Joint Committee on Vaccination and Immunisation

(Limited Text - Ministerial Extracts only)

Wednesday 8th January 2014 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Gray.

I congratulate my hon. Friend the Member for Finchley and Golders Green (Mike Freer) on securing this debate and on again bringing this important subject before the House. He has been a great champion. I also congratulate my hon. Friend the Member for Mid Derbyshire (Pauline Latham) on raising another vital aspect of the Joint Committee on Vaccination and Immunisation’s work, to which I will also respond, albeit briefly.

It may help the House if I provide some background. The JCVI is an independent departmental expert committee, and it is a statutory body constituted to advise the Secretary of State for Health on the provision of vaccination and immunisation services. The committee and its invited experts represent some of the finest clinicians and academics in the UK and Europe, and all members are selected for their expert knowledge of matters concerning vaccination, immunisation and associated disciplines, including immunology, virology, bacteriology, paediatrics, general practice, public health and health economics.

We all recognise that the NHS budget is a finite resource. New vaccination programmes and extensions to existing programmes represent a significant cost to the health service in terms of both vaccine procurement and administration. Obviously, it is essential that any recommendations from the JCVI on changes to the national vaccination programme are supported by evidence of cost-effectiveness.

The JCVI has adopted a methodology for assessing cost-effectiveness that is in line with that used by the National Institute for Health and Clinical Excellence. Using those processes, the committee basically ensures that increased spending on immunisation does not result in an overall decrease in the health of the population because resources are diverted from more cost-effective health care interventions. We all recognise that those decisions are not easy.

My hon. Friend the Member for Mid Derbyshire makes a powerful case for the meningitis B vaccine, which the JCVI is currently reconsidering. The updated statement published on 25 October 2013 reflects the JCVI’s recognition of the burden and severity of meningococcal meningitis and septicaemia in the UK and the need to explore the potential for their prevention through immunisation. The situation is difficult when we have a new vaccine, in this case against meningitis B, but lack important evidence on its effectiveness. We need to know how well the vaccine will protect, how long it will protect for and whether it will stop the bacteria spreading from person to person. At the committee’s next meeting in February, if it feels it is in a position to make such a decision because it is in possession of all the relevant facts, the JCVI will make a final recommendation on whether meningitis B immunisation should be introduced. Obviously at that point we will carefully consider and respond to the recommendation. I hope that my hon. Friend is reassured that the recommendation will get proper and careful attention.

On the issue raised by my hon. Friend the Member for Finchley and Golders Green, the primary aim of the UK’s national HPV vaccination programme, which began in 2008, is to prevent cervical cancer related to HPV infection. The HPV vaccine protects against two strains of HPV—16 and 18—that currently cause some 70% of cervical cancer.

As HPV is responsible for virtually all cases of cervical cancer, preventing the disease is the major aim, but as my hon. Friend rightly says, HPV infection has been associated with other cancers, including cancer of the penis and anus, and some cancers of the head and neck. The precise proportion of those diseases that can be attributed to HPV infection is less well defined, but evidence is emerging all the time, so HPV infection should be taken seriously.

Evidence from clinical trials demonstrates that the HPV vaccine has a very high efficacy against the precursors of cervical cancer. Evidence of efficacy against cancers at other sites is emerging, and it is recognised that the current programme may therefore provide protection against a wider range of HPV-related cancers in females and, indirectly, in males than originally envisaged.

It is also worth saying that the UK’s HPV vaccination programme has been a considerable success, with this country having some of the highest coverage in the world—something we can be very proud of. A recently published study by Public Health England provided new evidence that the programme is successfully preventing HPV infections in young women in England, and that adds to our confidence that the programme can achieve its aim of reducing cervical cancer.

With a high uptake of HPV vaccination among girls, transmission of HPV between girls and boys should, as my hon. Friend said, be substantially lowered. Many boys will be protected against HPV infection and will, therefore, be at reduced risk of developing the related cancers we have spoken about, such as anal, head and neck cancers. However, I appreciate that he is particularly concerned that the current programme does not extend to men who have sex with men. He argued strongly that that is an apparent health inequality, and he raised the issue with my predecessor in last July’s debate, for which I was present.

