David Winterflood, The HPV & Anal Cancer Foundation (HPVACF) and the NOMAN Campaign. HPVACF is part of HPV Action a collaborative partnership of 35 patient and professional organisations that are working to reduce the health burden of HPV.

• 80% of individuals will come into contact with Human Papillomavirus (HPV)
• HPV causes 5% of all cancer globally
• HPV is completely preventable through vaccination

Uncertainty although part and parcel of our daily existence, is hard to escape with stories daily in the mainstream media this Autumn about financial markets wavering, British politics receiving a ‘shake-up’, and the Ebola crisis escalating in Western Africa. Whilst these stories in the news can be enough to make us uneasy, when it comes to cancer, uncertainty is the enduring legacy on the horizon, which leaves patients frightened and unsure as to their next steps. But what if we could lessen that burden for specific diseases? The fact is - we can.

The solution for the carcinogenic human papillomavirus (HPV) is already out there – a cancer preventing vaccine – commonly known as the cervical cancer vaccine, which protects against this very common virus and one that almost every sexually-active person (1 in 3 carry the virus in the UK) will get at some time in their lives. Fortunately, most people with HPV will never develop symptoms or health problems, but not everyone is so lucky. HPV is responsible for 5% of all cancer globally including penile, anal and head and neck cancers and genital warts of which there were 48,000 new cases in UK men alone in 2013. The scary thing is HPV related disease is increasing annually, not decreasing.

Since 2008, girls aged 12-13 in the UK routinely receive the vaccine via the schools programme, however boys do not. It is argued that because take up amongst girls exceeds 80%, ‘herd immunity’ ensures that boys are protected; therefore extending the vaccination programme to include them would not be an efficient use of resources. But there are areas in the UK where vaccination rates for girls are below this critical threshold, and it doesn’t account for men having sex with men, or men who have sex with women from other countries.

Australia, United States, Canada and Austria, recommend vaccinating males as well and females, and as society, quite rightly, begins to address the existing gender equality issues we must ensure that this occurs within the health sector too, in the UK the burden of prevention of HPV lies with women. It’s no secret that inequalities are worse for men than women in health, as highlighted in the latest offering of the Marmot Indicators ‘Fair Societies, Healthy Lives’.

Men are at significantly greater risk than women from nearly all of the common cancers that occur in both sexes. Vaccinating males against HPV provides a chance to address this issue. How can we break down the barriers of gender equality when the current vaccination programme signals that women are responsible for the transmission of HPV? A gender-neutral virus requires a gender neutral vaccination - men hold an equal share of this burden, and need to be given their responsibility to prevent its transmission.

Every year we wait to make a decision over 367,000 12/13 year-old boys who are at risk from HPV-related diseases. Extending the vaccination is estimated to cost £20-22 million. The cost of treating genital warts alone in England is estimated to cost £52.4million per annum, and a study of the cost of treating 9 major HPV-related diseases in Italy produced an estimate of about £430 million a year. But whilst there are potentially huge savings that can be made in the long term, this is not just a financial decision. This is a decision that should consider public health, equality and the cost of human suffering involved. A parent’s choice should not be limited to their daughters.

In the context of our own work combating anal cancer, this is a vaccine that can strike a fearsome blow. Over 90% of anal cancer cases are caused by HPV, and in the UK some 1,100 people are diagnosed every year. But because of the social stigma that anal cancer carries, it prevents fair and equitable conversation, awareness, and funding that could support research and care for people with the disease. Through this vaccination we can make that fear and uncertainty patients experience, wholly unnecessary. 

In the coming weeks we will hear the JCVI’s decision on extending the HPV vaccination programme and the possibility of extension to men who have sex with men. If this does proceed, we will welcome this cautiously and hope that this is the first step towards vaccinating all boys, as although a step forward, vaccinating just MSM is not enough, especially as the optimal time for vaccination is prior to sexual activity and gives the highest level of protection if given at a younger age. As a recent BMJ editorial suggested, the extension of the HPV vaccination to all boys – ‘ is the only sensible answer’. We hope the government make the right decision.