Joint Committee on Vaccination and Immunisation

Mike Freer Excerpts

Wednesday 8th January 2014 Westminster Hall

[Mike Freer (Finchley and Golders Green) (Con)]

It is a pleasure to be here today under your chairmanship, Mr Gray. I am grateful to Mr Speaker for granting this debate on the work of the Joint Committee on Vaccination and Immunisation. I requested this debate following the JCVI’s decision on the 2 October 2013 to undertake further work on key issues surrounding the human papillomavirus, or HPV, vaccination programme. I understand that some colleagues may wish to comment on other aspects of the JCVI’s work. I want to focus particularly on the Committee’s decision to consider—I use its word—“urgently” vaccinating men who have sex with men, on attendance at sexual health services, and adolescent males. I intend to focus my remarks on that work now being undertaken with regard to the HPV vaccination programme, specifically in terms of exposure to HPV-related cancers, which are increasing in boys who have sex with females and the MSM community.

The decision of the JCVI to prioritise consideration of vaccinating MSM is noteworthy, not least because the minutes of its October meeting accept that a full economic model might not be necessary where sexual health clinicians can develop independent guidelines. Historically, the JCVI has often rejected vaccination of adolescent boys and MSM on economic grounds, so it is a major step forward for it to say that heath clinicians with expertise—particularly at sexual health clinics—can take such a decision on clinical grounds. That is welcome.

It is important—I have no doubt that my hon. Friend the Minister will need to ensure it—that any decision on extending vaccinations is clinically and financially sound. I do not seek to undermine that decision. I wish to stress the economic benefits of extending the vaccination swiftly, rather than stress other issues of equality, which I raised in an Adjournment debate last year.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing this important health matter to Westminster Hall for consideration. There have been significant positive results from vaccinating women and girls for HPV, so clearly there is an advantage shown in doing that. That consolidates the hon. Gentleman’s request for the same vaccination to take place in men and boys as well. Does he agree that the same should happen with regard to men as has happened for women and girls?

[Mike Freer]

The hon. Gentleman makes a good point that repeats some of the discussion we had in last year’s Adjournment debate. The success of the vaccination programme among girls has had a dramatic impact on HPV-related cancers among women. However, the flaw was that it assumed herd immunity for boys who were having sex either with girls or within the herd. But of course, not all boys have sex with girls: some—shock, horror!—have sex with other boys, and not all boys have sex within the herd. Increasingly, in a global economy, and particularly in Europe where the vaccination programme is not the same, adolescent boys in this country are exposed to women who have not been vaccinated. It is important to close the loophole for adolescent boys having sex with unvaccinated girls and those having sex with unvaccinated boys, who, obviously, grow to be unvaccinated men.

If the JCVI has agreed to urgently review the economic case for extending the vaccination programme, why is this debate needed? Before I discuss that, it is worth reminding ourselves what health problems we are trying to prevent. I recall, during the Adjournment debate, seeing the duty Whip sink ever further on the Bench as we discussed certain topics and cancers. This is not a pleasant subject, but I would rather discuss an unpleasant subject than have to deal with it in our hospitals.

Nine out of 10 cases of genital warts are HPV-related; oral-related HPV infections—men are six times more likely than women to have oral infections—increase the risk of cancers of the mouth, throat, neck and head cancers; and there are HPV-related penile and anal cancers: HPV is associated with 80% to 85% of anal cancer in men. In 2009, just after the HPV vaccination programme started, there were more than 6,500 cases of these cancers, with 47% of penile cancer and 16% of head and neck cancers thought to be HPV-related. The latest incidence data show that in 2010 there were 437 incidences of anal cancer and 5,637 of oropharyngeal cancer, 515 instances of penile cancer and 180,000 instances of genital warts. Rates of HPV-related cancers are on the rise in the UK. Throat cancer has overtaken cervical cancer as the leading HPV-related cancer. I am pleased that the JCVI has accepted that there is an urgent need to review the clinical and economic case for extending the programme to adolescent boys and MSM.

I should like to put on record my thanks to the Minister’s predecessor, my hon. Friend the Member for Broxtowe (Anna Soubry),for her support in this matter and for facilitating a teleconference, which she and I and representatives of the Terrence Higgins Trust had with the Chairman of the JCVI, which I believe gave some impetus to this change of heart and the speeding up of the work by the JCVI. That was a significant breakthrough.

The key point in this debate is that although the JCVI’s urgent report is due at some unspecified point later this year, the procurement of the next round of HPV vaccinations will commence in October or November this year. I am concerned that if the JCVI does not report in time and this procurement round is missed, we may have to wait four more years—I believe it is a four-year procurement round—before the HPV vaccination programme is extended to adolescent boys and MSM, if that is the recommendation.

[Alison Seabeck (Plymouth, Moor View) (Lab)]

I congratulate the hon. Gentleman on bringing this subject to the House. I share his concerns. Is he also concerned that although the JCVI undoubtedly does some excellent work, it does not share the flexibilities of the National Institute for Health and Clinical Excellence, in terms of its medical and health assessment processes? Would he welcome some movement there, which might in turn help bring this vaccine forward more quickly?

[Mike Freer]

The hon. Lady makes a good point and speaks, probably, with more knowledge than I have. If NICE is able to react more swiftly than the JCVI, I am sure that my hon. Friend the Minister will take that point away and consider whether the two organisations could share best practice. Clearly, as new drugs come on the market and new issues arise, we must ensure that the health advisers are able to respond quickly to changes.

The key point I was making is that if we miss the procurement window, and if we have to wait four more years, boys and the MSM community would be unnecessarily exposed to HPV-related cancers. There is not just a personal cost to those who become exposed to HPV-related cancers: the NHS would be exposed to treatment costs that might be mitigated or avoided if we get the JCVI to report in time for the procurement round later this year.

If we look at the costs, we can start to see the scale of the savings. To put that into perspective, the three-dose HPV vaccination programme currently costs some £260. I understand that the JCVI is also considering whether that may be reduced to a two-dose vaccination, which would reduce the outlay. Let us compare that with the £13,000 cost per patient of treating anal cancer, the £11,500 cost per patient of treating penile cancer, the £15,000 cost per patient of treating oropharyngeal cancer, or the £13,600 cost per patient of treating vulvar and vaginal cancer transmitted by an infected male. In 2010, the total cost to the NHS of treating genital warts was £52.4 million. If we multiply those figures by four, we can see the clear economic benefits of bringing forward the decision to coincide with the next procurement round.

The clinical reasons and the economic benefits are evident, and I hope that my hon. Friend the Minister will confirm today that, at best, the JCVI will be able to report in time for the procurement round later this year or, at worst, that any contract procured later this year will have flexibility built in to allow the Minister and the Department of Health to extend the vaccination programme to adolescent boys and MSM at some point after the report.