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The HPV vaccine, for those who are not aware of it, protects against four types of human papillomavirus - both the types which can lead to cancer and the types which cause warts. However, it was marketed as a cervical cancer vaccine alone, and is currently only given to school-age girls in this country. I believe that this is sexist and discriminatory, and unfair for all boys and men. In Australia, they have done really excellent research on the reduction of genital warts since the introduction of Gardasil for girls in 2007. On the strength of that evidence they started vaccinating all boys in 2013 because they showed that the incidence of warts declined in women and in heterosexual men, but there was no difference in incidence for men who have sex with men. This is because if you only vaccinate girls there is no herd immunity effect for men who have sex with men. Most men at the age of 12 don’t know if when they get older they’ll only want to have sex with women, or if they’ll have sex with men, or if they’ll have sex with both. You can’t go looking at boys at the age of twelve and say, “Oh you’re a bit camp - I’ll vaccinate you.” The other thing which is increasingly being shown is the incidence of other cancers related to HPV, such as anal cancer, oropharyngeal cancer, and penile cancer. And, of course, herd immunity only works for heterosexual men if they only have sex with other people from the UK who have also been vaccinated. So that would mean that you could never again go on a stag weekend to Prague, or do anything like that because you’d be having sex with someone who wasn’t vaccinated so you wouldn’t be protected. And what about men who have sex with older women who weren’t caught by the vaccination program? In addition, most of the cost-effectiveness modelling that was done only looked at the cost effectiveness of reducing cervical cancer. They didn’t look at the cost effectiveness of reducing genital warts. And from my clinics, if we could get rid of genital warts, I’d be able to see many more patients with other conditions. It’s a huge burden of morbidity on the population. So for all of those reasons, we should start vaccinating boys against HPV.
This blog is adapted from a speech given at the BMA’s Annual Representative Meeting.
A brilliant aim and intended outcome marred by the quoted statement of, “Oh you’re a bit camp - I’ll vaccinate you.” that unfortunately made the headline as if the BMA endorses this type of statement.
The thing about being camp is that it is not the sole preserve of the gay community, 'campness' is not a reliable marker for being gay. This very unfortunate example of stereotyping is probably unintended, but it makes the headline, and it risks becoming a 'soundbite' from the BMA that I hope the Association will take steps to dissuade readership that it supports.
Immunising the whole community against this transmissible infection that leads to cancer in hidden places is the aim of this speech and is highly laudable, but should not be tarnished by a clumsy and, in my opinion, ill-considered, outdated cliché.
Ewen Sim - I think that was the point!
The current UK vaccination programme includes only girls, doctors may prescribe HPV vaccine, on the NHS, where it's clinically indicated. Given that anal cancer rates are higher in MSM than cervical cancer rates are in women; and that a higher proportion of anal cancers than cervical cancers are vaccine preventable, I think we can justify vaccinating MSM - especially if we can do this early in their sexual career, when they haven't had many partners.
This is not easy to do, however, when we have no way of identifying [future] MSM; so the current position risks us being - or appearing to be - discriminatory, or using inappropriate criteria to identify these individuals.
1. English PM. Who should be offered the HPV vaccine outside the planned programme? Vaccines in Practice 2008;1(1):1-4. (www.vaccinesinpractice.co.uk/_year_search_review.aspx).
As usual, the main point gets lost in the noise of silly puerile attempts at trendy presentation. I remember this vaccine becoming available, and wearily reading the predictable news that it was only to be given to girls by way of a population based programme. An obvious, and avoidable stupidity given what we knew then about the neoplastic tendencies of HPV. It was a no brainer then, and it still is. As always though both the profession and the government keep their brains in a jar by the bed, and fall over their own feet whenever they encounter soluble problems. I wonder how long it will be before a young sufferer of anal cancer sues the NHS for failing to immunise him.
Anyone can get oral cancer, male, female, straight, gay, bi. It is sex discrimination not to give it to boys, all boys. The immunization rules in this country seem to be maintained by neo Victorians who give out dictates with no reasoning or access for anyone to voice an opinion. The MMR debacle was made worse by this method I think as it fueled people who were intelligent but lacking in information to make a reasonable choice, in deciding not to have their children immunized.
In addition to all the good reasons already given for extending HPV vaccination to boys there is another. These HPV viruses are "human only" pathogens and can therefore be eradicated by an efficient and comprehensive vaccination strategy. It can tbe envisaged that in due course vaccination against them could safely be discontinued. That will never be the case while only girls are vaccinated. This is another reason why the cost-benefit model used by the Department of Health is flawed
As a GU physician I agree that we shouid be vaccinating boys together with girls at school but the fact remains that even for girls the take up rate for Gardasil is not 100%. But we are not funded to offer catch up vaccine for young people who present to sexual health services and you might have thought this was a sensible option. In this era of budget restrictions and Local Authority commissioning this will never happen without a Central edict and funding. Also if we offered the vaccine to young men in discrete locations we could promote this and might see a reasonable take-up but if this was restricted to those who self identified as possibly being homosexual or bisexual I might be tempted to tell all the young men I saw all to say that they were.
Definitely agree, this whole programme was badly done right from the start, using an inferior vaccine while most of the rest of the world used Gardasil, then changing over (at the time I and many other doctors bought Gardasil for my daughter rather than have the other one that protects against less viruses), and we already know from the experience of vaccination against Rubella that for it to be effective it must be both girls and boys that are vaccinated.
I was an NHS GP for 23 years, and paid privately for my son to have HPV vaccine at the age of 13 some 5 years ago. Having recently left the NHS and become an independent GP in Sutton Coldfield, I am seeing increasing demand for Gardasil from young women who have missed their school vaccination as they were too old when the scheme started.
What is more interesting still is that since the Australian scheme began to include boys, the demand in the UK for boys to be vaccinated is growing steadily., as the news filters back here from expatriate parents.
Speaking to a gynaecologist yesterday, she also believes all boys should be vaccinated, and has already booked her 3 sons to come and see me. The day before, I met an ENT surgeon who felt exactly the same, as he has seen a significant rise in the incidence of throat cancer, believed to be associated with HPV transmission during oral sex.
It is frustrating that the opportunity to create herd immunity is being wasted by shortsightedness. Whilst this situation continues, only those who can afford it can protect their sons from what could be an unpleasant and prolonged illness at best, and a fatal one at worst.
Having held an interest in the gynaecological cancers throughout my career, I was amazed that the DOH did not organise the universal offering of HPV immunisation to all youngsters, irrespective of sex. How else can the level of herd immunity be sufficient to protect sexually active adults, whatever their preferred sexual practices ?
Connie Fozzard 15.07.14