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HPV vaccinations for men who have sex with men

Published Monday, June 6, 2016

This debate pack has been prepared ahead of the debate in Westminster Hall on Tuesday 7 June 2016 at 4.30pm on HPV vaccinations for men who have sex with men. The Member in charge is Mike Freer.

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Summary

A school based HPV vaccination programme to help protect against cervical cancer has been offered to girls aged 12-13 since 2008.

In November 2015, following a review of the evidence, the Joint Committee on Vaccination and Immunisation (JCVI) published a position statement recommending the introduction of a vaccination programme for men who have sex with men (MSM) aged up to 45, who attend genitourinary and HIV clinics.

Since the recommendation, both the Welsh and Scottish Governments have announced that they will roll out vaccination programmes in line with the JCVI recommendations.

A recent Ministerial Statement has announced that a pilot HPV vaccination programme for MSM in genitourinary (GUM) and HIV clinics will be implemented in England from June 2016. Decisions regarding the wider roll out of a vaccination programme for this group will be dependent on the results of the pilot. 

Human papillomavirus

Human Papillomavirus (HPV) are a group of more than 100 viruses that can affect the skin and the mucous membranes of the body (such as mouth, throat, anus, vagina and cervix).

HPV is common, often infections do not cause symptoms and resolve without treatment. However, infection with HPV is associated with certain types of cancer, and genital warts.  HPV that are linked to the development of cancer are classified as ‘high risk’ with other HPV classified as ‘low risk.’

As well as being associated with cervical cancer, certain strains of HPV are also associated with other less common cancers, such as cancer of the vulva, vagina, penis, anus and some head and neck cancers.

HPV is transmitted primarily through sexual contact. The use of condoms can reduce but not eliminate the transmission of HPV.

For more background on HPV, the NHS Choices website, Cancer Research UK and the Green book published by Public Health England may be useful.

Current HPV vaccination programme

A school based HPV vaccination programme to help protect against cervical cancer has been offered to girls aged 12-13 since autumn 2008. There has also been a catch up programme to immunise girls between 13 and 18 years of age. 

The vaccine used initially in the UK was the Cervarix vaccine but this changed to Gardasil in 2012. [1] Gardasil protects against the two types of HPV that cause 70% of cervical cancers and also provides protection against HPV that can cause genital warts.[2]

The Public Health England Green book provides some information on the effectiveness of the HPV vaccine:

HPV vaccines are highly effective at preventing the infection of susceptible women with the HPV types covered by the vaccine. In clinical trials in young women with no evidence of previous infection, both vaccines are over 99% effective at preventing pre-cancerous lesions associated with HPV types 16 or 18 (Harper et al., 2006; Ault et al., 2007; Lu et al., 2011). Current studies suggest that protection is maintained for at least ten years. Based on the immune responses, it is expected that protection will be extended further; long-term follow-up studies are in place. Some other high-risk HPV types are closely related to those contained in the vaccines, and vaccination has been shown to provide some cross-protection against infection by these types (Brown et al., 2009; Lehtinen et al., 2012). Gardasil® is also 99% effective at preventing genital warts associated with vaccine types in young women (Barr et al., 2007).[3]

HPV vaccination for men who have sex with men

The Joint Committee on Vaccination and Immunisation (JCVI) provides advice and recommendations on vaccinations to the UK Health departments.  It has undertaken a recent review of the current schedule of vaccination for HPV with a specific reference to, amongst other issues, extending the vaccine to those not currently offered, for example men who have sex with men.[4]

The JCVI published its final statement following this review in November 2015. This concluded that a targeted HPV vaccination programme for MSM who attend sexual health and HIV clinics should be undertaken, provided that the vaccine could be procured at a cost-effective price:

Given the evidence available and the modelling work undertaken JCVI advises that a targeted HPV vaccination programme for MSM aged up to 45 who attend GUM and HIV clinics should be undertaken, subject to procurement of the vaccine and delivery of the programme at a cost-effective price. Work is required by DH, PHE, local government and NHS England to identify the commissioning arrangements and potential routes for delivery of any programme to vaccinate MSM, and JCVI understands that this work may be challenging.

Prisoners who are MSM should also be able to access the HPV vaccine through prison sexual health services and transgender women should also be eligible.

