'Completely unethical': Women excluded from life-saving vaccine in Scotland

[IwantToRetire]

Women in Scotland are being left at risk of a killer cancer because of the refusal to fund a preventative vaccine through the NHS, according to a leading medical ethicist.

Females aged 26-45 are currently excluded from the HPV vaccine which protects against cervical cancer and genital warts even though it is offered to men in high-risk groups in the same age category.

Yet women are most at risk for deaths from cancers related to the human papillomavirus (HPV), according to Dr Cristina Richie, a lecturer in ethics at the University of Edinburgh.

Continues at https://uk.news.yahoo.com/completely-unethical-women-excluded-life-050000270.html

I cant quite work out from the article whether in fact this is the situation throughout the UK.

'Men who have sex with men, transmen and transwomen up to the age of 45 are also now eligible as they are all considered to be at high risk of catching the virus.'

Women may wish to identify as transmen in order to save £600.

I expect one could be a transman for a short period of time before detransitioning.

I don't really understand the ethicist's position. The vaccine works at preventing HPV infection only if transmission hasn't already happened. Which is why adolescents get the vaccine, before age of sexual maturity (UK wide, and in fact internationally as far as i can quickly googe). The article repeatedly mentions the vaccine is 'safe and effective' but does not reference studies re effectiveness - and this must be balanced against costs. Strikes me as a niche, and rather unevidenced, position.

If others know better I am keen to learn!

I would be interested to see the evidence on which vaccination of these groups has Bern based. Is the thinking that they reach sexual maturity later? Hmm.

No idea about this vaccine but if you’re ever having an operation you may find it useful to know that non binary people will be allocated an private/single room on the NHS…

Same info on NHS page

discussed on Reddit where it's said you might get it if you are a sex worker

looks like misogyny

it's partly chosen on the basis of who got it in trials

if no women were invited to trial aged between 26 and 45, that is also very odd

I do remember MPs saying gay men should be able to get it, I think that was when it was being given in schools

can't find anything specific to trans

wouldn’t it be even less useful for groups who are statistically having more unsafe sex and hence more likely to already have it? Despite being high risk, it’s too late? They give it to teenagers in Australia or at least they did when I was one for this reason. I have no idea where trans men or women sit but that does seem like it’s less useful for adult gay men on the whole than your average Joe.

But we should have data from who does and doesn't have it from first smear result. I cannot comprehend a reason that all those whose smears are not processed further than HPV neg should not be eligible for vaccine

Is it because when the HPV vaccine was first rolled out it was only administered to girls (if memory serves)? Meaning that more adult females have already been vaccinated than males?

there have also been more recent changes to the schedule, changing it from 2 doses to one.

I do wonder if there is some missing context here and it isn’t the problem it might appear to be.

"any transgender people who are felt to have the same risk as men who have sex with men"

Well that's bit of a poser isn't it because to claim in on that basis would having to say you are male?

https://www.nhs.uk/vaccinations/hpv-vaccine/

Its clearly spelt out in the article why it is being called unethical.

For females over the age of 25 and up to 64-years-old, the policy is to address the risk of cervical cancer through screening only, even though screening does not stop women contracting the disease.
Said Dr Richie: “The effects of cancer and other symptoms of HPV – like genital warts – are serious enough to expand access to the vaccine based on individual health alone.

“Women are most affected and a lot of it is just down to financial calculations. It is kind of horrible when you are thinking of things like cancer and life threatening diseases that you would just make a determination based on cost, especially when the NHS spends money on things that are not life-saving.

“Even if vaccinations were more expensive than cancer treatment, the terrible burden of a preventable and potentially lethal cancer in the face of a simple preventive strategy should take ethical priority.”

That’s what I thought, I’m 33 and had it in school.

It’s more effective to have the jag before being exposed to the virus (by having sex).. so less benefit if you’re older and more likely to have already been exposed to the virus.

So from public health Scotland, the targeted groups are

• age 11 - 13 although young people continue to remain eligible until age 25 if they missed the vaccine for any reason.
• men who have sex with men. (Due to the higher risks to men who have sex with men).

For an expensive vaccine, that isn’t an unreasonable decision in my view.

https://publichealthscotland.scot/population-health/health-protection/immunisation-vaccine-and-preventable-disease/immunisations-by-vaccine/hpv-immunisation/eligible-groups/children-aged-11-to-13/

By what metric are transmen considered at the same Torah as gay men?

