Jeremy Hunt’s refusal to give boys a vaccine that will protect them from a cancer-causing virus because of the expense is a ‘cop-out’ that is costing lives, experts warned last night
Jeremy Hunt’s refusal to give boys a vaccine that will protect them from a cancer-causing virus because of the expense is a ‘cop-out’ that is costing lives, experts warned last night.
For the past decade, teenage girls – but not boys – have been inoculated against the sexually transmitted human papillomavirus (HPV) for free on the NHS because it disproportionately affects females.
Every year about 1,550 women die from HPV-related cancers – two-thirds from cervical cancer.
Yet each year 650 men also die – and due to changing sexual behaviour, the number is rising fast.
Last summer advisers to Health Secretary Mr Hunt concluded that extending HPV immunisation to adolescent boys was ‘highly unlikely to be cost-effective’.
But top medics say their conclusion was based on ‘flawed assumptions’ about sex among young people today and the virulence of the virus. They want the Joint Committee on Vaccination and Immunisation (JCVI) to revise its ‘cost effectiveness’ models, to take account of concerns that:
- Members of the ‘Tinder generation’ are more likely to have a number of sexual partners and have oral sex than older age groups;
- HPV causes more cancers, particularly oral cancers, than previously estimated;
- Immigration and travel mean young men are much more exposed to HPV-infected young women than is appreciated.
The JCVI argues that vaccinating only girls is the best approach as this protects most males by default.
An NHS campaign to vaccinate boys would be a costly way of preventing relatively few cancers, the secretive committee contends.
Call for action: How The Mail on Sunday reported the story last month
But the JCVI has refused to publish its workings in full, leading critics including the British Dental Association to accuse it of ‘cherry picking’ evidence ‘just to keep costs down’.
Chairman Mick Armstrong said: ‘These models work on a “garbage in, garbage out” basis. If you start by understating a cancer risk and suggesting sexual habits haven’t changed in decades, then you get the wrong answer.’
Dentists are seeing a growing number of male patients with oral cancer – leading many with sons to pay for private vaccination. A two-shot course is about £300 – up to ten times the NHS cost.
The £30 jab that saves thousands
Girls receive two jabs of the Gardasil vaccine in Year 8, when they are 12 or 13. This protects them from four strains of the HPV virus. Boys are not yet inoculated.
Defence shield: The Gardasil vaccine
Mr Armstrong said: ‘When you’ve seen the devastating impact of oral cancer first-hand, you’ll understand why so many health professionals are prepared to protect their kids out of their own pockets.’
Professor Margaret Stanley, president of the International Papillomavirus Society, said a new analysis by Scottish experts concluded HPV resulted in more cancers than previously thought.
The NHS is thought to pay £20 million a year to inoculate 370,000 Year 8 girls using the Gardasil vaccine.
The price charged by makers MSD is confidential. Extending it to boys would double the order but not the cost, as the NHS would be in a position to drive a harder bargain.
Boys are routinely vaccinated in Australia, New Zealand, Austria, the US and parts of Canada, said Peter Baker, of pressure group HPV Action.
‘Obviously the NHS isn’t a bottomless pit,’ he added, ‘but the JCVI’s one-dimensional approach, only looking at cost-effectiveness, really shows the limitations of our vaccination policy.’
Dr Tony Narula, of the British Association Of Ear, Nose And Throat Surgeons, said: ‘This decision is too important to be left to accountants. It’s a cop out.’
Last summer’s JCVI conclusion was only an ‘interim statement’, meaning its advice could be changed.
Public Health England last night defended the committee’s work. Consultant epidemiologist Vanessa Saliba said both PHE and the JCVI ‘are in agreement that the parameters used in the PHE [cost-effectiveness] model are the most plausible based on the available evidence’.
Why did they keep missing the lump in my throat slowly killing me?
Because HPV is so hard to diagnose. Which is why this lucky survivor says: Protect the young – female AND male
By DAVID ROSE for the Mail On Sunday
The first time my sister-in-law Suzanne Vandervell had a tumour caused by the human papillomavirus (HPV) it was not spotted by a doctor but by my wife, Carolyn.
Suzanne and her husband Nick had come to our house for lunch on Easter Sunday in 2010.
For months she had been suffering from ear aches and a sore throat, but despite numerous visits to her GP, who had prescribed several courses of antibiotics, her symptoms were getting worse.
Agonising ordeal: Suzanne Vandervell had a tumour caused by the human papillomavirus (HPV). Doctors confirmed that Suzanne, who lives near Farnham in Surrey, had advanced tonsil cancer, which had already spread to the lymph nodes in her neck
Carolyn peered into Suzanne’s mouth and there it was: an angry, irregular red lump on her right tonsil. Carolyn was alarmed. She recalls: ‘I remember thinking, “This is serious.” It looked very sinister.’
Days later, doctors confirmed that Suzanne, who lives near Farnham in Surrey, had advanced tonsil cancer, which had already spread to the lymph nodes in her neck.
