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expert reaction to JCVI interim recommendation not to extend the HPV vaccination programme to adolescent boys, according to cost-effectiveness analyses

The Joint Committee on Vaccination and Immunisation published the minutes of their discussion which included their interim recommendation not to extend the HPV vaccination programme to adolescent boys, according to cost-effectiveness analysis.

 

Prof. Mel Greaves, Director of the Centre of Evolution and Cancer at The Institute of Cancer Research, London, and an expert in infection-related cancer, said:

“When HPV vaccines were introduced I couldn’t see the logic of not vaccinating boys, who will go on to become the main conduit of transmission to young females.  An additional argument is that HPV is significantly associated with anal and oral cancer and is therefore a risk factor for some homosexual men.  There surely is a strong case for routine, population-wide vaccination of young boys and girls.”

 

Prof. Peter Openshaw, President of the British Society for Immunology, said:

“Although the HPV vaccine was originally introduced in 2008 to prevent cervical cancer in women, it’s recognised that HPV causes a number of other diseases in both sexes including genital warts, a variety of cancers (including those of the anus) and some types of mouth and throat cancer.

“The decision to provide this vaccine to girls represented a major step forward in public health provision in the UK, allowing us to protect future generations of girls from contracting cervical cancers initiated by this virus and also conferring a lower level of protection from HPV to boys through the effects of herd immunity.

“It’s important that decisions on healthcare provision are based on a rigorous and objective analysis of the scientific evidence.  In this case, the Government’s Joint Committee on Vaccination and Immunisation (JCVI), the independent expert advisory panel which makes decisions on vaccine provision in the UK, has concluded that it is not currently recommended to routinely provide boys with the HPV vaccine as this would ‘result in relatively small gains in health benefits’ and ‘not be a cost-effective use of public money’ given the high rates of vaccine uptake in young women in the UK.  It is also important to recognise the benefits of vaccination for men who contract HPV by having sex with men, who would not be protected by female vaccination.

“The British Society for Immunology recognises the huge public health benefits that vaccines can confer to the population, but decisions must be guided by the evidence of cost effectiveness.  It is now crucial that we redouble efforts to ensure that HPV vaccination rates in girls remain high and that we actively communicate the benefits of the vaccination to parents and children.  We trust that the JCVI will keep fully abreast of any new research in this area and continue to base their decisions on the best current evidence.”

 

Dr David Elliman, Consultant in Community Child Health, said:

“The JCVI have to decide not only does a vaccine work but how much does it cost.  In this country, we have a very good immunisation programme in general and the uptake of HPV vaccine in girls is very high.  This means that HPV infection rates in boys have already gone down a lot.  The additional benefit of immunising boys is therefore much less in UK than it might be in most of the countries who have decided to offer the vaccine to boys.

“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.”

 

Prof. Helen Bedford, Professor of Child Public Health, Institute of Child Health, UCL, said:

“The UK has a very successful HPV vaccination programme for girls with high uptake and boys are already benefitting significantly from this via community (herd) immunity.  In other countries where uptake among girls is lower, the programme has been extended to boys.  In this country a pilot programme is running to immunise men who have sex with men, who are the males at greatest risk for adverse outcomes of HPV infection and who do not benefit from herd immunity from the girls’ programme.

“The draft recommendation from the JCVI seems appropriate on the basis of the evidence presented and I note that it is planned to keep this under close review.  In future it may be possible to use only one dose of vaccine, rather than two as currently.  If this were to be confirmed it may make a difference to the cost effectiveness analysis.”

 

Prof. Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:

“The human papilloma virus vaccine is now routinely administered to young girls because it protects against development of cervical cancer in later life.

“These same viruses also cause cancers that affect males, for example anal and penile cancer.  These cancers are more rare and it’s not totally clear that the vaccine would prevent these from occurring, but the evidence suggests that it would.

“So it all comes down to cost and how much benefit will be gained from vaccinating boys.  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 enroll in this, and we know the vaccine is most effective before someone becomes sexually active.

“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.”

 

Emma Greenwood, Cancer Research UK’s Director of Policy, said:

“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.

“We will respond to the JCVI’s consultation and will examine the factors they used to determine whether extending the programme to boys would be cost-effective.  We now urge the JCVI, NHS, Government and vaccine manufacturers to come together to ensure all possible solutions have been fully explored in an effort to make this affordable for the NHS.”

 

* JCVI minutes page on gov.uk website: https://www.gov.uk/government/groups/joint-committee-on-vaccination-and-immunisation#minutes

PDF of JCVI published minutes (HPV section is pages 8-13): https://app.box.com/s/iddfb4ppwkmtjusir2tc/file/198733240440

 

Declared interests

Prof. Helen Bedford: “I have no conflicts of interest.”

Prof. Jonathan Ball: “No conflicts.”

None others received.

 

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