Human Papillomavirus (HPV) Vaccination Programme

The introduction of a gender-neutral HPV vaccination programme to the UK

Human papillomavirus (HPV) is the world’s most common sexually transmitted infection and is strongly associated with the development of cervical cancer in women and other health conditions in both sexes including anal, oropharyngeal, mouth, and throat cancers, and genital warts. In 2008 the UK introduced bi-valent HPV vaccination of girls to safeguard against cervical cancer, changing to a quadra-valent vaccine in 2011 to provide additional protection for genital warts. On the basis of both gender equality and the risk of disease in males, there was considerable social and political pressure to introduce HPV vaccination of boys.

Research funded by: NIHR

The challenge

Over £200m per year is spent in the UK on vaccines and vaccine delivery. Infectious disease and health economic models are used to assess whether any change in the immunisation programme is cost-effective. The UK Department of Health and Social Care Joint Committee on Vaccination and Immunisation (JCVI) advises UK health departments on immunisation. The JCVI recommends a vaccination policy only if it is considered both safe and cost-effective.

Our approach

Professor Matt Keeling has substantial experience modelling the spread and control of infectious diseases. As a member of the JCVI from 2010, and with input from a Warwick Patient and Public Involvement (PPI) panel to advise on model assumptions, Keeling led a programme with colleagues in Warwick Medical School to assess cost effectiveness of a gender-neutral HPV vaccination campaign. This was evaluated by:

• Reviewing the cost effectiveness of the pre-existing vaccination strategy which targeted 12-13 year old girls

• Simulating transmission of sexually transmitted diseases based upon the National Surveys of Sexual Attitudes and Lifestyles (Natsal)

• Extending cost effectiveness modelling to consider vaccines which protect against 2, 4 or 9 strains of HPV, and gender-neutral vaccination

Our impact

Based on the recommendations from the Warwick model, the JCVI Statement on HPV vaccination in July 2018 recommended extending the HPV vaccination programme to include adolescent boys in the UK for the first time. Between September 2019 and March 2020, gender-neutral HPV vaccination started in 83% of the 150 local authorities in England. In addition, 5% of these fully completed the programme before school closures began due to the COVID-19 pandemic in March 2020, which produced a temporary pause in the campaign. Despite these difficult circumstances, the gender-neutral HPV vaccination programme succeeded in covering an impressive 54.4% of year 8 boys in England, around 170,000 individuals, with the recommended priming dose.

The switch to a gender-neutral national policy on vaccination against HPV in the UK is predicted over the next 50 years to lead to the prevention of approximately:

• 5800 cases of oropharyngeal cancer,

• 4000 cases of cervical cancer,

• 2000 cases of anal cancer,

• 1000 cases of penile cancer,

• 25,000 cases of cervical intraepithelial neoplasia, and

• 230,000 cases of genital warts.

Learn more about HPV vaccination research at Warwick

JCVI statement on HPV vaccination in 2018