HPV Action believes that today’s decision is a step forward but one that does not go nearly far enough. HPV Action's Campaign Director Peter Baker said “HPV Action hopes the Government now moves quickly to a decision to vaccinate all boys. While vaccinating MSM is a step forward, it is not sufficient to protect the UK population as a whole from the human papillomavirus and the entirely preventable diseases it causes. As things stand, the UK government is still putting parents in a position where they can see their daughters protected but not their sons.”
HPV Action believes vaccinating just girls and MSM is not sufficient for the following reasons:
a. Just vaccinating MSM leaves men who aren’t MSM at risk. Even if HPV infection is reduced in girls and MSM, men who do not have sex with men, would still be at risk of contracting HPV. The evidence from Denmark on the impact of HPV vaccination on the incidence of genital warts shows that it has fallen in women but not in men. This is almost certainly because men are having sex with unvaccinated women from Denmark and/or other countries. The rapid increase in the incidence of HPV-related head and neck cancers over the past 20 years impacts on all men, not mainly MSM.
b. Vaccinating MSM who attend GUM clinics, as now recommended by JCVI, wil not protect the majority of MSM. UK data suggests GUM clinics will not see young MSM before they become infected with HPV. MSM are at risk of HPV infection immediately after beginning sexual activity. A study of young gay men in Australia found that transmission of HPV occurred between men soon after their first sexual experiences and recommended that HPV vaccination should commence early for optimal prevention of HPV among MSM. The median age at attendance at a Southampton GUM clinic is 32 and the median age at first attendance at the clinic is 28. Most MSM are likely to have had multiple sexual partners with increased risk of HPV acquisition before they attend a sexual health clinic. Also, many gay and bisexual men do not attend GUM clinics, the Stonewall health survey found that 44% had never discussed STIs with a healthcare professional. There are also MSM who do not identify as gay or homosexual and will not disclosure their sexual activity to a healthcare professional, meaning they will never be offered the vaccination.
c. Immunity against HPV is greater if the vaccine is administered before age 16. The CDC (USA) says: “Data on immunogenicity in males are available from the phase III trial conducted among males aged 16 through 26 years and from bridging immunogenicity studies conducted among males aged 9 through 15 years. Seroconversion was high for all four HPV vaccine types and post vaccination antibody titers were significantly higher in males aged 9 through 15 years compared with males aged 16 through 26 years.” Offering a vaccination to MSM that will be provided after age 16, means these men will have less effective protection against HPV and the diseases it causes than their female peers. This will further entrench the inequalities in health outcomes that this group already experiences in relation to the general population.
d. The most effective way to protect MSM is to protect all boys through a vaccination programme for all boys and girls aged 12/13. A recent BMJ editorial on the issue stated: ‘The only sensible answer ... is a gender neutral vaccination strategy in schools that gives two doses of the vaccine to all 12 to 13-year-old boys and girls. Anything else is discriminatory, inequitable, less effective, and difficult to explain.’
This September, a group of MPs called for all adolescent boys to be offered the vaccine. They wrote that "The long-term savings in treatment and care of men with HPV-related diseases would considerably outweigh the extra cost of extending the programme." Signed by the heads of the All-Party Parliamentary Groups on Cancer, Dentistry, Sexual and Reproductive Health, Men's Health and HIV and AIDS, this is a powerful call for the need for a policy change.
HPV Action estimates that the additional cost of extending the HPV vaccination programme to boys in the UK would be in the region of £20–22 million a year. However, HPV Action believes that any decision about whether to vaccinate boys should not be made solely on a financial basis. Public health, equity and, above all, the human costs of HPV-related disease for both sexes must be the primary considerations.