Author: Dr Shaun Griffin
Last month the world marked Immunization Week, an opportunity to raise awareness about the importance of routine life-saving immunizations and how they have transformed our approach to public health over the course of centuries. Close the Immunization Gap was this year’s theme by the World Health Organisation. Progress towards global vaccination targets for 2015 is far off-track, according to the WHO one in five children still miss out on routine life-saving immunizations that could avert 1.5 million deaths each year from preventable diseases.
The immunization gap also extends to gender, age and sexuality. A vaccination programme against the human papillomavirus (HPV) began in 2008 in the UK for girls aged 12-13 to reduce their risk of developing cervical cancer, which is caused by HPV. However, emerging research over the past eight years has found that cancers of the head, mouth, throat, penis and anus can also be caused by strains of the virus.
The incidence rate of anal cancer in men who have sex with men (MSM) is increasing. Anal cancer incidence rates in MSM are equivalent to the rates that existed for cervical cancer in women before 1988, when the Government introduced the cervical cancer screening programme. Cancer Research UK (CRUK) estimated incidence rate of anal cancer is 78 per 100,000 per year in HIV-positive MSMs who are on HAART (anti-retroviral treatment), compared with 5 per 100,000 per year in HIV-negative MSMs. Around 5,500 men were diagnosed with oral, penile or anal cancer in the UK in 2011.
Heterosexual men gain indirect protection from HPV through “herd protection” if a majority of women in the population are vaccinated. But if men have relationships with women who did not receive the vaccine they are at risk. Additionally, the current programme offers no protection to MSM.
At Terrence Higgins Trust we believe that the HPV vaccine should be extended to all boys irrespective of their sexuality and to MSM as a matter of urgency. This is why we are working with other health organisations as a member of HPV Action to call for the school HPV vaccination programme to include boys as well as girls. Last month Terrence Higgins Trust attended the European Men’s Health Forum (EMHF) HPV Symposium in London. The significant and growing rate of anal and other HPV-related cancers in Europe was described a “time bomb” at the meeting.
We believe that the case for extending the HPV vaccine is a clear and urgent one but progress has not happened at the speed we would like. Since October 2013 the Joint Committee on Vaccination and Immunisation (JCVI) has been considering whether MSM and/or adolescent boys should also be offered the vaccine. The JCVI made an initial recommendation in November 2014 that MSM aged 16-40 should be offered the vaccine in GUM clinics and HIV clinics.
However, the JCVI delayed making its full recommendation until October 2015, following concerns from GUM clinics that the cost for administering the vaccine for MSM would make it not cost-effective. Each delay leaves these groups unprotected against HPV-related cancers and that is why Terrence Higgins Trust is calling for these inequalities to be urgently addressed by the next Government so that the gap for the HPV vaccine is well and truly closed.
Note: Dr Shaun Griffin is Director of External Affairs at Terrence Higgins Trust, the UK’s largest HIV and sexual health charity