HPV Vaccinations for MSM

Part of the debate – in Westminster Hall at 5:23 pm on 7th June 2016.

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Photo of Jane Ellison Jane Ellison The Parliamentary Under-Secretary of State for Health 5:23 pm, 7th June 2016

Thank you, Mr Hollobone, for giving me the opportunity to respond to the debate. I have to say at the outset that we are actually announcing good news in this debate. I accept that Members of this House wish to challenge me on a whole range of areas in which we might go further, but this is the announcement of a major pilot, and I will go on to talk about what we are actually doing. I really think that we should see this as an important step forward and an important part of delivering on LGBT health. I just wanted to say that at the outset, because it was a bit hard to get that from some of the contributions. I will talk a bit about the issue of action, which I have been challenged on.

Let me start, as I should, by congratulating my hon. Friend Mike Freer not only on securing the debate but on championing the issue so consistently and passionately. The point has been made that we should be talking about these issues more often—well, he has been talking about them consistently over many years and the persistence of parliamentary prioritisation is showing results. It is really good to see him in his place and I congratulate him on what he has done.

As hon. Members know, and as many people have mentioned, we are advised on all immunisation matters by the Joint Committee on Vaccination and Immunisation. Back in 2008, on the advice of the JCVI, an HPV vaccination programme for girls was introduced across the UK. It is worth reminding the House that the primary objective of that programme was to protect against cervical cancer. The latest data—just to remind people—shows that there are about 2,500 cervical cancer cases a year and up to 900 deaths from that terrible disease. To give some sense of comparison, there are around 300 anal cancer cases among all men in a year. Those are the origins of this programme.

The HPV vaccine has been given to more than 3 million teenage girls across the UK since the programme started, and coverage is actually among the highest in the world. Hon. Members have, again, made reference to international comparisons. I was recently in Geneva for the World Health Assembly, discussing HPV vaccination with a small group of other health ministers; our rates are the envy of much of the world, so we must accept that this is an important and world-leading programme. The number of young women with pre-cancerous lesions is falling, here and around the world, and we expect protection against cervical cancer to be long term, eventually saving hundreds of lives each year.

The vaccine has been subject to numerous safety reviews and I have gone over that in some detail in other debates. I will write to the shadow Minister, Andrew Gwynne, about the specific issues that he raised today, but I want to assure him about the EMA reviews and the WHO reviews, which are all publicly available.

Protecting girls against HPV has wider benefits and will result in fewer HPV infections and less disease in heterosexual males. However, I recognise, as the House has today, that men who have sex with men—MSM—receive little or no benefit from the programme for girls. It was the increasing evidence of the link between HPV and oral, throat, anal and penile cancers, alongside the incidence of genital warts, that led the JCVI to decide to consider the possibility of HPV vaccination for MSM, and to reconsider the case for HPV vaccination of boys. I will come to the issue of boys, which has been raised by several hon. Members, if there is time—I think and hope there will be. However, I want to focus most of my time on MSM, which is the subject of the debate.

I do not intend to include a lot of statistics in my speech, as my hon. Friend the Member for Finchley and Golders Green has set them out and described the context well. However, I want to point out, with regard to the detail behind the figures he quotes, that some of it is not directly relevant to an HPV/MSM programme, as the figures include both male and female cases and cases of cancer unrelated to HPV.

MSM are one of the groups at highest risk of sexually transmitted infections in the UK and the Government are already taking a number of steps to improve their health and wellbeing. Again, I reject any suggestion that this issue is not a priority. It is quite the opposite: there has been a focus in the last year or so on MSM health and on LGBT health—that is something that we had previously not even begun to do. That includes, for example, the first LGBT health conference run by Public Health England and a number of other things that we have done. I am happy to speak to Stewart Malcolm McDonald about that separately on another occasion.

The JCVI’s advice was that a targeted HPV vaccination should be introduced for MSM aged up to 45 who attend genito-urinary medicine and HIV clinics, if procurement of the vaccine and delivery of the programme is possible at a cost-effective price. Everything in that sentence is the JCVI’s advice. It is not just about the vaccine but about the delivery of the programme and the interrelationship between vaccination and attendance at GUM and HIV clinics, which is germane to the way that we are introducing this pilot.

In the JCVI’s formal advice to us, it acknowledged that commissioning and delivering such a programme would be complex and challenging. It made it clear that the Department of Health and Public Health England would need to work together, and with others, to consider the commissioning and delivery routes for the programme. Over the last few months that is exactly what we have been considering with stakeholders, and on several issues. Demand is one such issue, and we have had to consider whether the programme will result in a greater than expected increase in attendance by MSM at GUM clinics, and the impact of that on broader sexual health services.

We have also had to consider administration costs and what is a reasonable and realistic price to pay for administration of this vaccine in GUM and HIV clinics. Stakeholders raised that during the consultation on the original JCVI advice. How do we monitor the success of a three-dose programme when data collected in GUM clinics are anonymised and MSM could go to different GUM clinics for each dose? There are complexities in this programme that are not present in, for example, the school-based HPV programme for girls.