All girls in the UK aged between twelve and thirteen should be vaccinated against the most frequently found cancer-causing strains of the human papilloma virus (HPV), a panel of experts has recommended.
Clinical trials have shown that Gardasil, which has already received formal marketing approval, provided very high levels of protection against HPV 16/18 in young women who were not yet sexually experienced. A second vaccine, Cervarix, is expected to receive formal approval later this year.
Although the UK government has welcomed the recommendation, it will be conducting pilot cost-benefit studies before rolling-out a vaccination programme. The vaccination is administered using a course of three injections and the cost, £250, is higher than that of all other childhood immunisations combined.
However, Scotland is planning to introduce an immediate vaccination programme.
Suggestions that girls between the ages of 13 and 16 should receive the vaccination were rejected. There are high levels of teenage sexual activity in the UK, and the panel was persuaded by evidence showing that the efficacy of the vaccine declined significantly in sexually experienced women.
No recommendations have been made regarding the use of HPV vaccinations in boys and men. Nor did the panel provide guidance on the use of the vaccination in HIV-positive individuals. Large numbers of people with HIV are infected with potentially cancer-causing strains of HPV, but as the candidate vaccines are preventative rather than therapeutic the benefits of the vaccine in individuals who have already been exposed to HPV are doubtful. However, clinical trials are currently underway to assess the safety and efficacy of Gardasil in males and individuals with HIV.
Although anal cancer - which, like cervical cancer, is caused by some strains of HPV - occurs more frequently in gay men, particularly in those with HIV, its incidence is still very rare. However, anecdotal evidence suggests that gay men in London and the US are already accessing Gardasil privately at a cost of approximately £400. Few of these men are likely to benefit as the majority of sexually active gay men will already have been exposed to the potentially cancer-causing strains of HPV. Furthermore, private doctors providing HPV vaccination are not conducting pre-vaccine screening to determine if an individual has already been infected with HPV.
The introduction of opt-out vaccination programmes in several US states has occasioned a fierce moral argument, with some arguing that provision of a vaccination against a sexually transmitted infection will encourage teenage sexual behaviour. However, parents in the UK seem to have a more pragmatic attitude to the vaccination. The BBC is reporting that researchers from Manchester University have found that only a minority of parents would object to their child receiving the vaccination on moral grounds, with most supporting the provision of a safe and effective vaccine.