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expert reaction to HPV vaccine, modelling of cancer prevention, and introduction in September of vaccine programme for boys

Public Health England (PHE) have announced plans to provide boys with the HPV vaccine for the first time. This in light of estimates that suggest that the HPV vaccine programme will lead to the prevention of over 100,000 cancers by 2058. 

 

David Elliman, Immunisation Expert for the Royal College of Paediatrics and Child Health (RCPCH), and Consultant in Community Child Health, Great Ormond Street Hospital, said:

“The UK programme to vaccinate girls against HPV infection has been very successful.  It is estimated that by 2058, it will have prevented over 64,000 cases of cervical cancer and we have already seen a major reduction in cases of ano-genital warts.  While, because of herd immunity, there has also been a reduction in HPV infection in males, the most effective way to protect them is for them to have the vaccine themselves.  Therefore, we welcome the introduction of the vaccination programme for Year 8 boys in September.  In time, this will lead to a significant reduction in cancers of the anus, penis and head and neck.  The latter is currently increasing in incidence, but this trend will be turned around as the vaccination programme takes effect in the future.”

 

Prof Jack Cuzick, Director of the Wolfson Institute of Preventive Medicine and Head of Centre for Cancer Prevention, Queen Mary University of London, said:

“The highest priority needs to be to maintain or improve further the vaccine coverage in girls.  However vaccination of boys is to be welcomed as HPV-caused cancers in men are just as common as those in women, but occur at an older age and mostly are not in the genital tract and don’t have known precursors so it will take longer to see an effect.  These cancers do not appear to have been included in the model1.  Especially for girls, there is also a need to move from the current vaccine that has only two anticancer types (plus two more for genital warts – Gardasil 4) to the better vaccine that has seven anti-cancer types (plus two types for genital warts – Gardasil 9).”

1 ‘Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK’ by Samik Datta et al was published in BMC Infectious Diseases on 24 June 2019.

 

*Comment from one of the authors of a recent paper which provided some of the modelling data to PHE*

Prof Matt Keeling, Professor of Populations and Disease, University of Warwick, said:

“Our mathematical predictions and economic analysis fully support the cost-effectiveness of introducing the vaccination of boys to the HPV immunisation programme. Our model was formulated using data from natsal (The National Survey of Sexual Attitudes and Lifestyles); as such our model can accurately recreate the patterns of sexual mixing in the UK, which we then use to predict the spread of HPV as well as the associated health consequences and costs. Our work clearly shows how effective the girls vaccination programme continues to be; the addition of boys will generate extra protection to both genders against a range of cancers.”

1 ‘Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK’ by Samik Datta et al was published in BMC Infectious Diseases on 24 June 2019.

 

Prof Robin Weiss, Emeritus Professor of Viral Oncology, UCL, said:

“The HPV vaccine has enjoyed 10 years of success in protecting girls from acquiring cervical cancer as women.  The new modelling evidence from Warwick1 focusses on the cost effectiveness of extending HPV vaccine to boys as well as girls, which is minor.  It appears clear, however, that vaccinated boys will themselves benefit from not getting cancer of the penis, anus, and a diminished risk of head and neck cancer.  In addition, young women who have not been vaccinated will be less likely to contract HPV if their partners are not carrying it.  Thus extending HPV vaccination to boys should be a win-win situation.”

1 ‘Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK’ by Samik Datta et al was published in BMC Infectious Diseases on 24 June 2019.

 

Dr Thomas House, Reader in Mathematical Statistics, University of Manchester, said:

“It is not scientifically controversial that HPV is linked to cancer, or that HPV vaccination is a safe and effective way to reduce these cancers and associated deaths.  The difficulty is in assessing whether it is cost-effective to run a particular vaccination programme or not.  There is almost no doubt that the programme for girls is cost-effective, or that a joint programme for all children is cost-effective; the question is whether it is cost-effective to add boys to the existing programme, which at present covers girls only.  The study in question1 shows that we can get a different answer to this question depending on what “discounting rate” is used.  A discounting rate is used by health economists to reflect the belief that health benefits and costs now are worth more than those in the future, and this kind of consideration tends to work against taking preventative measures.  So if you think that a death in a year is up to 1.5% less important than a death today, then this study provides evidence that adding boys to the vaccination programme is cost-effective; if you think that a death in a year is over 3.5% less important than a death today, then this study provides evidence of the converse.  There are other uncertainties discussed in the original study, but these turn out to be less decisive than the question of discounting.”

1 ‘Assessing the cost-effectiveness of HPV vaccination strategies for adolescent girls and boys in the UK’ by Samik Datta et al was published in BMC Infectious Diseases on 24 June 2019.

 

Prof Arne Akbar, President of the British Society for Immunology, said:

“The British Society for Immunology welcomes the extension of the HPV vaccine programme to boys from September this year.  Numerous studies have shown that the HPV vaccine is safe and extremely effective, offering protection against a number of diseases, including a variety of cancers and genital warts.  Since the introduction of the HPV vaccine to girls in 2008, there has been a substantial decline in HPV infections, with some types reduced by 86% in 16-21-year-old women in England.

“The extension of the HPV vaccine to boys will build on the proven success of the girls’ programme to protect boys from human papilloma virus infections that can cause a variety of cancers including those of the anus, mouth and throat.  The Government now needs to work with the NHS and local authorities to ensure that we maintain efforts to actively communicate the important health benefits of this vaccine to parents and adolescents.  We encourage parents of eligible boys and girls to take up the offer and protect future generations against these preventable diseases with the HPV vaccine.”

 

Prof Geoffrey Smith, Wellcome Trust Prinicipal Research Fellow, and Head of the Department of Pathology, University of Cambridge, said:

“The announcement from PHE that the HPV vaccination programme will be extended to both boys and girls from September is most welcome indeed.  Just as was seen with the implementation of vaccination of both boys and girls against rubella virus (the cause of German measles, and of serious damage to the unborn child if infection occurs during pregnancy), this policy will drive down the reservoir of virus and prevent infection where it is most damaging.  Our nation will be healthier because of this policy.

“We should remember always the huge benefits of vaccination.  Prevention is better than cure, and prevention is most easily achieved by vaccination.  Ultimately vaccination can lead to eradication as was shown with smallpox.”

 

Declared interests

Prof Robin Weiss: “I declare that I have no competing or conflicting interests on this matter.”

Dr Thomas House: “I collaborate with some of the modellers at Warwick on other projects, but not on this one.  My son would be eligible for this vaccination.”

Prof Arne Akbar: ““Arne receives grant funding from the BBSRC, MRC and Dermatrust.”

Prof Geoffrey Smith: “I have no conflicts of interest in making this statement.”

None others received.

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