On 7th January, the Anal Cancer Foundation submitted a testimony to the UK’s Joint Committee on Vaccination and Immunisation (JCVI) in response to the Committee’s interim position statement and recommendation to offer the human papillomavirus (HPV) vaccine to men who have sex with men (MSM) aged 16-40 at GUM (sexual health clinics) and HIV clinics.
The JCVI is a government body that advises UK health departments on immunisation practices.
The Anal Cancer Foundation stressed the insufficiency of this recommendation stating that it fails to fully protect MSM as well as men who have sex with women (MSW). The recommendation as it stands leaves both populations vulnerable to preventable diseases. The Anal Cancer Foundation urged the JCVI to change its recommendation to include vaccination of all boys, in addition to its current recommendation to vaccinate girls.
The Foundation’s testimony expressed the insufficiency of the model that was used to make the initial recommendation for a vaccination campaign that excludes males, explaining that the objective of vaccination programs should be targeted at all six cancers caused by HPV and anogenital warts. The Anal Cancer Foundation urged the JCVI to have future models account for sexual activity with unvaccinated foreigners as well as with unvaccinated people of different ages. The results of recent studies pointing to the cost effectiveness of preventing anal cancer versus treating it should also be taken into consideration.
The testimony stated that the interim recommendation to only vaccinate men 16-40 that attend a GUM clinic and disclose that they are MSM fails to confer protection on multiple groups of people, inclusive of MSM for which it is tailored. Obtaining the vaccine would require males to present at GUM and HIV clinics and identify themselves as MSM. Furthermore, the age restrictions placed on the recommendations may mean that boys obtain the vaccine past the point of sexual debut and associated HPV exposure, rendering the vaccine less effective in many cases. Immune response is also higher at ages younger than those in the current recommendation, placing MSM further at risk. Finally, the recommendations fail to protect men who have sex with unvaccinated women, and unvaccinated women who have sex with unvaccinated men.
The HPV and Anal Cancer Foundation concluded its testimony by expressing the iniquity at expecting women to shoulder responsibility for controlling the spread of HPV and urged the JCVI to strive for health equity by protecting both men and women against the devastating effects of HPV infection by providing equal access to the vaccine for both boys and girls at the same age.
Also responding to JCVI’s interim recommendations was HPV Action, a coalition of 36 patient and professional organisations working to reduce the health burden of HPV, of which the HPV and Anal Cancer Foundation is a founding member. HPV Action commended the JCVI on its attention to the coverage need amongst MSM, but emphasised that the only effective way to protect all MSM, as well as most other men, is through a universal gender-neutral vaccination programme targeting adolescents.
The HPV and Anal Cancer Foundation also provided testimony on the 8th of January in New York with regard to preventing HPV and the cancers it causes.
*Please note that, as this occurred in the UK, British spelling is used in this blog post as well as in the accompanying testimony.