JCVI considers that there may be considerable benefit in offering the HPV vaccine to other individuals who have a similar risk profile to that seen in the 16 to 40 year old GUM attending MSM population, including some MSM over 45, sex workers, HIV+ve women, and HIV+ve men. Clinicians are able to offer vaccinations outside of the national programme using individual clinical judgement, and HPV vaccination could therefore be considered for such individuals on a case-by-case basis. Following the meeting, the Department of Health has agreed to consider this from a national perspective alongside the advice of the Committee on the vaccination of MSM up to 45 years of age who attend GUM and HIV services, and will report back to the Committee at a future date[5]

A Ministerial Statement on 26 May 2016 announced that an HPV vaccination pilot would be implemented for MSM from June 2016 in GUM and HIV clinics in England. The Parliamentary Under-Secretary of State for Health, Jane Ellison reported that a decision on a full roll-out would be dependent on the outcome of the pilot:

I am today announcing that a human papillomavirus (HPV) vaccination pilot for men who have sex with men (MSM) will start this June.

Since 2008, an HPV vaccination programme for girls has been delivered to help prevent cervical cancer, which also confers a benefit for many boys over the life course.

HPV infection is also associated with ano-genital and oral cancers, and genital warts. In November 2015, the Joint Committee on Vaccination and Immunisation (JCVI) advised that a HPV vaccination programme should be introduced for MSM aged up to 45 years who attend genitourinary medicine (GUM) and HIV clinics, subject to procurement of the HPV vaccine and delivery of the programme at a cost-effective price.

Through this pilot, the HPV vaccine will be offered during existing appointments at selected GUM and HIV clinics in England to test delivery in these settings. Public Health England is in the process of agreeing which GUM and HIV clinics will take part in the pilot. A full roll-out of a HPV vaccination programme for men who have sex with men will be dependent on the progress and outcome of the pilot.[6]

The Scottish Government announced in March 2016 that MSM would be eligible for HPV vaccination in Scotland in line with the guidelines from the JCVI. The Public Health Minister, Maureen Watt said that the Government would be working with Health Protection Scotland and NHS Scotland to look at the best way to deliver the programme.[7] 

In December 2015, the Welsh Health and Social Services Minister, Mark Drakeford announced the introduction of an HPV vaccination programme for MSM in line with the JCVI recommendations in Wales.[8]

A number of organisations have expressed concerns that the pilot programme in England will mean that vaccination will not be available to all MSM in GUM and HIV clinics. The Terence Higgins Trust have said that the pilot programme is unnecessary and a “stalling tactic”.[9]  They have said it will delay the implementation of the full vaccination programme for MSM that is needed.  It has also been reported that the immunisation lead at the Royal College of General Practitioners has said that the extension to MSM is welcome, but that it should be extended to all boys:

RCGP immunisation lead Dr George Kassianos said: ‘The extension of HPV vaccination to GUM clinics for men aged 15 to 45 years is very welcome, but why not vaccinate all boys, as we do vaccinate girls?’

He previously told GPonline: ‘We really need every child – every boy, every girl – to be immune to this viral disease that we have a vaccine for.

‘We have decided to give it to girls to prevent disease, and we need to prevent it in boys as well. No, they don’t have a cervix for cervical cancer, but they [are vulnerable to] penile cancer, anal cancer, laryngeal cancer, oropharyngeal cancer and so on.[10]

The JCVI is not expected to be able to make a recommendation regarding extension of the HPV vaccination programme to adolescent boys until early 2017.[11]

 

 

[1]     Department of Health Press Release: HPV vaccine to change in September 2012

[2]     NHS Choices, HPV vaccine, September 2014

[3]     Public Health England, Green Book: Human Papillomavirus, June 2014

[4]     Call for evidence to support HPV immunisation programme review, 14 August 2012, gov.uk

[5]     JCVI,  JCVI statement on HPV vaccination of men who have sex with men,

November 2015

[6]     HC Written Statement, HPV vaccination, 26 May 2016

[7]     Scottish Government, HPV vaccination programme, 23 March 2016

[8]     Welsh Government, New HPV vaccine programme for gay men to be introduced in Wales, 21 December 2016

[9]     Terence Higgins Trust, HPV pilot is ‘stalling tactic’ and will delay a national vaccination programme for all MSM, 26 May 2016

[10]    GPonline, GPs call for all boys to receive HPV jab as scheme for gay men launched, 2 June 2016

[11]    HC written Question 218969, 5 January 2015

Commons Debate packs CDP-2016-0112

Authors: Alison Pratt; Sarah Barber

Topics: Diseases, Health education and preventive medicine, Health services, Vaccination

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