Marge Berer, RHM Editor
The Joint Committee on Vaccination and Immunisation (JCVI) advises the UK Department of Health on its vaccination programme and has been considering the question of whether to vaccinate boys against the Human Papillomavirus (HPV). Today it published its interim recommendations, which do not address a universal programme of vaccination for boys as well as girls.
Background
The UK currently has a programme of HPV vaccination for girls to prevent cervical cancer which is most commonly caused by infection with HPV. Because it is important to vaccinate before they become sexually active and come into contact with the virus, the vaccination is offered to all girls aged 12-13 years old.
In addition to cervical cancer, HPV is a factor in many other cancers including anal cancer, penile cancer, mouth cancer and oropharyngeal cancer, all of which affect men as well as women. People living with HIV are at higher risk of all these cancers. Under the current regime, there is no HPV vaccination programme for boys. Assuming men in the UK only have sex with women who have been vaccinated, they should be protected from HPV. However it is safe to assume that men in the UK may also have sex with:
- women who missed out on vaccination because of their age (vaccination for girls was only introduced in 2008) or parental withdrawal from the scheme,
- women from countries where there is no vaccination programme,
- and other men
Recognising the range and seriousness of diseases that can be prevented, the Australian government introduced HPV vaccination for teenage boys in 2013. HPV action, a UK coalition of 35 health-related organisations, has been lobbying for the same ‘gender-neutral’ vaccination in the UK.
The interim decision of the JCVI, published today, is to advise that “a programme for the vaccination of MSM aged 16 to 40 years of age should be implemented in GUM and HIV clinics in the UK using the quadrivalent HPV vaccine, subject to the programme being provided at a cost-effective price”. This suggestion is shortsighted beyond comprehension.
The whole point of talking about the sexual health needs of MSM (men who have sex with men) as opposed to homosexual or gay men in the first place is because men who have sex with men don’t all only ever have sex with other men. As both men and boys, they also sometimes have sex with women. Given that universal vaccination of girls to prevent human papillomavirus (HPV) and genital warts has been accepted as a public health priority globally, surely universal vaccination of boys is equally a priority – since boys and men are at risk of an equally serious range of cancers and other diseases from HPV (especially if they have HIV), and they have genital warts as often as girls and women.
How could anyone have suggested, let alone seriously considered, vaccinating only MSM in the male population in the first place. What did they expect to do as regards adolescent boys – walk into schools and say “Which boys are having sex with other boys here? Raise your hands − and please come to the school clinic now.”?? Or even more absurd, how can they advise waiting until a boy or man attends an STI clinic in order to recognise they are at risk of HPV, and offer them a vaccination after the fact, when it may be too late! It also seems transgender people aren’t on the radar at all, in spite of findings from 15 countries in the Lancet Infectious Diseases in 20131 that 19% of transgender women have HIV(1), and transgender men also have a high HIV prevalence, which puts them at increased risk of HPV infection and HPV-related diseases.
Moreover, studies have shown that a female-specific vaccination approach would be only 60–75% as efficient at reducing HPV prevalence in women as a gender-neutral vaccination(2).
The only sensible policy is universal vaccination, from the same age as girls of 13, and with the same catch-up provisions for those who are older.
References
(1) Baral SD et al. Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. Lancet Infect Dis, 13: 214-22, 2013.
(2) Kubba T. Human papillomavirus vaccination in the UK: what about boys? RHM 16(32) 97-103
All RHM papers and research round ups on HPV are available to download here