Vaccine update: issue 326, April 2022, HPV special edition
Published 26 April 2022
Applies to England
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Gay and bisexual men and those aged 15 and over to receive 2 doses of the HPV vaccine. People with HIV or known to be immunocompromised will continue to receive 3 doses.
From Friday 1 April, gay and bisexual men and those aged 15 and over will only need to receive 2 doses of the human papillomavirus (HPV) vaccine instead of 3 to be fully vaccinated, based on advice from the Joint Committee on Vaccination and Immunisation (JCVI).
The vaccine helps to prevent HPV infection which can cause genital warts and HPV-associated cancers such as cervical cancer, some other cancers of the genital areas and anus and some cancers of the head and neck. Those who are eligible for the HPV vaccine can get it free on the NHS up until their 25th birthday.
There is also a HPV vaccination programme for gay and bisexual men and other men who have sex with men (MSM) up to 45 years of age, who attend sexual health or HIV clinics.
The routine adolescent HPV vaccination programme, offered to 12 to 13 year olds in school, has been following a 2-dose schedule since September 2014. In May 2020 the JCVI, who regularly review all vaccination programmes, advised that the 2-dose schedule could be extended to adults as the evidence showed 2 doses offers good protection in older individuals. The 2 doses should be given at least 6 months apart.
The committee also advised that the 3-dose schedule should continue to be offered to eligible individuals living with HIV or known to be immunocompromised at the time of vaccination.
Dr Vanessa Saliba, Consultant Epidemiologist at UKHSA, said:
It is great news that from today almost all those eligible for the HPV vaccine will need just 2 doses to be fully vaccinated. This has already been the case for several years for 12 and 13 year olds but now the evidence is clear that 2 doses offers very good protection in all age groups.
We know that the HPV vaccine offers excellent protection against HPV infections and some cancers in men and women and we urge everyone who is eligible to get this potentially life-saving vaccine when it is offered. It also remains important for all women to attend their cervical screening appointment when they are invited as this can detect if you are at risk of cancer and save lives.
Main points about the changes to the programme
Update on the UK programme
There is growing evidence of the success of the programme so far. In 2018, 10 years after the introduction of the programme, the prevalence of HPV types 16/18 in 16 to 18 year old women in England who were offered vaccination at age 12 to 13 years had reduced substantially to less than 2% (compared to over 15% prior to the vaccination programme in 2008). A 2018 Scottish study showed that the vaccine has reduced pre-cancerous cervical disease in 20 year old females by up to 71%. In England, diagnoses of genital warts have declined by 91% and 81% between 2015 and 2019 in 15 to 17 year old girls and boys, respectively (the latter demonstrating herd protection). From September 2019 the adolescent HPV vaccination programme became universal with 12 to 13 year old males becoming eligible alongside females.
In June 2020, following the impact of the first wave of the coronavirus (COVID-19) pandemic, school-aged immunisation providers commissioned by NHSE were able to implement their restoration and recovery plans to commence catch-up of partially or incomplete programmes during the summer period. This included delivery of programmes in school and community settings.
During the 2020 to 2021 academic year, school-aged providers have continued to catch up the 2019 to 2020 academic year pupils, alongside the current year. We would like to take this opportunity to thank all involved for their hard work to continue to deliver the HPV immunisation programme during this challenging time.
Why the vaccine has been changed
The vaccine supplied for the programme will change from Gardasil® to Gardasil® 9 during the 2021 to 2022 academic year. UKHSA will continue to supply vaccine for the HPV programme in the usual way and will issue the remaining central supplies of Gardasil® before the switch to Gardasil® 9. This change will affect both arms of the HPV programme (adolescents aged 12 to 13 years and those who remain eligible until their 25th birthday, and MSM up to 45 years of age).
For the school-based programme in particular, there will need to be clear communication with parents and eligible adolescents and robust arrangements in place to ensure the consent process is adequate for this transition period during the 2021 to 2022 academic year.
