January 16, 2013
Colm O' Mahoney, chairperson of the the British Medical Association's (BMA) dermatology and venereology subcommittee, and Penelope Toff, BMA's public health committee co-chair, have written to UK Health Minister Anna Soubry in support of Gardasil vaccines for gay men. The letter commented on the increasing incidence of human papillomavirus (HPV) and development of anal lesions in gay men, particularly those who are HIV positive. Using a reference to Australian data, the letter explained that the current vaccination of girls ages 12 to 13 years protects heterosexual men, but that the same protection is not provided to men who have sex with men (MSM). It acknowledged the difficulty of identifying young gay men for a vaccine program, but suggested that the HPV vaccine could be administered at genitourinary medical clinics or community sexual health clinics, possibly as an additional inoculation for patients already receiving the hepatitis B vaccination. The letter argued the case for preventing HPV in gay men, and supported the right of individuals to protect themselves and the need to work toward protecting them from acquiring infections at an early age. It concluded that the Gardasil vaccination program would be of great benefit in decreasing incidences of anal warts, anal pre-cancers, and cancers, as has been shown in Australia.
A Health Protection Agency (HPA) spokesperson explained that the Joint Committee on Vaccination and Immunisation (JCVI) concluded that HPA should investigate the matter further. The results of the investigation are not likely to end before late 2013. Also, a Department of Health spokesperson said that JCVI reviews eligibility criteria of all vaccination programs. At present, there were no plans to extend HPV vaccination to males based on an assessment of available scientific evidence, but JCVI was conducting research for a future assessment of HPV vaccination of MSM.
Dr. Richard Ma, a general practitioner and a member of the Royal College of General Practitioners' Sex, Drugs, and HIV task group expressed support for BMA. He agreed that gay men were at higher risk of developing anal cancer and that the vaccination of girls would not carry over into protection for these men. Ma felt that evidence was required to prove the cost efficacy of Gardasil vaccine for men, and understood that work was needed before instituting a mass program. Ma also suggested that delivery of the vaccine was a problem as it should be given at sexual health clinics as well as at general practices. According to Ma, part of the problem of giving the vaccine is that many gay men do not reveal their sexuality to health practitioners because of the fear of homophobia and discrimination. He suggested that the problem of MSM revealing their sexual orientation needs to be settled so that at-risk males could learn about the campaign for HPV immunization and would feel free to come forward and request the vaccine.