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House of Lords Hansard
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26 March 2018
Volume 790

Question

Asked by

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To ask Her Majesty’s Government, in the light of the recent decision to offer HPV vaccinations to gay men, whether they plan to provide HPV vaccinations to all boys; and if so, when.

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My Lords, following a consultation, our expert group, the Joint Committee on Vaccination and Immunisation, is reviewing the evidence for vaccinating adolescent boys against HPV. We are awaiting its final advice, and it is important not to pre-empt the decision of the joint committee.

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I thank my noble friend for his reply. HPV-related oral cancers are the fastest-growing type of malignancy and affect thousands of men each year. Recent studies suggest that the vaccination of boys is cost effective, and I congratulate the Government on their decision to vaccinate gay men. Does not my noble friend agree, however, that the only way in which to protect men directly is to vaccinate them before they become sexually active, as they already do in many countries, including Australia, Canada, Austria or the United States? Would he also agree that we have a duty and responsibility to protect these boys, rather than leaving them vulnerable to potentially fatal cancers when it will be too late for them to do anything about it, because we neglected them when young?

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My noble friend makes an important point, that vaccinations against the HPV virus brings wider health benefits beyond defending against cervical cancers. It is important to state that it is not my judgment that matters here but that of our expert group, and in its interim advice it did not recommend an extension of the HPV programme to boys as being cost effective, not least because of the high levels of immunity and uptake among girls, with the indirect benefit that that has. But that was its interim advice; the final advice is being considered at the moment, and I can tell the House that that advice and the underlying assumptions on cost benefit will be published when the decision is made.

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My Lords, last year’s interim statement referred to by the Minister mentions referring the issue of equality of access to the HPV vaccine to the Department of Health for consideration. Has that referral been made? Given that the clinical benefits of gender neutrality have been so widely advocated by top medics over a very long period, is the department treating this with urgency? When is a response expected, and has any legal advice been taken on whether the current situation of only directly protecting girls and gay men constitutes discrimination by gender or sexual orientation?

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The noble Baroness is quite right that equality is an issue, and an equality analysis will take place. That can be completed only once we have the final advice from the joint committee. I can also promise her that we will publish that analysis, so that will be able to be scrutinised. As for legal advice, it is subject to threats of judicial review at the moment, so I cannot go any further than that, but I can promise that equality considerations are very high on the list of the issues that we are dealing with.

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My Lords, we welcome the decision to vaccinate gay men in England, but sex and relationships are no respecter of national borders. Has NHS England had any conversations with the NHS in Northern Ireland, Scotland or Wales to ensure that gay men are protected right across the UK?

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We are beginning a national rollout of the programme for men who have sex with men in terms of the provision, because of course they are not necessarily getting the indirect benefits from the girls’ immunisation programme. I do not have the details of the working relationships with the devolved Administrations, but I shall write to the noble Baroness with details.

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My Lords, I am glad that the Minister said that the committee looking at the benefits of immunisation to boys recognises the wider benefits of immunisation for both boys and girls. However, he did say that it was not convinced about the cost effectiveness. Is that cost effectiveness merely for the cost of the programme if instituted now or the long-term benefits?

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The committee has to take a number of considerations into account—the public health benefits, short-term and long-term, and cost effectiveness—just as NICE does when approving medicines. It has to make a judgment about whether the incremental pound spent could be better spent across the entire health system, where, of course, there are many competing demands. But it is up to it to make that decision, and that will inform its final advice.

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My Lords, is the Minister aware that oral cancer is very largely due to the papilloma virus? As a dentist, and on behalf of the dental profession, I strongly support immunisation, but there will always be people who do not attend to have it, even when it is introduced. So it is also important to be aware that dentists are usually the first people to detect oral cancer. For many years I have proposed that, when people go into accident and emergency for anything, someone should take one minute to see if there was any abnormality in the mouth which could be referred on at that stage. Could this even be included in a questionnaire when people go in for treatment? It would be a way of picking up oral cancer, which has increased by 23% in the last 10 years.

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My noble friend is quite right to highlight the link between HPV and oral cancer. The growing evidence base is one of the things which the JCVI is taking into consideration. There is absolutely no doubt that HPV causes around 99% of cervical cancers. The link to other cancers, such as the one my noble friend mentioned, is not quite the same and is still disputed, but it is one of the issues being considered.

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My Lords, given that the Government have recognised the importance of HPV, do they also recognise that some boys who are having a homosexual relationship will not come forward and may, therefore, be at very high risk prior to being offered immunisation? Boys also act as a reservoir for HPV among girls. There may be girls whose parents do not consent to them having immunisation but they are particularly at risk because 70% of cervical cancers are caused by HPV.

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Yes, of course. Among the technical issues which the JCVI has to take into account is the risk profile of boys at different ages and with different sexual behaviours.