Vaccines are one of the most important advances in medical history. To eliminate the risk of an illness before it even begins is the ultimate in rational medicine. How ridiculous, then, that when we have a vaccine that can defeat a really nasty disease, in the form of cancers of the genitals and mouth, we are failing to get full benefit from it.
The vaccine in question protects against HPV (human papillomavirus), and was one of the first immunisations to prevent a form of cancer. This virus, which is passed on during sex, causes tumours of the cervix, vagina, penis, anus, mouth and throat, as well as genital warts.
Such cancers are life-threatening, as well as disabling and disfiguring, and even genital warts can be distressing and hard to treat. But yesterday a UK advisory committee decided not to extend vaccination to teenage boys, a move that is short-sighted and discriminatory.
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HPV’s role in cervical cancer was discovered first, and so it initially made sense to prioritise vaccinating girls. In the UK, the vaccine is offered from the age of 12, to ensure teens are protected before they start having sex.
Oral cancer
But in the past few years evidence has grown that the virus can cause other cancers that affect men as well as women, such as oral cancer. Oral tumours are on the increase in many countries, including the UK, probably because we are having more oral sex.
Several countries offer the vaccine to both sexes, including the US, Canada and Australia. It’s too soon to see an effect on cervical cancer rates as this condition can take 20 years to develop, but in Australia, which was one of the first countries to make the vaccine part of its standard immunisation programme.
The UK’s Joint Committee on Vaccination and Immunisation said yesterday boys shouldn’t get the vaccine on the NHS because it’s not cost-effective enough. Vaccinated girls can’t pass on the virus, and since around 85 per cent of girls in the UK get the full course, there would be , says the committee. While it’s chiefly heterosexual boys that get the benefit of this herd immunity, gay men can get the vaccine from some sexual health clinics, so they are covered too, the committee points out.
But this is flawed logic. People are often uncertain of their sexuality as teenagers – and sometimes for much longer. So some teens and young men will end up having sex with another male without ever having thought of themselves as being gay or bisexual, never mind having reached the stage of going to a clinic to ask for a vaccine.
Vaccine uptake
And since the , they are likely to have been having sex for many years before they get vaccinated. It’s a marked contrast with how eager we are to step in early to protect teenage girls. It’s also less efficient, because adult men need three doses of the vaccine while teens only need two because they have stronger immune systems.
Some straight teenage boys will also end up contracting the virus from girls who haven’t been vaccinated. Uptake among girls is lower in , and some girls will have emigrated from countries that don’t offer the vaccine.
Vaccinating only girls therefore discriminates against boys who are poor, from ethnic minorities or are gay. And how depressing that in 2017 we are sending out yet another societal message to girls that it is their job alone to mitigate any unwanted consequences of sex.
Many parents in the UK are choosing to pay for their sons to get the vaccine privately, but with a price tag of about £300 for the course, only the better-off will do this. The committee has now begun a consultation on whether its advice is right; once it has decided, the government normally follows its recommendations. Let’s hope this is one decision where rationality and fairness prevail.
