Last summer, the Joint Committee on Vaccinations and Immunisation (JCVI) announced its recommendation that boys should receive the HPV (human papillomavirus) vaccination at the same time as girls as part of the schools-based vaccination programme.
Health Secretary Vaughan Gething AM was quick to respond, confirming that the programme would be extended to all young people in Wales as soon as possible.
The programme, introduced in 2008, currently offers the vaccine to girls aged 12-13. In its early stages, there was also a ‘catch-up’ programme for girls aged up to 18 to ensure that those who would still benefit from the vaccine didn’t miss out just because of their age.
Boys were not offered the vaccine as it was considered that, as the virus is sexually transmitted, they would be protected from HPV indirectly by girls being vaccinated. It has long been clear, however, that this is a flawed premise that has left men – especially gay and bi men – and many trans people at an increased risk of HPV and developing associated cancers of the head, neck, mouth, cervix, anus and penis, as well as genital warts.
Only offering the vaccine to girls excluded trans people in different ways. Trans women and non-binary people who were assigned male at birth are unlikely to have been vaccinated when younger. Trans men and boys may also have been excluded from the vaccine programme due to incorrect assumptions about their health needs.
HPV has a high prevalence among men who have sex with men, who also face some of the highest incidences of anal cancer linked to HPV. In recognition of this increased risk, sexual health clinics in Wales have run a programme offering the vaccine to gay and bi men aged 16-45. Trans people and older gay and bi men can also receive vaccinations through these clinics based on clinical assessment.
To be most effective, however, the HPV vaccine needs to be given before people are sexually active. This means that offering gender-neutral vaccination to all young people of high school age is critical. At Stonewall Cymru, we made gender-neutral HPV vaccination one of our priorities for the next National Assembly in our manifesto for the 2016 elections and Terrence Higgins Trust has long been campaigning on the issue.
The decision to extend the vaccination programme to all adolescents is welcome news which will save lives, but it needs to go further. We are therefore dismayed to learn that the Welsh Government will not be replicating the good practice of the girls’ vaccination programme by implementing a catch-up programme for boys, trans girls and non-binary young people up to the age of 18, as well as any other students who haven’t been vaccinated against HPV.
The reason given is that the JCVI has not specifically recommended a catch-up programme. However, neither did the JCVI advise against a catch-up programme; its recommendation was to extend the vaccination on a gender-neutral basis.
In fact, the case for a catch-up programme is broadly accepted by the medical profession. When the UK Government announced in November that it would not be rolling out a catch-up programme, it faced widespread criticism from leading medical experts on HPV, who wrote an open letter calling on public health minister Steve Brine to reconsider.
This is because the reason for making the HPV vaccination programme gender-neutral was out of recognition that relying on the ‘herd protection’ of vaccinated girls is not sufficient to ensure all young people are adequately protected, especially LGBT young people. This same reasoning equally applies to older pupils who would fall under a catch-up programme.
The need to ensure widespread take up of HPV vaccination is becoming even more urgent: diagnoses of HPV-related cancers in men have risen significantly in the past decade. Currently, it is possible to pay privately to be vaccinated. Of course, this is only available to families with the means to pay.
The health benefits of making sure young people are vaccinated regardless of their gender are not in dispute, that’s why the HPV programme is being extended in the first place. However, by ruling out a catch-up programme, the Welsh Government is missing an invaluable opportunity to offer the same protection to those who would have been vaccinated had they been born one or two years earlier.
The decision is a false economy: like so much preventative healthcare, HPV vaccinations are much cheaper than treatments for the diseases they prevent. Moreover, not including a catch-up scheme alongside the roll-out of the gender-neutral programme contradicts the JCVI’s advice that it is cost-effective to provide all students with the vaccine.
In the context of the HPV vaccination, the Welsh and UK Governments’ decisions have a special irony. The JCVI was meant to issue its official guidance on gender-neutral vaccination in 2015. It finally recommended extending the HPV programme this summer after significant delays. It is the young people who began high school in those intervening years who will now be denied protection from the virus and the diseases it can cause.
The NHS Wales PrEP trial is an important example of how Wales can show leadership in championing preventative care and health equality. In this spirit, the Welsh Government should urgently reconsider its decision and introduce a catch-up programme when the gender-neutral HPV vaccination programme is rolled out.
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