Interesting question, Jelly. The correct answer should be that they are eligible up to age 25 just like other women.

But knowing how some people will interpret “men who have sex with men” It does seem likely that some captured folk will be offering it to females in a heterosexual relationship who say the magic words. I bet the NMC (who are equally captured) wouldn’t even consider it a drug error.

Just noticed the bizarre autocorrect in my post. Hope it's obvious that I meant to ask

By what metric are transmen considered at the same risk as gay men?

It is very concerning that medical guidance can be so manipulated by reality-denying ideology.

Sure, but that's not really telling us much about whether that particular viewpoint is correct.

Just because the same thing isn't done for both sexes doesn't always mean it's unfair, there can be all kinds of reasons that a policy like this could exist and make sense.

Unfortunately it's difficult to know without understanding how this came to be the policy.

My understanding has always been that once people of either sex have been sexually active for a time, HPV vaccination isn't very worthwhile. So in many places it's only given to adolescents.

So I am surprised it would be given to older men or older women.

That being said - if I were to make a guess, I would speculate that this came down to equity thinking.

For example, in my workplace we host a public service that is targeted to low income people, because others are expected to pay for the service.

But because of the "equity lens" they also offer it to certain named groups of people - immigrants, the black community, seniors, LGBTQ+, - because those groups are known to have more low income people (or some portion of the group, in the case of LBGTQ+).

Frankly, it's stupid, there are plenty of individuals from the "marginalized" groups who are very well off - there are extremely wealthy seniors, gay men are actually more likely to be rich - but they have access to the service.

In this case, I wonder if some idiot said, oh, gay men are marginalized, and more likely to get HPV cancers, so we need to allow them this service at any age, even though it is a waste of money.

Because all that is important is to be seen to be applying the equity lens.

But, as I said, that's a guess.

The FtM reddit boards are full of straight trans identified young women who cruise the male gay scene in search of validating 'gay' sex. They use Prep to prevent HIV and claim to be stealth. I suppose, depending on the acts performed, passing might be possible. But I suspect they underestimate the male sex drive and just how unfussy men who lurk in public cruising spots might be.

It turns my stomach to think of the risks to these young women, both immediate and long term health-wise.

Just because the same thing isn't done for both sexes doesn't always mean it's unfair, there can be all kinds of reasons that a policy like this could exist and make sense.

I suspect part of it is also thinking in terms of gender stereotypes its not that some men's sexual behaviour creates more dangers, but probably the thinking is also that men are more likely to having sex with more than one partner, whilst women are presumed to be sitting at home being demure.

It’s not though, when it doesn’t even discuss proportion of girls and boys vaccinated as teens or checking rates of contracting it. When I was younger they only vaccinated girls, I think recently they’ve started to vaccinate boys. There’s no useful data at all in that article really, It’s laughable to say it’s clearly spelt out reasoning. This is a policy that can only be made well if based on the data.

There’s no useful data at all in that article really

None of the article is about data.

It is just about the broad brush stroke of this groups rather than that group.

I am not saying I agree but the Doctor concerned is saying it would be better for women to be vaccinated than rely on a not always thorough screening and means they are already infected.

She is saying if men are worth the money (and various other groups) they are women not.

Why would anyone want to argue that action should only be taken once women are alreach infected.

Wouldn't expect FWR posters to be arguing women's health isn't equally important.

And again its in the article, the reason is of course cost.

But again, of course, it is always women who are meant to bare the costs of cuts.

But were the women already vaccinated at the period when it was effective ie before they started to have sex? And were the men not offered that as teens? That changes the game entirely from ‘leaving the women out.’

The HPV vaccine was initially given to schoolgirls, starting in the mid-2000s, it was given to schoolgirls with the premise that it needed to be given before the girl became sexually active. Boys were excluded, the thought was that if the girls were vaccinated the boys would also be protected. There was no thought to MSM. Hence the vaccine schedule developed for MSM (and trans) as they were excluded from the original schedule but the four strains of the virus linked to cervical cancer can also cause penile throat and rectal cancers so there was a definite need to cover this previously excluded group.
Boys are now, finally, included in the school vaccination schedule.
The 'girls only' school schedule pre-dates the 'MSM' schedule by over a decade so this is not an instance of MSM/ trans being favoured over women

This seems like basic and highly relevant data?

https://www.gov.uk/government/publications/human-papillomavirus-hpv-the-green-book-chapter-18a