgins Trust, HPV Action, the British Association for Sexual Health and HIV, and the British Medical Association all support expanding vaccination to boys through the existing school-based programme. That would mirror the position in Australia, Canada and the United States, ensure that high vaccine coverage rates are achieved and protect all males and females, whatever their sexual orientation, from such serious diseases.

In public health debates, there will always be competing claims about money, priorities and whether proposed action has more positives than negatives, but in this debate the jury has delivered a clear verdict. The vaccine has saved the lives of countless girls and women. Is it not time that we showed some gumption and delivered the same benefits for young men?