The World Health Organization is calling on countries that are vaccinating boys against the human papillomavirus (HPV) to suspend these programmes until all girls who need the vaccine can get it.
The recommendations from WHO’s Strategic Advisory Group of Experts on immunisation (SAGE), come just months after the UK began immunising boys aged 12-13 against the virus.
“SAGE was deeply concerned that the current HPV vaccine shortage could result in failure to introduce or sustain programmes in some countries, particularly those with a high burden of cervical cancer,” the group said in WHO’s
Weekly Epidemiological Record of 22 November.
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HPV causes most cases of cervical cancer and the vaccine, first introduced in the US in 2006, has proven so effective that WHO says it could, in combination with screening, eliminate cervical cancer worldwide by the end of the century.
But global demand has soared in recent years and MSD, which produces Gardasil, and GlaxoSmithKline, which makes Cervarix, have been unable to keep up. 2018 saw a shortfall of 6% and that is expected to rise to 32% by 2022.
MSD and GSK say that they are investing in increasing their manufacturing capacity, but the process of making vaccines is complex and WHO predicts supply will not meet demand before 2024.
MSD says half of all doses are going to lower and middle income countries and that should increase to 60% by the end of this year.
Yet of the 115 countries which have begun immunisation programmes (the richest paying as much as $154 (£119; €140) per dose) only 13 low income countries have introduced the vaccine (some paying as little as $4.50 per dose) despite having some of the highest rates of cervical cancer.
Meanwhile, countries that can afford to (including Australia, Austria, Bermuda, Brazil, Canada, Croatia, Germany, Israel, Italy, Lichtenstein, New Zealand, Serbia, the UK, and the US) have begun “gender neutral” immunisation programmes and programmes for older girls and women based on growing evidence this improves protection not just against cervical cancer but cancers of the genital areas, throat, neck, head, and mouth.
In the context of a limited supply of HPV vaccine “all countries should temporarily pause implementation of gender neutral, older age group, and multi-age cohort HPV vaccination strategies until supply allows equitable access by all countries,” SAGE said. It is also recommending several strategies for making existing supplies of the vaccine go further.
Asked whether it would consider suspending the UK programme for boys, the Department of Health and Social Care was unable to comment because of purdah ahead of national elections. The recommendations should be considered at the next meeting of the joint committee on immunisation and vaccination in February 2020.
Modelling produced by the University of Warwick estimates that by 2058 in the UK the HPV vaccine programme currently being used (vaccinating both girls and boys) may have prevented up to 64 138 HPV related cervical cancers and 49 649 other HPV related cancers.
Since the launch of the programme for boys in the UK in September, there have been growing calls from patient organisations and websites like jabsfortheboys.uk, which is funded by MSD, for older cohorts of boys to be included in the national programme.
“There are lots of calls for boys to be vaccinated. Those arguments make perfect sense if you’re in a world where there is enough for everyone,” said Mark Jit, professor of vaccine epidemiology at the London School of Hygiene and Tropical Medicine, who conducted some of the work to inform SAGE’s recommendations.
“People making decisions in countries about who to vaccinate need to become more aware that there is currently not enough for all the girls who need it.”
