Tuesday, 5 May 2015

Should boys be given the HPV vaccine on the NHS?

by Charlotte Randall

Since September 2008, under the NHS childhood vaccination programme, every girl in the UK aged 12 to 13 has the opportunity to have two doses of Gardasil on the NHS, a vaccine that protects girls from type 16 and 18 HPV as well type 6 and 11 which cause genital warts. The vaccine was designed to protect girls from developing cervical cancer, which can be caused by HPV. This has seen to be a major development in the battle against sexually transmitted diseases, and is predicted to give a substantial reduction in the number of cases of the cancer associated with the virus. However, the current procedure of vaccination is hugely discriminating by leaving half this generation’s population at potential risk, and can lead to a sharp increase of anal and oropharyngeal cancers in men. In this article, I am going to talk about why it is vital that this vaccination must become gender neutral on the NHS else face some devastating consequences.

What is HPV?

The Human Papilloma Virus (HPV) is the general name for a family of 100 viruses of which 60% cause warts on areas such as the hands and feet and 40% are sexually transmitted diseases, which are drawn to areas, which have moist, mucous membranes-the genital areas. Sexually transmitted HPV can be contracted through vaginal, anal or oral sex with someone who had contracted the virus. As there is no cure, the virus is incredibly common and it is thought that almost half the population has come into contact with it. Most types of HPV have no symptoms, and the immune system can generally combat the virus so the body can clear itself of the infection over the course of a few years. Due to the lack of symptoms many don’t even know they have the disease and can pass it on to others. Some types, however, such as type 16 and type 18, can result in cancers in both genders as well as genital warts.  

Why should young males be vaccinated?

In theory, vaccinating boys is not necessary; if girls are vaccinated, they won’t contract HPV and then transmit it to their male partners, meaning, that over time HPV would, theoretically, become “extinct.” This is known as herd immunity. However, this theory leaves out a small but present proportion population: male homosexuals. Male and male intercourse has a high chance of transmitting HPV, especially as the use of a condom cannot always protect from the transmission. It is estimated that 90% of cases of anal cancer are linked to HPV in the UK and, according to new data published by Cancer Research UK; anal cancer rates have increased almost 300% in the past 40 years. It has been argued that the vaccine should be given to men who declare themselves to be homosexual however, this tends not to happen until late teens by which time they may have had sexual partners and contracted many types already and the vaccine would be of little use.  While men are able to get the vaccine it can cost up to £100 per dose and if taken after the recommended age of 12-13, then three doses may be needed. Is it fair, though, for people should be denied vital and potentially life saving healthcare due to their sexual orientation?

The Increasing Danger in Heterosexual Men:

While the risk of heterosexual males getting HPV is diminishing, it will still exist, for two main reasons. Primarily, pretty much the entirety of the female population aged 21 and over, (women who were too late to receive the vaccine when it was first offered or did not participate in the catch up programme) that are sexually active are at risk of having HPV, which thus means that they have the ability to transmit it.  Young men that choose to have sexual relationships with these women are at risk of getting HPV and developing penile cancer through vaginal intercourse, and even oropharyngeal cancer through oral sex. The British Medical Journal (BMJ) also offers another cause for concern for young British males. It offers a comparison in the effectiveness of female only immunisation in Australia and another European country, Denmark. In Australia, one of the first countries to try the herd immunity program, after four years after initiation, researchers reported a highly significant decrease in genital warts in young men and women. However, in Denmark, it was reported that, while that there was a decline in genital warts in women, there was little decline in men.  The BMJ suggests that this could be due to the “easier flow of populations across land borders.” Without getting bogged down in immigration statistics and political discussion, due to the general concept of immigration, it is inevitable that some young men will have relationships with women who have immigrated into Britain and are may not have had the vaccination, thus HPV will remain.

How much will immunising boys cost?

Of course, with any argument for a new procedure on the NHS, cost always comes into play. The principle argument at the moment against HPV male vaccinations relies mainly on costs. While there are few certified estimates of how much the programme would cost and save, many newspapers, such as the Telegraph, Guardian and Independent, claim that it would cost around £20 million a year. Although this seems a large sum, Dr Max Pemberton, a medical journalist and psychiatrist argues that the cost of treating the increasing numbers of anal cancers cost between £70-£90 million, thus this programme would save money. However, this data cannot be necessarily relied upon as the sources are dubious. It is therefore very important that this debate contiuesso that better estimates can be made. 


My view still stands that it is imperative that boys are vaccinated against the disease. According to cancer research UK, there are 1175 cases of anal cancer a year accompanied by roughly 300 deaths. Although these numbers are low, suggesting the rarity of developing anal cancer, they are increasing every year correlating positively with the increase of numbers of HPV cases in men. It is thus likely that the vaccine could prevent these deaths.  It could also reduce the risk of cancers in heterosexual men (there are around 7300 cases of penile and oropharyngeal cancers each year.) However, I will admit I am being driven for the ideal of social justice here. To make a through conclusion I would need to compare the costs of the programme, which I am not able to do here. While I believe this is an imperative and life saving ideal, it will not be until we can establish how much it would cost would we be able to confirm that it is practical.


British Medical Journal Issue 7969: August 2014

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