Last month, the government announced an extension of the national HPV vaccination campaign to include men who have sex with men who are aged less than forty. This was welcomed, as this group, particularly men who exclusively have sex with men, are excluded from the direct effects of the vaccination of women. Vaccination is offered when men come into contact with health services.
Around 20% of 16-20 year old men who have sex with men (MSM) are HPV positive, Whilst the age at which gay men identify as gay appears to be decreasing with increasing acceptance of non-hetrosexual identities, the targeted vaccination campaign towards MSM makes the presumption that all MSM wish to identify as such to their health provider, at an age at which they will still be seronegative. We have the opportunity to offer to vaccinate MSM where we find them, but this will not be a great deal of comfort to those who have already been exposed to HPV and already suffer from the disease burden, usually in the form of genital warts. Australian data after the introduction of the quadrivalent vaccine to women showed that significant declines could be achieved by vaccinating women and heterosexual men, but the rates in MSM remained static.
The estimated cost of rolling out vaccination to all children is estimated to be around £20 million pounds. Some good analysis of the cost of anal cancers, a disease that disproportionately affects MSM has has already been done, the cost effectiveness of the additional protection from vaccinating boys on HPV related disease has already been done. The JCVI will convene in two years to decide whether universal vaccination of children is cost-effective.
Cost effectiveness is the ultimate outcome measure for a healthcare system that is government funded, as we as taxpayers want to see the most value for our money, but in focusing the entire argument on the basis of cost, do we effectively say that the lives of MSM are not worth enough?