HPV Vaccine

Mark Spencer Excerpts

Tuesday 2nd July 2013 Commons Chamber

[Mike Freer (Finchley and Golders Green) (Con)]

I am grateful to Mr. Speaker for granting me this debate on vaccinations against the human papillomavirus, otherwise known as HPV. My main aim is to raise the issue of the inherent inequality of the vaccination programme, which excludes men.

Discussing this issue involves raising topics that people often do not want to talk about, but such discussion is easier than having to deal with the illnesses and diseases that arise from not vaccinating. Embarrassment is preferable to the many cancers that are associated with HPV.

Let me begin by saying that it is important to acknowledge the success of the programme. Since its launch in 2008-09, it has successfully screened and vaccinated more than 80% of applicable girls. Last year the original HPV vaccine was replaced with the quadrivalent HPV vaccine, which provides protection against the two strains of HPV that cause at least nine in 10 cases of genital warts. Of course this added protection is above the primary purpose of the vaccination programme—to bring down rates of cervical and vaginal cancer in women. Men are, however, up to six times more likely than women to have oral HPV infection, thereby increasing the risk of cancers of the throat, neck and head.

[Mr Mark Spencer (Sherwood) (Con)]

I am pleased to hear my hon. Friend mention throat cancers in men. Will he address how much the treatment of such diseases would cost compared with the cost of the vaccine?

[Mike Freer]

Yes, I will raise the cost-effectiveness of the vaccine as compared with the treatment costs of many cancers, including oral or pharyngeal cancer, which is throat cancer.

In 2009, just after the HPV vaccination programme started, there were over 6,500 cases of these cancers, with 47% of penile cancers and 16% of head and neck cancers thought to be HPV-related. Today, however, overall rates of HPV-related cancer and warts should—should, I stress—subsequently come down in heterosexual men, because of so-called herd immunity.

Herd immunity is where men have sex with vaccinated women and thereby get protection against warts, as well as other cancers including penile, anal, oral and pharyngeal cancers. However, they get such protection only if they have sexual contact with UK-born women who have been vaccinated, or with Australian women or those of the very few countries that have had a mass vaccination programme.

--- Later in debate ---

[Mike Freer]

I am grateful to the right hon. Gentleman for intervening on me to ask the Minister a question and I am sure that she will answer it in due course. He makes a valuable point, however. I, too, have a constituent who had an adverse reaction to the vaccine and who is believed to have myalgic encephalomyelitis as a result. Statistically, such reactions might only be small in number compared with the benefits of the widespread vaccination programme, but he makes a good point in that it is important that the Department of Health tracks them to see whether a pattern emerges over time.

[Mr Spencer]

My hon. Friend is being very generous with his time. Is screening available on the NHS to prove whether someone is a carrier of HPV? If I presented myself to my local GP and asked to be screened, would such screening be readily available?

[Mike Freer]

To be honest, I am not sure that I can answer the question. I suspect, however, that if my hon. Friend presented at a sexual health clinic, the staff might be able to advise on what screening or tests were available to identify whether he is a carrier of HPV. It is quite common in men, so in all probability he is. He might want to visit a sexual health clinic tomorrow—if I have not frightened him too much.

I understand that the JCVI inquiry is limited to considering cervical cancer, which restricts the review to women and girls. I press my hon. Friend the Minister to confirm that the JCVI’s scope will be extended to include all HPV cancers so that we can look at how best to vaccinate boys, girls, women and men. The Department of Health must redefine the formal aim of the programme, because if it does not it will be compounding inequality and cost-ineffectiveness.

Males must be protected against the four strains of HPV. The herd immunity that will potentially result from the current programme is often used as a defence for not vaccinating boys, but that implicit intention of excluding men who have sex with men or men who have sex with women who are not vaccinated is simply not sustainable.

The inequality of health protection is obvious and so are the cost savings that I have identified. I know that the Minister will be as concerned as I am that that cost-ineffectiveness and inequality cannot be allowed to continue, and I look forward to hearing her confirmation that the scope of the review will be widened.

--- Later in debate ---

[Anna Soubry]

I am going to repeat everything that has been said, and I agree; that is a very important point. As my hon. Friend the Member for Finchley and Golders Green argues, the vaccine does not protect men who have sex with women who have not been vaccinated, because they may have been in a country where the vaccine was not available to them. So I completely take the point, which is well made, and ask my officials to take it back to the Department.

