Dentist leaders have accused the Joint Committee on Vaccination and Immunisation (JCVI) of leaving 400,000 boys a year at risk of cancer, after using opaque and apparently flawed modelling as a basis to reject blanket vaccinations against the human papillomavirus (HPV). The JCVI made an interim decision on 19 July, launching a consultation on its ruling that closes today (31 August).
The British Dental Association (BDA) understands the committee has withheld vital information from publicly-funded studies, because authors of the models wish to keep their work confidential until they can publish it in academic journals. Of the two models considered by the JCVI, one has not even been subjected to peer review, so its validity has not been established.
Based on the limited information supplied by the JCVI, the BDA has said that the models are likely to give an over-conservative estimate of the benefit of vaccinating boys and have led the JCVI to a misguided conclusion on cost-effectiveness.
HPV has emerged as the leading cause of oropharyngeal cancer, especially among young people, and rates are rising steeply overall. It is linked to 5% of all cancers worldwide, including some that affect only men. Dentists are often the first to spot the tell-tale signs of oral cancer.
Currently only school-age girls are covered by the vaccination programme. A recent survey conducted by the BDA showed 97% of dentists would back a gender-neutral approach.
The BDA has outlined 3 areas which undermine the JCVI's conclusions:
- The JCVI has used under-estimates of the proportion of cancers that are caused by high-risk HPV types.
- Data used to model sexual behaviour are out of date, and factors such as the recent introduction of dating apps may have led to significant changes in behaviour over the last few years, which have not been considered.
- Models have been over-simplified and have ignored factors such as increasing oropharyngeal cancer incidence, the full societal costs of treating diseases caused by HPV, transmission of the virus to men from unvaccinated UK or foreign women, and reduced vaccine uptake following safety scares.
The BDA has also attacked the JCVI's suggestion to simply expand the Public Health England pilots to vaccinate men who have sex with men (MSM) attending sexual health clinics – as most will already have been exposed to the virus by the time they are vaccinated, and many others will still not receive the vaccine at all.
Dentists claim the JCVI has also failed in its commitment to equality, as required of a public body, by failing to extend cover to teenage boys. The BDA argues failure to offer protection to all boys against HPV disregards the need for equality according to gender, sexual orientation and economic status. They claim it is indefensible to leave men who may unknowingly choose unvaccinated female partners, MSM who are not offered pre-exposure protection and have higher rates of infection, and any male unable to afford the substantial cost of private vaccination, vulnerable to a range of preventable and life-threatening diseases caused by HPV.
Campaign coalition HPV Action estimates the cost of extending the programme amounts to around £20 million a year – a fraction of the treatment costs of conditions caused by HPV.
BDA Chair Mick Armstrong said:
"It is shocking that 400,000 boys a year can be left at risk of oral cancer thanks to a decision that cannot be properly scrutinised.
"Based on the scant information the JCVI has made public, its verdict is based on false assumptions. Whether by accident or by design they have understated cancer risk, and completely ignored the sexual habits of the Tinder Generation. That choice will cost lives.
"The JCVI is failing in its duty as public body to treat all our children equally. They should not be leaving parents to reach into their own pockets to protect their sons.
"Expanding the pilots to vaccinate men who have sex with men attending sexual health clinics provides too little protection too late. Only a gender-neutral vaccination programme can offer all our children the best defence."