Human papilloma virus (HPV) is a very common sexually transmitted infection that can cause a range of cancers (cervical, vaginal, vulval, penile, anal, and oral) as well as genital warts. HPV Action estimates that, each year, HPV causes over 2,000 cases of cancer and 48,000 cases of genital warts in men; in women, it causes almost 5,000 cases of cancer and over 39,000 cases of genital warts. The incidence of anal cancer is highest in MSM and particularly in HIV-positive men.
Vaccinating just girls and MSM is not sufficient for these reasons:
- Just vaccinating girls and MSM leaves men who have sex with women (MSW) at risk from infection by women who have not been vaccinated in the UK or other countries.
- Vaccinating MSM who attend sexual health clinics is not the best way to protect the MSM population as a whole. This is because many MSM do not attend sexual health clinics and the average age of first attendance is 28. Despite advice that MSM should have an HIV and STI screen at least annually, and every three months if having unprotected sex with new or casual partners, an estimated 16% of MSM who are living with HIV remain undiagnosed.
- Immunity against HPV is greatest if the vaccine is administered before age 16.
The most effective way to protect MSM – and MSW – is therefore to protect all boys through a vaccination programme for all boys and girls aged 12/13.
JCVI is considering whether to extend the national vaccination programme to all adolescent boys but its timescale is far too long. Its inquiry began in 2013 but it will not report until 2017 at the earliest. Even if it does then decide to vaccinate boys, implementation may not happen until 2020.
Cost need not be a significant barrier to vaccinating boys. HPV Action estimates that it would cost no more than £22m a year to vaccinate boys and, depending on the vaccine price, possibly as little as £12m. The cost of treating just oropharyngeal cancer in the UK was over £30 million a year in 2010/11 and the annual cost of treating genital warts is an estimated £58.5 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.
HPV Action Campaign Director Peter Baker said: “HPV Action hopes the government now makes a speedy decision to vaccinate all boys. Vaccinating some MSM is a step forward but is not sufficient to protect the UK population as a whole from a range of serious but preventable HPV-related diseases. Vaccinating all boys could cost about the same as Wayne Rooney’s annual salary at Manchester United but, following today’s announcement by the JCVI, parent’s are left in a position where their daughters are protected but not most of their sons.”