The 9-valent vaccine Gardasil® 9 (manufactured by Merck Sharp & Dohme Limited (MSD)) received licensing approval from the European Medicines Agency (EMA) for a 2-dose schedule in adolescent girls in April 2016 and is licensed for individuals aged 9 up to and including 14 years of age (Summary of Product Characteristics (SPC), Gardasil 9).
For the 9-valent vaccine, the indication is based on:
- non-inferiority with the 4 vaccine types in the 4-valent vaccine for girls, women and men
- demonstration of efficacy against HPV types 31, 33, 45, 52 and 58 in girls and women
- demonstration of non-inferior immunogenicity against the Gardasil 9 HPV types in boys and girls aged 9 to 15 years and men aged 16 to 26 years, compared to girls and women aged 16 to 26 years
Gardasil® 9 can be used for all those eligible: adolescents aged 12 to 13 years and those who remain eligible until they turn 25 years of age, and MSM up to 45 years.
Cervical cancer rates are 87% lower in women who were offered vaccination against HPV when they were between the ages of 12 to 13 than in previous generations confirms a new study published in The Lancet.
The researchers also found reductions in cervical cancer rates of 62% in women offered vaccination between the ages of 14 to 16, and 34% in women aged 16 to 18 when vaccination was introduced. This is the first direct evidence of prevention of cervical cancer using the bivalent vaccine, Cervarix.
HPV vaccination has been introduced in 100 countries as part of efforts by the World Health Organization (WHO) to eliminate cervical cancer. England initially used a bivalent vaccine which protects against the 2 most common types of HPV, responsible for approximately 70 to 80% of all cervical cancers.
The English HPV vaccination programme was introduced in 2008, with vaccines given to women between 12 to 13 years old and ‘catch-up’ vaccinations offered to older age groups up to the age of 18.
During the study period, 28,000 diagnoses of cervical cancer and 300,000 diagnoses of CIN3 were recorded in England. In the 3 vaccinated cohorts there were around 450 fewer cases of cervical cancers and 17,200 fewer cases of CIN3 than expected in a non-vaccinated population.
The research found reductions in cervical cancer rates of 87% (with a confidence interval of 72 to 94%) in women targeted between the ages of 12 to 13 (89% of whom received at least 1 dose of the HPV vaccine and 85% of whom had received 3 jabs and were fully vaccinated), 62% (CI: 52 to 71%) in women potentially vaccinated between the ages of 14 to 16, and 34% (CI: 25 to 41%) in those eligible for vaccination between the ages of 16 to 18 (60% of whom received at least 1 dose and 45% of whom were fully vaccinated).
The corresponding reductions in CIN3 rates were 97% in women vaccinated between the ages of 12 to 13, 75% in women vaccinated between the ages of 14 to 16 and 39% in women vaccinated between the ages of 16 to 18.
Dr Kate Soldan from UKHSA and co-author says:
This study provides the first direct evidence of the impact of the UK HPV vaccination campaign on cervical cancer incidence, showing a large reduction in cervical cancer rates in vaccinated cohorts. As expected, vaccination against HPV was most effective in the cohorts vaccinated at ages 12 to 13 amongst whom the uptake was greatest and prior infection least likely.
This represents an important step forwards in cervical cancer prevention. We hope that these new results encourage uptake as the success of the vaccination programme relies not only on the efficacy of the vaccine but also the proportion of the population vaccinated.
It is important to note that the 2 most common HPV infections which the bivalent vaccine protects against are present in as many as 92% of women diagnosed with cervical cancer before the age of 30.
It should also be noted that the bivalent vaccine Cervarix was used in the UK from 2008 to 2012. Since September 2012, the quadrivalent vaccine Gardasil has been used instead.
