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expert reaction to JCVI statement on whether to extend the HPV vaccination programme to adolescent boys in the UK

The JCVI has made a statement about whether to extend the HPV vaccine to adolescent boys.

 

Prof Keith Neal, Emeritus Professor of the Epidemiology of Infectious Diseases, University of Nottingham, said:

“They allude to equality but what needs to happen is the cost-effectiveness methods must be published.  Warwick will need to submit and unless the contract says otherwise they will almost certainly want a publication.”

 

Prof Geoffrey Smith FRS, Department of Pathology, University of Cambridge, said:

“The news today that the JCVI has recommended that vaccination of both boys and girls against HPV is likely to be highly cost effective, when an appropriate discount rate is used to calculate cost-benefit, is most welcome. Implementation of this recommendation will not only benefit boys directly, but it will also reduce transmission of HPV to females and thereby reduce cancer caused by HPV.

“In some respects, this recommendation parallels what happened with vaccination against rubella (German measles) in UK. Originally, only females were vaccinated to provide protection during child-bearing years and prevent infection of the foetus during pregnancy. Thereafter, UK changed to vaccinating both boys and girls and this is has been very successful in driving down the pool of rubella virus and consequential disease.

“It is very probable that the same benefit will derive from gender-neutral vaccination against HPV.”

 

Prof Kevin Harrington, Professor of Biological Cancer Therapies at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust, said:

“I am delighted with the recommendation to extend human papillomavirus (HPV) vaccination to boys in the UK. The recommendation recognises the fact that this virus is the cause of many different tumours, such as head and neck and anal cancers, in both women and men, and I believe that HPV vaccination will have a major impact on the incidence of HPV-related cancers in the future.

“I now hope that the Department of Health and Social Care (DHSC) will adopt this recommendation. By protecting boys through vaccination, we will be reducing the risk of disease in the entire population through effects on ‘herd immunity’. A positive decision by DHSC will send a clear message to others in the global community and will, hopefully, signal similar policy changes in other parts of the world.”

 

Emma Greenwood, Cancer Research UK’s director of policy, said:

“We welcome the recommendation to extend the HPV vaccination programme to boys. If the Government agrees to roll this out, it will help to reduce the risk of HPV infection across the whole population. HPV causes around 2,500 cases of cancer in males every year in the UK, including mouth, throat, anal and penile cancers.

“We urge the Government to give the green light on this recommendation without delay so that no one is excluded and we can help protect all young people against HPV-linked cancers.”

 

Prof Helen Bedford, Professor of Children’s Health, UCL Great Ormond Street Institute of Child Health, said:

“Many countries now offer HPV vaccine to boys as well as girls to protect against cancer and genital warts.  In the UK HPV vaccine has been offered to girls for 10 years and whether this should also be rolled out for boys has been under consideration for some years.  The JCVI has announced that under the current rules for estimating cost effectiveness, rolling out HPV vaccine to include all boys in UK is still not cost effective and on this basis they cannot recommend extending the HPV vaccination programme to include boys.  However, in view of the long interval between infection with HPV and development of disease, they are supportive of changing the methods for calculating cost effectiveness to consider HPV vaccine for boys.  If the proposed new methods were used, it is likely that the programme would be cost effective and then they would advise its introduction.  A review of cost effectiveness modelling is soon to be concluded and this is one of the issues that is being considered as part of that review.”

 

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

“As recent studies have shown, the introduction of the HPV vaccine to girls in 2008 to prevent cervical cancer has been a major step forward in public health provision, significantly decreasing HPV infections in 16–21-year-old women by 86%.  In addition to cervical cancer, the human papilloma virus causes a number of diseases that affect both sexes, such as genital warts and a variety of cancers including those of the anus, mouth and throat.  This safe and effective vaccine has given us the ability to provide protection against, and significantly decrease levels of, these serious diseases within our communities and ultimately save lives.  The British Society for Immunology supports the extension of the HPV vaccination to boys.

“Today’s statement from the Government’s Joint Committee on Vaccination and Immunisation (JCVI) on HPV vaccination for boys is complex and requires careful consideration.  Their recommendation on whether boys should receive the HPV vaccine hinges on what discount rate the Department of Health and Social Care decide to adopt – this is the rate used to calculate the level of health benefits that any vaccination might confer to people throughout their lives.  Using the current methodology, which has a 3.5% discount rate, providing the vaccine to boys is not cost-effective.  However, the committee argue that for this vaccine, a revised rate of 1.5% could better take into account the long-term benefits of HPV vaccination.  If this recommended revised rate was used, the Committee state that it would support extending HPV vaccination to adolescent boys.  We await, with interest, a response from the Department of Health and Social Care on this point.

“It’s important that decisions on healthcare provision are based on a rigorous and objective analysis of the scientific evidence.  The British Society for Immunology celebrates the huge health benefits that the HPV vaccine can deliver to all.  Alongside decisions on who is eligible to receive the vaccine, it’s also crucial that we maintain efforts to actively communicate the important health benefits of this vaccine to parents and children.”

 

https://www.gov.uk/government/publications/jcvi-statement-extending-the-hpv-vaccination-programme-conclusions

https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/726319/JCVI_Statement_on_HPV_vaccination_2018.pdf

 

Declared interests

Prof Kevin Harrington: “No declared interests.”

Prof Geoffrey Smith: “Note these views are my own, I am not representing any organisation and I have no conflict of interest.”

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

Prof Peter Openshaw: “Prof Peter Openshaw’s research is funded by the Wellcome Trust, the MRC, BBSRC and the European Union. He has received honoraria or consultancy fees from GSK, Janssen, and Mucosis BV.”

None others received.

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