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Expanding HPV vaccine to teenage boys ‘not cost effective’, says official advice

The HPV vaccination should not be extended to boys as it is not cost effective, the Joint Committee on Vaccination and Immunisation (JCVI) has recommended.

In an interim statement, published today by the Department of Health, the JCVI concluded that the risk of infection in males has already been substantially reduced by good vaccine uptake in girls.

The JCVI based its conclusion on a cost-effectiveness analysis, which found extending the HPV vaccine to boys would not meet the NICE cost-effectiveness threshold of £20,000 per quality adjusted life year.

It also took into account a meta-analysis looking at 16 mathematical models that simulated the outcomes of extending the vaccination programme, which found that in areas of high vaccine coverage in girls there was little associated benefit in also vaccinating boys.

It found that vaccinating boys would only confer substantial benefit if the coverage in girls was around 40% – much lower than the current rate in the UK.

The JCVI acknowledges that vaccinating girls only does not completely eliminate the risk of HPV-related cancers in men who have sex with men, suggesting that this demographic would benefit from the vaccine being extended to boys.

But the committee instead advised a targeted programme for men who have sex with men attending GUM and HIV clinics, the pilot for which was launched in June 2016.

The statement says: ‘While it is clear that a programme to vaccinate adolescent males would provide those vaccinated with direct protection against HPV infection, and associated disease, all the evidence suggests that the risk of infection in males has already been dramatically reduced by the girls programme and that these herd effects will continue to have a substantial impact.

‘Therefore, most of the benefit in boys can be achieved through achieving high uptake in a girls-only vaccination programme.’

BMA GP Committee prescribing lead Dr Andrew Green said: ‘I am very disappointed that the opportunity to protect boys has not been taken.

‘There is a significant population of men who have sex with men and the burden of HPV-related disease affects them every bit as much as women. The only way to offer them effective protection is a universal vaccination programme for boys.’

The JCVI statement was also met with criticism from charities such as the Terrence Higgins Trust and Jo’s Cervical Cancer Trust.

Ian Green, chief executive of the Terrence Higgins Trust, said: ‘We are deeply disappointed by this short-sighted recommendation to deny teenage boys the potentially life-saving HPV vaccine. 

‘To eradicate HPV and protect people from related cancers, we need protection for boys and girls before they become sexually active. While this is ‘interim’ advice, it is a worrying sign.

‘Before a final decision is taken, we strongly urge the Government to listen to the campaigners, experts, charities, parents and young people who have campaigned so passionately for equal access to the vaccine, and to do the right thing.’

The DH will consult with stakeholders on the JCVI statement before final advice is published.


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