As hon. Members know, the Department of Health is advised on all immunisation matters by the Joint Committee on Vaccination and Immunisation—an independent expert advisory committee—and our HPV vaccination policies are accordingly based on the advice of the JCVI. When the committee considered the introduction of the HPV vaccine in relation to cervical cancer, it did not recommend the vaccination of boys because with high vaccine uptake among girls, as is the case in the UK, it is judged that there would be little benefit in vaccinating boys. With the high uptake of HPV vaccine among girls, we would expect many boys to be indirectly protected against vaccine-type HPV infections and associated diseases, including anal cancer, head and neck cancers and penile cancers. However, the JCVI recognises that under the current programme, the same protection may not be provided to men who have sex with men, and of course men who have sex with women who have not had the vaccination.

[Mr Spencer]

I hope the Minister would recognise that, obviously, ideally we should be vaccinating boys who are pre-puberty, and at that stage we have no idea of their sexual orientation or whether they may fulfil their career abroad or in the UK, so we have no way to identify whether they are at risk.

[Anna Soubry]

I am going to struggle, because that is another good point. I always try to be honest when I come to the Dispatch Box and when hon. Members make good points—points that were made not only by my hon. Friend, but by the hon. Member for Airdrie and Shotts (Pamela Nash).

The point raised by the right hon. Member for Wolverhampton South East (Mr McFadden) is related to the actual vaccine, and I am more than happy to discuss that case, or any other adverse reactions of young women to the vaccine, with him. I am very sorry for his constituent, and I am more than happy to have that discussion with him and help in any way I can. He raises an important point.

As we have heard, in June 2012 the JCVI was presented with data on HPV infections and it noted that there is early evidence to suggest that the HPV immunisation programme in England is lowering the number of HPV 16 and 18 infections—the strains of HPV that are linked to these unpleasant cancers—in females in birth cohorts that have been eligible for vaccination.

I accept that the data are very limited on the prevalence of HPV infections among men who have sex with men, but we hope that research under way at University College London will provide more data and an age profile of HPV prevalence. HPVs, particularly types 16 and 18, are associated with the majority of anal cancers as well as cervical cancers, and to a lesser degree with penile, vaginal, vulval and head and neck cancers, but HPV types 16 and 18 predominate in cancers at those sites that are HPV-related. Data on the impact of HPV vaccination on infection at some of these non-cervical sites are limited.

The JCVI noted that the potential impact of HPV vaccination on non-cervical cancers would make the current HPV immunisation programme even more cost-effective, but it would remain the case that, given the expected effects of immunisation on HPV transmission and the indirect protection of boys that accrues from high coverage of HPV vaccination in girls, vaccination of boys in addition to girls was unlikely to be cost-effective. That argument, which we know is advanced, is combated by all that has been said by my hon. Friends the Members for Sherwood (Mr Spencer) and for Finchley and Golders Green, who urge us to consider the cost of treating someone who has one of these cancers.

Evidence for indirect protection would continue to be evaluated by the ongoing HPV surveillance programme at the former Health Protection Agency, now part of Public Health England, but the JCVI agreed that there may be little indirect protection of men who have sex with men from the current immunisation programme. Therefore, the impact and cost-effectiveness of vaccination strategies for men who have sex with men, with the offer of vaccination through general practice and/or at genito-urinary medicine clinics, needed to be assessed. In addition, data on the prevalence by age of HPV infections in men who have sex with men and in the settings where vaccination could be offered to them were needed to determine the potential effectiveness and cost-effectiveness of HPV vaccination of men who have sex with men. It would also be important to understand better the rates of HPV-related disease in men who have sex with men and the influence of HPV on HIV infection.

As we have heard, in August 2012, the JCVI issued a call for evidence from interested parties, including for information to inform a study on the impact and cost-effectiveness of HPV vaccination of men who have sex with men. Any new proposals for the vaccination of additional groups will require supporting evidence to show that this would be a cost-effective use of resources. The JCVI also asked the HPA, now part of PHE, to undertake that study. The study is under way and, once completed, will be considered by the JCVI, at the earliest in 2014. The Department will consider carefully the advice from JCVI, once the committee has completed its assessment.