Source: Peter Russell
Date: July 20, 2017
Source: www.medscape.com

Health bodies are condemning a decision not to include boys in the human papilloma virus (HPV) vaccination programme as “shameful” and a “missed opportunity”.

The Joint Committee on Vaccination and Immunisation (JCVI) has concluded that it “did not recommend vaccinating boys at this time as it was considered unlikely to be cost-effective”.

Girls aged 12 to 13 have routinely been offered the HPV jab since September 2008 as part of the NHS childhood vaccination programme.

The JCVI has been considering whether to include boys on the scheme since 2014.

Protection Against Some Cancers

HPV is the name for a group of viruses that are most commonly passed on through genital contact between straight and same-sex partners.

It is a very common infection. Almost every sexually active person will get HPV at some time in their lives.

Most people who get HPV never develop symptoms or health problems, but for some it can lead to cancer of the cervix, vulva, vagina, penis, anus, and head and neck, as well as cause genital warts.

According to health professionals, the virus has been linked to 1 in 20 cases of cancer in the UK.

Campaigners in favour of giving boys the jab argue that HPV does not discriminate between the sexes and that offering the vaccine to boys in school would save lives.

‘Few Additional Benefits’

The JCVI has decided that a high take-up of the vaccine among girls would provide ‘herd protection’ to boys, and that vaccination of boys “would generate little additional benefit to the prevention of cervical cancer, which was the main aim of the programme”.

Additionally, the committee found insufficient evidence that the jab would protect against cancers affecting males such as anal, head and neck cancers. However, it agreed to keep evidence under review, particularly for men who have sex with men.

‘An Astonishing Decision’

Several health bodies have issued statements criticising the JCVI’s decision. The Faculty of Sexual and Reproductive Healthcare says it’s a “missed opportunity” and is urging it to reconsider its stance in October after a period of public consultation. Peter Baker, HPV action campaign director, says: “It is astonishing that the government’s vaccination advisory committee has ignored advice from patient organisations, doctors treating men with HPV-related cancers, public health experts and those whose lives have been devastated by HPV.

“The interim decision not to vaccinate boys is about saving money not public health or equity.”

Dentists are also condemning the decision. Mick Armstrong, chair of the British Dental Association, says: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible. The state has a responsibility to offer all our children the best possible defence.

Dentists are also condemning the decision. Mick Armstrong, chair of the British Dental Association, says: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible. The state has a responsibility to offer all our children the best possible defence.

“Dentists are on the front line in the battle against oral cancer, a condition with heart-breaking and life-changing results. Ministers can choose to sit this one out, or show they really believe in prevention.”

‘Shameful’

Emma Greenwood, Cancer Research UK’s director of policy, comments: “We’re disappointed to hear that the JCVI has made an interim recommendation not to offer the HPV vaccine to boys. If boys were included in the vaccination programme, it would help reduce the risk of HPV related cancers for the whole population, compared to vaccinating girls alone.”

The Terrence Higgins Trust describes the JCVIs decision as “shameful”. Its chief executive, Ian Green, says: “A gender neutral policy on HPV vaccination is long overdue and would protect boys from cancers caused by untreated HPV, including penile, anal and some types of head and neck cancer.”.

Jonathan Ball, professor of molecular virology at the University of Nottingham, says: “As increasing numbers of girls take up the vaccine then risk of heterosexual transmission decreases and the benefit of vaccinating boys diminishes.

“But of course, this reliance on herd immunity doesn’t provide optimal benefit for boys who go onto have sex with other men in adulthood.  There is a pilot vaccination programme running for men who have sex with men, but not all men at risk are likely to enrol in this, and we know the vaccine is most effective before someone becomes sexually active.

Limited Health Resources

“Unfortunately, it isn’t a question of science – it’s one of cost – and at the moment the Vaccination and Immunisation Committee doesn’t consider that the benefits are worth the investment.”

Dr David Elliman, consultant in community child health, adds: “Although it always seems hard to have to consider cost, it is important to make sure that we spend the money available to the NHS in a way that gets us best value.”

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