Writing in a linked comment, Professor Maggie Cruickshank from the University of Aberdeen (UK), who was not involved in the study, says:
The scale of HPV vaccination effect reported by this study should stimulate vaccination programmes in low and middle-income countries where the problem of cervical cancer is a far greater public health issue than those with well-established systems of vaccination and screening.
The most important issue, besides the availability of the vaccine (related to the decision-makers in the health policy), is the education of the population to accept the vaccination, as an increase in the rate of immunisation is a key element of success.
Samantha Dixon, Chief Executive, Jo’s Cervical Cancer Trust says:
It is so exciting to have eliminating a cancer within our sights. We have the tools to do so with vaccination and screening, and the latest research on the success of the HPV vaccine on reducing diagnoses among young women is incredibly positive. However, we have a mountain to climb on the way there and cannot afford to be complacent.
While national uptake statistics have been largely high over the years, there remain widespread inequalities in access and uptake with some groups far less likely to have a vaccine or attend screening. We are also living through a time of high vaccine mistrust and face ongoing disruption to delivery of the vaccination as a result of COVID-19.
The WHO has launched a global call for action to eliminate cervical cancer and it’s fantastic to see the potential recognised on an international stage. At Jo’s, we urge governments to put cervical cancer elimination in their strategies and to invest in the resources and technology to ensure we are providing the most effective programmes possible.
HPV vaccine dramatically reduces cervical cancer
The UK HPV vaccine programme works and will save lives, according to Cancer Research UK.
In the first study to show its impact, published in the Lancet, the vaccine was shown to dramatically reduce cervical cancer rates by almost 90% in young women in their 20s who were offered it at age 12 to 13.
The study, which was funded by Cancer Research UK, shows the potential for HPV vaccination and cervical screening to reduce cervical cancer to the point where almost no-one develops it.
The researchers, from King’s College London and UKHSA (published previously under Public Health England), estimate that the HPV vaccination programme prevented around 450 cervical cancers and around 17,200 pre-cancers over an 11-year period.
The study, published in the Lancet, looked at all cervical cancer diagnosed in England in women aged 20 to 64 between January 2006 and June 2019. The vaccine reduced cervical cancer incidence by 34% in those who had the vaccine aged 17 to 18 and by 62% in those who received the vaccine aged 15 to 16.
Almost all cervical cancers are caused by HPV and the HPV vaccine protects against the main cancer-causing strains of the virus. Protecting girls against the infection helps to prevent abnormal changes in cervical cells, leading to fewer cases of cervical cancer.
The vaccine is most effective when given between the ages of 11 and 13 when someone is less likely to have been exposed to HPV. The virus is linked to other cancers including vaginal, vulval, anal, penile and some head and neck cancers.
Since 2008, girls aged 11 to 13 in the UK have been offered a vaccination against the 2 most common ‘high-risk’ types of HPV: HPV 16 and 18. Since September 2019, all children aged 11 to 13 in the UK can get the HPV vaccine. And anyone who missed their vaccine can request it through the NHS up to the age of 25.
Around 3,200 cases of cervical cancer are diagnosed in the UK each year.
Professor Peter Sasieni, lead author from King’s College London, said:
It’s been incredible to see the impact of HPV vaccination, and now we can prove it prevented hundreds of women from developing cancer in England. We’ve known for many years that HPV vaccination is very effective in preventing particular strains of the virus, but to see the real-life impact of the vaccine has been truly rewarding.
Assuming most people continue to get the HPV vaccine and go for screening, cervical cancer will become a rare disease. This year we have already seen the power of vaccines in controlling the COVID-19 pandemic. Now we have evidence of how they can also be used prevent some cancers.
Michelle Mitchell, Cancer Research UK’s chief executive, said:
Results like this show the power of science. It’s a historic moment to see the first study showing that the HPV vaccine has and will continue to protect thousands of women from developing cervical cancer.
Cancer Research UK has been funding research in this area for many years and we’ve been eagerly waiting for these results since the introduction of the vaccination programme. Around 860 women die from cervical cancer each year, so we are on target to save many lives.
