HPV Vaccination for Boys

Sharon Hodgson Excerpts

Wednesday 2nd May 2018 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Henry. I thank the hon. Member for North Thanet (Sir Roger Gale) for securing this important and long-awaited debate, and for speaking with such knowledge and passion. I also thank the hon. Members for Henley (John Howell), for Worthing West (Sir Peter Bottomley) and for West Dunbartonshire (Martin Docherty-Hughes) for their contributions. Although we are few in number, due in no small part to the local elections, that has been more than made up for by quality.

As we have already heard, 70% to 80% of sexually active women and men will acquire HPV at some point in their lives. Most healthy people will be able to clear the infection out of their system and will never know that they had been infected, but 3% to 10% of cases lead to serious health conditions. HPV is a major cause of cancers in men and women, and accounts for 4.8% of the estimated 12.7 million new cancer cases occurring annually among men and women worldwide.

HPV is linked to nearly all cervical cancers, 70% to 75% of vaginal cancers, 29% of vulvar cancers, 50% of penile cancer and 85% to 90% of anal cancers in both sexes. HPV can also cause genital warts, as we have heard, which is the most common sexually transmitted disease caused by the virus in both sexes. Why, then, do we vaccinate only girls, when men and women can be infected?

Since 2008, girls aged between 11 and 13 in the UK have been offered the HPV vaccination. My daughter was in the first cohort. As a parent, I was a bit anxious when the new vaccination was rolled out, but I need not have been. The vaccination programme has been mostly successful, with a high uptake of about 85% nationally, and it has made an important contribution to reducing the burden of infection among young women in the UK.

However, there are significant regional differences in the uptake of the vaccination, with the lowest level of uptake of two doses at 48.3% in my region, in Stockton-on-Tees, compared with the highest level of uptake in East Renfrewshire at 95.6%, which is astonishingly high. What steps will the Minister take to address those regional inequalities in the vaccine uptake? How does he expect a herd immunity philosophy to apply in areas such as Stockton in the north-east, where uptake is so low?

It is clear from the ever-growing evidence that it is time to extend the HPV vaccination to boys. The Joint Committee on Vaccination and Immunisation believes that the high uptake in girls protects enough males and makes it cost-ineffective to vaccinate boys too, but that short-sighted view protects only heterosexual men who come into sexual contact with a woman who has been vaccinated, and leaves out a significant proportion of the population. Despite the high uptake among young girls, a heterosexual man still has a one in seven chance of meeting an unvaccinated woman in a sexual encounter.

Men who have sex with men are also unprotected by a girls-only vaccination programme. They are 20 times more likely than heterosexual men to develop anal cancer, but the men who have sex with men—MSM—programme being piloted in England will not be sufficient to protect that population.

Between 2009 and 2014, the median age of the first presentation of men who have sex with men to sexual health services in England was 32 years old. They are therefore likely to have been having sex for many years before they attend a sexual health clinic. A recent study of men who have sex with men attending a London sexual health clinic found that 45% had a current HPV infection of a type that could cause cancer or genital warts, which suggests that a significant proportion of them will have already been infected before they are offered the HPV vaccination. Offering the vaccine in a sexual health clinic is too little, too late for men who have sex with men.

In addition, as we know, sexual health services are at a tipping point after demand for them increased by one quarter in the past five years, but at the same time, spending on them was cut year on year. Offering the vaccination in a sexual health clinic adds to the ever-growing demand on those services, but still excludes a significant proportion of the population and is far too late for some men.

The optimum age for the HPV vaccination to work is around 12 or 13 years old, when boys are unlikely to attend a sexual health clinic or may not be aware of, or willing to declare, their sexual orientation. The only solution to the problem is to offer the vaccine to both girls and boys while they are still at school and not sexually active. That will protect girls and boys from preventable disease.

HPV Action estimates that more than 2,000 new cases of HPV-related cancers are diagnosed each year in men in the UK. Like me, the Minister is passionate about reducing the incidence of cancer in this country. Extending the HPV vaccination programme to boys would be a step forward in doing that.

In response to a written question earlier this year, the Minister stated that the Government do not have an estimate of the number of boys and men each year who are left unprotected against HPV because of a lack of direct or herd immunity. However, HPV Action estimates that, with each year that passes, another cohort of almost 400,000 boys is left unvaccinated and potentially at risk of HPV infection and the diseases it causes. As the briefing I received from the Terrence Higgins Trust says:

“When we have a vaccine that can provide effective protection against such illnesses, it is unacceptable to maintain that vaccinating only one half of the population is sufficient to stop preventable ill health.”

