HPV Vaccination for Boys

Debate between Peter Bottomley and Steve Brine

Wednesday 2nd May 2018 Westminster Hall

[Steve Brine]

Not wishing to mislead the House, my honest answer is that I am not aware of that paper. Whether my officials are aware of it is another matter—I will ask them. I know that the hon. Gentleman will not be shy about putting a copy in my hand after the debate.

The good news is that HPV vaccination of girls also provides some—I emphasise “some”—indirect protection for boys. When the vaccination uptake rates are high, as they are in England, there are fewer HPV infections in heterosexual males, because the spread of HPV infection between girls and boys is reduced. There is evidence to back that up; it is not just words. For instance, diagnosis of first-episode genital warts in young heterosexual men between the ages of 15 and 17 declined by 62% between 2009 and 2016. That suggests that there is some—again, I emphasise “some”—herd protection from the existing HPV vaccination programme. However, that is not the start of the story, and neither is it the end, and I have to put it on the record that nobody in Government has ever said that it was. Nevertheless, I take the points that have been made today about herd immunity; it is only part of the story.

Of course, it will take much longer to see the impact that the girls programme has on HPV-related cancers, but we should not wait for those results before considering whether more needs to be done now for boys. As my hon. Friend the Member for North Thanet said, this is a slow-burn problem.

[Sir Peter Bottomley]

It is just a matter of pure mathematics. If 100%, or nearly 100%, of any age cohort —male and female—gets the vaccination, the herd immunity develops much faster than just relying on vaccinating up to 50% of that cohort.

[Steve Brine]

I think that my hon. Friend is stating facts, and I know that the JCVI officials who are here today will have heard him.

The JCVI keeps all vaccination programmes under review, as it should, and it keeps Ministers informed of any reviews. As my hon. Friend the Member for North Thanet is aware, given the increasing evidence about the link between HPV infection and oral, throat, anal and penile cancers, alongside the incidence of genital warts, the JCVI has considered whether HPV vaccination is now needed for males.

I understand the point that the hon. Member for West Dunbartonshire (Martin Docherty-Hughes) made about the surprise about penile cancer. He has more experience of the subject than I do, but it is not a surprise to me. I work with a very good charity called Orchid Cancer, some of whose staff attend my cancer roundtable regularly. It deals with male cancers and is trying to raise awareness of penile cancer as a challenge in society today. It is an issue that is difficult for society, let alone for men, to talk about. I thank the hon. Gentleman for what he has said today.

The JCVI considered its current piece of work in two parts: first, whether the HPV vaccination should be introduced for men who have sex with men—MSM—and secondly, whether it should be introduced for adolescent boys. MSM, as we know, are a group at high risk of HPV infection. Unlike heterosexual men, of course, they are unlikely to receive much, if any, indirect protection from the HPV vaccination programme for girls. The JCVI advised us that a targeted HPV vaccination programme should be introduced for MSM up to the age of 45 who attend genitourinary medicine clinics or HIV clinics. Following a successful pilot in 42 clinics that was led by Public Health England, we announced in February that the programme would roll out across the country from April, and it is now being rolled out. That programme is welcome, but again I fully appreciate that it is not the start and it is certainly not the end of the story, for some of the reasons that the hon. Member for Washington and Sunderland West set out in her very coherent remarks.

Let me turn to the issue of adolescent boys. Of the non-cervical HPV-associated cancers, not all cases are caused by HPV—indeed, the percentage of cases that are attributable to HPV is widely debated. My hon. Friend the Member for North Thanet mentioned The Swallows, which I do not have much contact with, although I have heard of it. I passed a note to my officials asking them to get in touch with the charity as a result of this debate, so it should look out for that. For head and neck cancers, alcohol is an important risk factor to take into account, but HPV does play a role, and that is why the JCVI is considering whether vaccination for boys should be introduced.

The JCVI issued interim advice on HPV last July. As Members know, that was subject to consultation. It is reviewing the evidence ahead of finalising its advice to Ministers. Its members are the experts, and they are best placed to consider the evidence and provide advice to Ministers. That is the system that Parliament has mandated. Parliament could change it, but that is our system.

[Sir Peter Bottomley]

When the Minister sends a report of this debate to the JCVI, it might be worth him respectfully saying that some of us here are aware of how long it took it to agree to bring in HPV protection even for females. It might want to consider whether postponing that decision was right or wrong. In my view, it was wrong. The people at the British Association for Sexual Health and HIV knew that it was wrong, and it took an awfully long time for them to change their minds. Can we please ask them respectfully not to make the same mistake again?

[Steve Brine]

Those people are nearer to my hon. Friend than he knows, and they will have heard his point.

In his opening remarks, my hon. Friend the Member for North Thanet asked the JCVI to take the long view, and I hope that I can reassure him somewhat on that point. Some examples of what the JCVI is taking into account in its considerations include: the projected future number of HPV cancers resulting from the current incidence of HPV infection; the potential savings as a result of preventing future cancers, which a number of Members have mentioned; the potential savings from preventing genital warts; and, crucially for my hon. Friend’s point, the long-term impact of HPV infection up to 100 years into the future, which will outlive even him.

The JCVI’s interim advice indicated that to vaccinate boys would be

“highly unlikely to be cost-effective in the UK, where uptake in adolescent girls is consistently high”.

It is true that the UK has achieved high uptake for the girls HPV immunisation programme for the past 10 years. In 2016-17, 83.1% of girls completed the current two-dose course, including the daughter of the hon. Member for Washington and Sunderland West. I have two young children—one of each—and of course those of us who are parents want what is best for our children. Somehow arguments about cost-effectiveness do not feel right. Cost-effectiveness is important, however, because it is about how to fairly, consistently and robustly assess which interventions and treatments should be funded in what we must remember is a publicly funded health system. We need to deliver value for money for the taxpayer and deliver the most health benefit possible to all patients. That is our system.