For further information about Cancer Research UK’s work or to find out how to support the charity, please call 0300 123 1022 or visit Cancer Research UK.
You can also follow the charity on Twitter (@CRUKresearch and @CR_UK) and Facebook.
Home schooled children
Registration might help identify children and young people who miss in schools vaccinations for flu, MenACWY, teenage boosters and HPV vaccinations.
HPV vaccine and sexual behaviour
There is no evidence that the HPV vaccine will impact future behaviour.
Some parents worry that giving their children the HPV vaccine may lead them to have sex sooner or to have more partners, but there is no evidence supporting this. Studies show that young people who have received the HPV vaccine do not start having sex sooner and do not have more sexual partners than those who do not get the vaccine.
Giving a child the HPV vaccine reduces the risk of cervical, other cancers and genital warts. Having the HPV vaccine is a positive step to improve future health and wellbeing.
Children who have missed their HPV vaccinations
Children and young people (CYP) who have missed their 2 doses of HPV vaccine should be encouraged to attend further School Age Immunisation Service (SAIS) sessions, or to contact their GP practice to catch up if they have now left school. In addition to being off sick due to COVID-19 or other infections there can be many reasons why a CYP missed their vaccinations.
CYP who are home-schooled, excluded or not attending school, or who have a learning disability or experience autism, should also be encouraged to have their vaccines. It may be helpful to advise parents who delay, to set a reminder so that their child does not miss out on the important cancer prevention vaccine.
Professor Helen Bedford (University College London (UCL) Great Ormond Street Institute of Child Health) opinion:
HPV jab cuts cervical cancer cases by almost 90% but 1 in 10 girls still haven’t had it.
Green book on immunisation – HPV chapter 18a
The chapter has been revised to include the changes to the schedule and includes previous revisions.
Training and guidance
HPV vaccination guidance for healthcare practitioners version 6. Please note this is HTML only. It can be printed but is not available as a PDF.
HPV (universal) adolescent vaccination programme guidance and MSM vaccination programme guidance for healthcare practitioners have been combined into one document. It includes information about Gardasil 9 vaccine for the adolescent programme and eligibility, scheduling and vaccine administration for both programmes.
Slide sets for the universal HPV vaccination programme and HPV MSM programme to accompany the guidance above are available to download.
HPV universal factsheet for health professionals.
HPV cervical cancer factsheet.
Other resources relating to the universal HPV vaccination programme and the HPV MSM programme are available.
Information on Gardasil® 9
Whether Gardasil® is inferior to Gardasil® 9
Gardasil® has been shown to be highly effective in preventing the types of HPV infection for which it is indicated. Evidence from clinical trials has shown that protection is maintained for at least 10 years but is expected to last much longer and may be lifelong.
Gardasil® has been shown to give good protection against HPV types 16 and 18 which account for around 70% of all cervical cancers and HPV6 and HPV11, the 2 HPV types that cause approximately 90% of all anogenital warts in males and females.
In clinical trials in young women with no previous history of HPV infection, the vaccine was 99% effective at preventing pre-cancerous lesions associated with HPV types 16 and 18. Gardasil® is also 99% effective at preventing genital warts associated with vaccine types in young women.
Further information on Gardasil® 9
A complete list of ingredients for the Gardasil® 9 vaccine is given in the Patient Information Leaflet (PIL). The Summary of Product Characteristics (SPC).
You can read more about the main questions and answers relating to Gardasil® 9.
Adolescent collection (HPV, MenACWY and Td/IPV) user guidance 2020 to 2021.
Latest published coverage data:
Vaccine coverage
Adolescent HPV immunisation programme – vaccine coverage collection
The routine HPV vaccine coverage collection for the adolescent programme should not be impacted by the changes.
Dose 1 and dose 2 coverage of HPV vaccine will continue to be evaluated for both males and females in school year 8 (ages 12 to 13 years old) and year 9 (ages 13 to 14 years old) as part of the routine universal programme.