Her treatment, at the Royal Surrey Hospital in Guildford, lasted seven months, with weeks of chemotherapy and radiotherapy followed by ‘neck dissection’ surgery – peeling back flesh from her neck and scraping away fat and lymph nodes to remove the remaining malignant tissue.
The physical side effects – including pain, stiffness and an extreme dry mouth – were permanent. Before she had cancer, Suzanne was a wine expert and at one time made her living conducting tours of famous vineyards. Now she couldn’t drink wine at all. She also experienced almost constant anxiety: like many HPV cancer patients, she was terrified the disease might return.
Her fears were well-founded. At the beginning of February last year, Suzanne told her GP she was convinced there was something seriously wrong because she felt exhausted and was losing a lot of weight, despite eating heartily.
Astonishingly, despite her history of cancer, it was not until the end of June – 20 weeks later – that her illness was diagnosed. She had cancer again. Exactly where it started is uncertain, but by the time it was finally detected, it had spread through the space between her throat and the back of her nose and was starting to press up into her brain. The cancer was also threatening her carotid artery that delivers blood to the brain.
All the time that Suzanne had been feeling ill it had been growing steadily – and so becoming far more difficult to treat. In July, doctors at Guy’s Hospital in London told Suzanne her condition was terminal, and they could provide only palliative care. ‘The surgeon just looked at me and said there was nothing he could do, because the tumour was too close to my artery. He said I’d live for a few months, but when I died, I wouldn’t feel anything because the cancer would shut off the blood supply to my brain.
‘It was so shocking, hideous. I asked if we could go to seek treatments abroad, and he said, “You haven’t got time.” ’
Suzanne’s ordeal has cast a shadow across our family for years. It is also one reason why I have, over the past few months, been investigating HPV and challenging the NHS to extend its vaccination – provided to all girls aged 12 and 13 since 2008 – to boys. Suzanne’s illness would not afflict anyone immunised in childhood.
The Mail on Sunday has revealed that HPV, spread by sexual contact and kissing, causes thousands of cancers a year, while the incidence of head and neck cancer – the fourth most common type among men – is rising rapidly. Countries including Australia, Canada and the US already vaccinate males, yet the NHS insists it would not be ‘cost effective’ – claiming it is cheaper to treat HPV cancers than to spend between £12 million and £22 million a year on immunising boys.
Suzanne’s story highlights another reason for vaccinating as many people as possible. Horrendous as they are, HPV cancers are often difficult to diagnose, and the consequent delays in starting treatment that Suzanne has had to face, not once but twice, are common.
‘We see many patients with HPV-related cancers who have been to their GPs, been given antibiotics and the suspicion of cancer has not been raised,’ says Professor Chris Nutting, from the Royal Marsden Hospital in London, whose team has been treating Suzanne, 55, despite the prognosis from Guy’s.
‘Typically, these cancers may only start to cause symptoms when they’ve already spread to the lymph nodes.
‘It’s unfortunate because the earlier patients get treatment, the less gruelling it will be and the better the chances of a cure. This is a further argument in favour of vaccinating boys as well girls.’
In 2010, after Suzanne’s first diagnosis, followed by an operation to remove her tonsils, she had gruelling chemotherapy and radiotherapy. But through it all she remained optimistic. She recalls: ‘My skin felt tight, like I was being strangled. Nerve damage meant I’d get spasms, like electric shocks, running into my jaw. I aged ten or 15 years as the chemo triggered the menopause.
‘But slowly I adapted to my new body and almost a year after the diagnosis, we went to the Canary Islands on holiday. I began to adjust, to feel OK.’
A five-year survival after cancer is seen as a milestone, and after passing this, Suzanne’s confidence grew. But then, in the autumn of 2016, came the weight loss: half a stone in weeks, then more.
‘I told my doctor I looked crap and I felt crap,’ says Suzanne. ‘But despite my history, and despite the fact that I had no gastric symptoms, she was convinced I had a stomach problem. She should have been saying, “Hold on, this could be serious.” ’
A scan last May revealed a mass that needed investigation. However, delays in arranging a more precise MRI scan meant Suzanne did not get a full diagnosis until June 23.
Normally, standard radiotherapy is not administered to the same area of the body twice, because the side effects are so bad. Prof Nutting was prepared to try. He put the chances of killing the cancer at 30 per cent.
Several times, Carolyn had to persuade Suzanne not to abandon her latest rounds of chemo and radiotherapy, because from the outset, the side effects were extreme. One terrible weekend, she made an overnight trip to Switzerland to investigate the possibility of arranging her own death at Dignitas.
Then – incredibly – just before Christmas, a further scan showed that Suzanne was cancer-free.
She is still in such pain that she needs a constant supply of Fentanyl, the synthetic form of heroin, and has a steadily enlarging hole in her soft palate that will not heal – the result of soft tissue radionecrosis – the death of cells caused by re-radiating areas where she had already been treated in 2010.
‘No one will tell me what my chances are now,’ Suzanne says. ‘Let’s face it, how could they know? I have a profound fear it will come back again, and that next time I won’t be able to eat, or speak, or I’ll be disfigured.
‘But ask yourself this question: Why would you not provide a vaccine which would stop this disease from happening? How can you possibly justify that?’