HPV Vaccination Programme Extended to Boys This Autumn

Peter Russell

July 09, 2019

The success of extending human papilloma virus (HPV) vaccination to boys in England this autumn could depend on countering the activities of the so-called 'anti-vax' lobby, health experts said.

From September this year, boys in school year 8 in England will be offered the free HPV vaccine for the first time. The move could lead to a reduction of 28,952 cases of oropharyngeal, penile, and anal cancers among boys in the 50 years up to 2058, Public Health England (PHE) said.

Free HPV vaccination for adolescent boys will also be made available for boys in Northern Ireland, Wales in Spring and Summer terms in 2020, and year S1 in Scotland at the start of the new academic year.

The decision to extend the programme followed a recommendation by the Joint Committee on Vaccination and Immunisation (JCVI) in July last year.

Cervical Cancer

Girls have been offered the HPV vaccine on the NHS in the UK since 2008.

When the JCVI recommended a universal HPV vaccine programme for girls its priority was to reduce rates of cervical cancer. It decided that high coverage in girls would provide 'herd protection' to boys.

Ten years later the Committee decided there was now stronger evidence that HPV was associated with non-cervical cancers, which affect men as well as women, and that vaccination would help prevent these other HPV-related cancers.

PHE said modelling produced by the University of Warwick estimated that the HPV vaccine could have prevented up to 64,138 HPV-related cervical cancers and 49,649 other HPV-related cancers by 2058.

The British Dental Association (BDA), which had pressed for the extension to help combat rising rates of oral cancers, warned that the success of the programme was in jeopardy because of the rising profile of campaigners opposed to vaccination.

It said that official data showed that uptake rates among girls for two doses of the vaccine had fallen in recent years.

The BDA called on the Government to redouble efforts to educate parents about the importance of vaccination for boys and girls.

Boys to Miss Out on Catch-up Programme

From September 2019, the first dose of the HPV vaccine, Gardasil (Merck Sharp & Dohme) will be offered to boys as well as girls aged 12 and 13 in year 8. The second dose will be offered between 6 months to 24 months later.

Girls and boys who have their first vaccination after the age of 15 will need to have three doses.

There will be no 'catch-up' vaccination programme for older boys.

Dr Mary Ramsay, head of immunisation at PHE, said: "This universal programme offers us the opportunity to make HPV-related diseases a thing of the past and build on the success of the girls' programme.

"Offering the vaccine to boys will not only protect them but will also prevent more cases of HPV related cancers in girls and reduce the overall burden of these cancers in both men and women in the future."

Dr Frank Atherton, the Chief Medical Officer for Wales, said: "A recent study has shown that there is compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and pre-cancerous growths among girls, women, boys and men.

"I hope that all parents of eligible boys and girls will take up the offer of this life-saving vaccine."

A Scottish Government spokesperson said ensuring that eligible people were vaccinated would "save lives in years to come".
 

NHS England said that so far, 10 million doses of HPV vaccine have been given to young women aged 15 to 24 – over 80% of the cohort.

Countering Campaigners Opposed to Vaccination

The BDA said uptake remained below the 90% to 95% needed for 'herd immunity', and that while the 80% vaccination target was being met, regional uptake variations persisted.

It expressed concerns over false social media claims linking vaccination with serious health conditions, and by reports that anti-vaccination messages had been inserted into children's books.

Mick Armstrong, BDA chair, said: "A universal HPV programme will offer protection to all children from life-changing conditions like throat cancer. But with uptake among girls already in decline, ministers need to cut through the noise, and make a clear and compelling case.

"Online and off, parents are being bombarded with fake news and bad science. We need real investment in a hard-nosed, evidenced-based approach that pulls no punches with the myth-makers."

The BDA said it also wanted to see a catch-up programme for boys.

Prof Arne Akbar, president of the British Society for Immunology, said: "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, head of the Department of Pathology at the University of Cambridge, commented: "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."

'Only Right' That Boys Are Offered the Same Protection

Prof Dame Parveen Kumar, chair of the British Medical Association's Board of Science, commented: "Given the growing body of evidence that HPV is also responsible for a range of cancers that can affect men, this is a very important step.

"Following the success of the vaccination programme for girls, it is only right that boys are now afforded the same protection."

Prof Jack Cuzick, director of the Wolfson Institute of Preventive Medicine and head of the Centre for Cancer Prevention at Queen Mary University of London welcomed the vaccination programme for boys but said the highest priority should be to "maintain or improve further the vaccine coverage in girls".

Prof Cuzick called for the programme to substitute the current vaccine, Gardasil 4, for Gardasil 9, which protects against more types of cancer.

Prof Arne Akbar receives grant funding from the Biotechnology and Biological Sciences Research Council (BBSRC), Medical Research Council (MRC), and Dermatrust.

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