HPV is not gender specific, so the vaccination programme should not be gender-specific either.

This is not a new philosophy. In fact, 14 countries are already vaccinating boys against HPV, or they will be soon. They include Australia, Austria, Bermuda, Brazil, Canada, Croatia, the Czech Republic, Israel, Italy, New Zealand, Norway, Serbia, Switzerland and the US. Compared with their international peers, therefore, boys in the UK are at risk of being disadvantaged.

This is an opportunity for us to play a leading role globally in the elimination of cancer caused by HPV, but we are at risk of letting that opportunity slip away. Since 2013, the JCVI has been reviewing whether to extend the HPV immunisation programme to boys. However, the publication of a final decision has been deferred twice. The thousands of boys who go unvaccinated each year cannot afford to wait any longer and the JCVI must make a decision this year, preferably when they meet next month. I therefore urge the Minister to work with the JCVI as it comes to make its decision, so that both genders can be protected from these preventable diseases.

--- Later in debate ---

[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.

[Mrs Hodgson]

I take on board what the Minister is saying for areas where uptake is high but, as I cited earlier, there are parts of the country where uptake is nowhere near high enough, such as Stockton, where it is 48%. How does that work? How does that argument stand up for those parts of the country?

[Steve Brine]

The hon. Lady makes a very good point. I was hoping to have a note to respond on that specific point about regional inequalities, but I will have to write to her. Perhaps it is something we can discuss offline. That very good point has not been raised with me recently, but I will take it away and follow it up.

My hon. Friend the Member for North Thanet did not mention discrimination and equality, but other Members certainly did. I accept that equality needs consideration in this case, and I confirm that the Department is carrying out an equality analysis. That cannot be completed until we have received the JCVI’s final advice and we know what it is advising and why, but I can confirm that officials will make contact with key organisations such as HPV Action—I met members of it recently at a roundtable I held on cost-effectiveness methodology for immunisation programmes and procurement, and I know that some of them are here today—as they progress the equality analysis to ensure that such views are taken into account. I confirm that the equality analysis will be published, and I will make the House aware when it is.

There have been a number of threats of judicial review related to equality and sex discrimination in relation to HPV vaccination. I do not think it would be appropriate to say more at this stage, but the House will have heard those two commitments.

[Mrs Hodgson]

On the equality point and the herd immunity point, may I raise the issue of men who have sex with men and the fact that their first presentation at a sexual health clinic could be at the age of 32? Again, there is no way for there to be herd immunity or even for us to extend the vaccination, as we have done in the pilot, to men who have sex with men. There will still be huge numbers of people not covered. Does the Minister agree, and what is he going to do about that?

[Steve Brine]

The hon. Lady makes her point, and it is not one that I miss, I assure her. That issue forms part of the ongoing deliberations. She has made that point twice, and it is a good point.

I know there are concerns, to put it mildly. My hon. Friend the Member for North Thanet set out the timeline of how long it is taking the JCVI to finalise its advice. However, the consultation raised some important, complex issues around the cost-effectiveness model, and it would be remiss of the JCVI not to ask for those issues to be addressed before it puts the matter on its agenda and makes its final decision. I appreciate that my hon. Friend and other Members want the advice quickly—believe me, so do I—but I cannot advocate asking the JCVI to cut corners, which would call into question the quality and robustness of its advice and undermine an internationally respected organisation. The JCVI will get its advice on boys to me as soon as it can, and I am certainly expecting it this year. As soon as I have it, we will turn it around as quickly as we can.

I am totally committed to our world-leading vaccination programme. It is an area where this country leads the world. I am as keen as my hon. Friend and other Members present to hear the JCVI’s final advice on HPV vaccination for boys as soon as possible. The JCVI has helped successive generations of Ministers and, as my hon. Friend said, it will help those who come after me—there will be many, and maybe sooner than we think. It has helped Ministers make decisions that are fair and justifiable, and we need to allow it to complete its advice without too many distractions that could slow it down even further, which no one wants.

We have heard an impassioned case for an HPV vaccination programme for boys from, among others, the hon. Member for Washington and Sunderland West, for whom I have so much respect. As my hon. Friend the Member for Worthing West (Sir Peter Bottomley) suggested, I will send a transcript of the debate to the JCVI to ensure that in the unlikely event there are any issues it was not aware of, that can be reflected in its final advice. It is listening to the debate today. For the reasons I gave at the start of my remarks, I cannot give the House an indication of when exactly a decision will be made, or what that decision might be—trust me, I would love to—but I can say that I will prioritise consideration of the JCVI’s final advice as soon as I receive it.