HPV coverage is based on aggregated school-level data. The data is entered manually on a secure web platform called ImmForm. Vaccination type is not recorded.
Guidance for the 2020 to 2021 annual survey was updated and is available on GOV.UK
Annual HPV coverage reports are available GOV.UK.
MSM HPV immunisation programme – vaccine coverage collection
HPV vaccination uptake collections for the MSM programme will not be significantly impacted by the changes announced in this letter.
Vaccine coverage (uptake and completion) will continue to be evaluated for MSM aged up to and including 45 years attending specialist sexual health services (SSHS) and HIV clinics.
HPV vaccination data for MSM is entered for all attendances via the GUMCAD and HARS mandatory reporting systems for SSHS and HIV clinics, respectively.
Annual reports of HPV vaccination uptake in MSM are available on GOV.UK.
HPV videos
The year 8 HPV vaccine video
This HPV vaccine video is available to view on NHS YouTube.
In this video immunisation nurse Michele Olphonse explains about the HPV vaccination programme. This can be shown to parents and children in any school settings. It can be shown to introduce the HPV vaccine programme to year 8 children and their parents at parents’ evenings. School teams can offer for it to be shown in assemblies, school lessons and uploaded to the school’s intranet or website. Families who home school their children should also be encouraged to watch it and make an appointment with their GP for their son or daughter to have their 2 doses of HPV vaccine.
You can download this video using product code HPV050 and show it offline so that you do not need to stream it live in areas where you have low bandwidth, no internet or poor internet connectivity. Both videos can also be added to websites and shared on social media (use the YouTube link).
Arm against cancer in school video
This short video explains the HPV vaccination programme benefits, shows the vaccination process and valuable feedback from the girls and boys about the experience. It is suitable for social media, school immunisation teams, school teachers and support staff and all health professionals to use to promote the programme.
This video is available to download using product code 2019227.
HPV resources for the universal programme
These HPV resources for the universal (adolescent) programme are available to order or download:
HPV vaccination resources for gay, bisexual and MSM
HPV vaccination leaflet and posters for the MSM programme.
These resources are live on the Health Publications website ready for ordering. The product codes are as follows:
- poster should be displayed in all MSM Specialist Sexual Health Services who offer the vaccination – product code 2021HPV2P
- leaflet should be given to all eligible MSM – product code 2021HPV2EN
- record card should be given to all patients at their vaccination appointment and to remind them of their next or final appointment – product code 2021HPV2
Resources for health professionals
Resources for health professionals available to download:
- incomplete vaccination algorithm
- guidance for healthcare practitioners
- MSM programme training slide set
- universal programme training slide set
- HPV immunisation programme changes from April 2022 letter to the health system
- May 2020 HPV subcommittee minutes
Further information and resources
The information on the HPV vaccination programme has been updated across the following pages on NHS.UK which mentioned the need to (previously) have 3 doses:
Who should have the HPV vaccine?
Vaccine supply
HPV vaccine:
- MSD: Gardasil has been discontinued (please refer to ImmForm for NIP supply status)
- MSD: Gardasil 9 is currently available
- GSK: Cervarix has been discontinued
Registering for a new or updating your existing ImmForm vaccine ordering account
When you register for or update an existing ImmForm account, UKHSA as a wholesaler of vaccines need to verify the requesting customer.
Please ensure you have your professional regulatory body registration number or Wholesaler Dealer Licence and an organisation code which can be verified when requesting updates or requesting a new vaccine ordering account.
For more information please see the ImmForm Helpsheet – how to register
Movianto UK drivers delivering centrally supplied products are not able to phone delivery points
Please note that Movianto UK drivers delivering centrally supplied products are not able to phone a delivery point upon arrival at the delivery location. Customers are expected to make arrangements ahead of the scheduled delivery day to receive their deliveries.