As my hon. Friend will know, the JCVI has recognised that, under the current programme, the protection that accrues from reduced HPV transmission from vaccinated girls may not extend to men who have sex with men. He made the additional point about men who might have sex with girls and women from elsewhere who have not been subject to the broad coverage provided by our programme.

That is why, in October 2013, the JCVI agreed to set up a sub-committee on HPV vaccination to assess, among other issues, the question of extending the programme to MSM, adolescent boys or both. The JCVI therefore recognises the issue as a priority, and I congratulate my hon. Friend on championing it, because the attention it received in Parliament was obviously part of the reason that it was given a fresh look and is regarded as a priority. I know the JCVI took events in Parliament into account, and, indeed, my hon. Friend made his case directly.

The sub-committee will aim to identify and evaluate the full range of options for extending protection from HPV infection to men who have sex with men, and that will cover a range of settings, including genito-urinary medicine clinics. However, as my hon. Friend will be aware, GUM clinics may not be the best setting for offering vaccination, as those presenting may already have been exposed to infection, so their ability to benefit from vaccination will inevitably be limited.

The sub-committee is scheduled to meet for the first time on 20 January, when it will assess currently available scientific evidence and consider what further evidence is required to advise the JCVI on the suitability of possible changes to the HPV programme. For the reasons I outlined earlier, any proposals for the vaccination of additional groups will require supporting evidence to show that it would be a cost-effective use of NHS resources.

Public Health England has begun preliminary modelling to assess the impact and cost-effectiveness of vaccinating MSM, in anticipation of further guidance on the issue when the HPV sub-committee meets. Further work to assess the impact and cost-effectiveness of vaccinating adolescent boys against HPV infection is also planned, but it will take some time to do that important modelling, and I am conscious that that is one of the predominant concerns on my hon. Friend’s mind. These are complex issues, and the development of the evidence base and the mathematical models by PHE, as well as the deliberations of the JCVI itself, take time. However, that process and the time that it takes ensure that we get important decisions right and that decisions are taken on the basis of the best evidence. We cannot, therefore, undertake to take decisions hurriedly, because they are big decisions with, potentially, big implications.

Should the JCVI recommend the targeted vaccination of MSM, flexibility around contracted volumes in the current vaccine contract may allow a programme to be undertaken without the need for a new round of vaccine procurement—the numbers involved are relatively small in the context of the existing programme—if additional vaccine was available from the manufacturer in the required quantities. We are therefore cautiously optimistic that we can accommodate targeted vaccination of MSM in the existing programme, were it to be recommended by the JCVI. I hope that is a little encouraging for my hon. Friend.

Vaccine supply contracts are let for as long a period as is considered appropriate, taking into account the timing of potential changes to JCVI advice, policy and market forces, as well as Government procurement guidance. Obviously, longer contracts can secure firm prices for a longer period and allow for more accurate budget planning. However, we are exploring the flexibility that we have in existing contracts to align the window for the new contractual discussions with any potential recommendations by the JCVI, especially on the wider vaccination programme, were that what it recommended. We have not completed that work yet, but what I have seen so far leads me to conclude that we might be able to do something around the existing contract. We are looking at that to ensure that we do not miss the window of opportunity, which my hon. Friend identified as a chief cause of concern.

In conclusion, this important work has yet to be completed. We have to get some clarity on the time lines. We cannot achieve one of the things my hon. Friend mentioned—bringing the work on the assessment forward—because we have to review the available evidence and fill in any gaps if further evidence is needed. A decision on the vaccination of adolescent boys will probably require the development of quite a complex model to determine whether vaccination would be cost-effective, because the numbers involved are large. Such a model may identify a need to generate additional evidence, so a decision on that wider programme is not likely before 2015. However, as I said, the evidence to support a decision on a selective programme to target men who have sex with men may become available during 2014.

I can certainly give my hon. Friend the commitment that I will keep under careful review the timetable for key decisions when the committee makes its assessment and look at how they align with what we know about the flexibility that we have under the procurement contract. We will keep that under careful consideration. I conclude by congratulating him again on bringing this important issue before us and on continuing to keep it on the Government’s agenda.