Chamber
Plenary, 01 Feb 2007
01 Feb 2007 · S2 · Plenary
Item of business
Cervical Cancer
I am happy to speak in this debate on an issue that I think is going to become a medical hot topic. The first paragraph of the briefing that members have received from Cancer Research UK Scotland states:
"The advent of a vaccine against Human Papilloma Virus (HPV) is a very exciting development for cancer research and cancer prevention. HPV vaccination has the potential to prevent the majority of cases of cervical cancer in the UK."
That makes it sound as though we have solved the problem of cervical cancer, does it not? Unfortunately, the situation is not quite like that. As Ken Macintosh eloquently argued, we need to continue with our screening programme because the effects of the vaccine will take many years to show because it is effective only in preventing infection in young girls who are not already affected. There is no evidence that the vaccine will be effective in eradicating the virus in those who have already acquired it.
Despite our effective screening programme, people still die of cervical cancer. Cervical cancer accounts for only 1 per cent of cancer deaths, but it is the second most common cancer in women under 35 in the United Kingdom. As Ken Macintosh said, that means that families are left without mothers and so on. That is awful, so we need to continue screening. Although people are being treated for precancerous conditions and are being treated successfully for cancers, screening will still be needed in the long term. I endorse what Ken Macintosh said about ensuring that the screening reaches groups who are traditionally hard to reach and among whom there is lower take-up of screening. The vaccine could, theoretically, prevent 70 per cent of cervical cancers that are directly due to the strains of human papilloma virus against which it will confer immunity. However, there will be some cancers that the vaccine will not prevent.
There are some practical issues on which it would be interesting to see what the JCVI has to say. For example, there is the issue of the age at which the vaccine should be given. It should be given before a girl becomes sexually active—there is no evidence that it will be effective in eradicating the virus when it has already been acquired, so it is not a treatment for people who already have the virus. There is also the question of the length of immunity and whether further doses of the vaccine will be needed. Given that the vaccine will be administered to young people, there is a question about whether the immunity will be lifelong or will need to be boosted.
Another question is whether boys should be vaccinated. Ken Macintosh talked about herd immunity, so the question arises whether we should be attempting to eradicate the virus from the population. Most immunisation programmes attempt to do that, so I think it would be more logical to vaccinate boys and girls. There is also the question of whether a catch-up campaign should be instituted and who should be part of it, given that it would probably not be effective for people who already have the virus.
Acceptability has been touched on. I am encouraged that the research so far suggests that the vaccine will be widely acceptable. In the past, there has been concern among parents groups about the number of vaccines that are being given, but that is really about baby vaccines and about many vaccines being given within a short time. I suspect that the HPV vaccine—which I imagine will be given to girls in early adolescence, who will not be being given other immunisations—should be more acceptable.
On HPV's being a sexually transmitted disease and the suggestion that vaccination would encourage unprotected sex, I do not believe that that should be any sort of objection. The goal is cancer prevention. For many years, I helped to give the rubella vaccine to 12-year-old girls, which was meant not to protect them, but to protect their unborn children. No concern was expressed that the vaccine would encourage them to get pregnant. There are probably one or two people out there who are happy to contemplate their daughters becoming pregnant at a future date, but who cannot ever contemplate their being sexually active. That is a paradox of Scottish society.
There are other issues, such as the cost of the vaccine, which I think is within the limits that Parliament would accept, considering the savings that would be made further down the line. There are, however, costs for poorer countries where the vaccine is really needed—where there is a less-effective screening programme, where more people are dying and where the vaccine will be needed even more than it is in East Renfrewshire.
I very much welcome the debate tonight. I also welcome the on-going discussion and publicity surrounding the vaccine and the national debate that will have to take place in the lead-up to the introduction of the vaccine.
"The advent of a vaccine against Human Papilloma Virus (HPV) is a very exciting development for cancer research and cancer prevention. HPV vaccination has the potential to prevent the majority of cases of cervical cancer in the UK."
That makes it sound as though we have solved the problem of cervical cancer, does it not? Unfortunately, the situation is not quite like that. As Ken Macintosh eloquently argued, we need to continue with our screening programme because the effects of the vaccine will take many years to show because it is effective only in preventing infection in young girls who are not already affected. There is no evidence that the vaccine will be effective in eradicating the virus in those who have already acquired it.
Despite our effective screening programme, people still die of cervical cancer. Cervical cancer accounts for only 1 per cent of cancer deaths, but it is the second most common cancer in women under 35 in the United Kingdom. As Ken Macintosh said, that means that families are left without mothers and so on. That is awful, so we need to continue screening. Although people are being treated for precancerous conditions and are being treated successfully for cancers, screening will still be needed in the long term. I endorse what Ken Macintosh said about ensuring that the screening reaches groups who are traditionally hard to reach and among whom there is lower take-up of screening. The vaccine could, theoretically, prevent 70 per cent of cervical cancers that are directly due to the strains of human papilloma virus against which it will confer immunity. However, there will be some cancers that the vaccine will not prevent.
There are some practical issues on which it would be interesting to see what the JCVI has to say. For example, there is the issue of the age at which the vaccine should be given. It should be given before a girl becomes sexually active—there is no evidence that it will be effective in eradicating the virus when it has already been acquired, so it is not a treatment for people who already have the virus. There is also the question of the length of immunity and whether further doses of the vaccine will be needed. Given that the vaccine will be administered to young people, there is a question about whether the immunity will be lifelong or will need to be boosted.
Another question is whether boys should be vaccinated. Ken Macintosh talked about herd immunity, so the question arises whether we should be attempting to eradicate the virus from the population. Most immunisation programmes attempt to do that, so I think it would be more logical to vaccinate boys and girls. There is also the question of whether a catch-up campaign should be instituted and who should be part of it, given that it would probably not be effective for people who already have the virus.
Acceptability has been touched on. I am encouraged that the research so far suggests that the vaccine will be widely acceptable. In the past, there has been concern among parents groups about the number of vaccines that are being given, but that is really about baby vaccines and about many vaccines being given within a short time. I suspect that the HPV vaccine—which I imagine will be given to girls in early adolescence, who will not be being given other immunisations—should be more acceptable.
On HPV's being a sexually transmitted disease and the suggestion that vaccination would encourage unprotected sex, I do not believe that that should be any sort of objection. The goal is cancer prevention. For many years, I helped to give the rubella vaccine to 12-year-old girls, which was meant not to protect them, but to protect their unborn children. No concern was expressed that the vaccine would encourage them to get pregnant. There are probably one or two people out there who are happy to contemplate their daughters becoming pregnant at a future date, but who cannot ever contemplate their being sexually active. That is a paradox of Scottish society.
There are other issues, such as the cost of the vaccine, which I think is within the limits that Parliament would accept, considering the savings that would be made further down the line. There are, however, costs for poorer countries where the vaccine is really needed—where there is a less-effective screening programme, where more people are dying and where the vaccine will be needed even more than it is in East Renfrewshire.
I very much welcome the debate tonight. I also welcome the on-going discussion and publicity surrounding the vaccine and the national debate that will have to take place in the lead-up to the introduction of the vaccine.
In the same item of business
The Deputy Presiding Officer (Trish Godman):
Lab
The final item of business today is a members' business debate on motion S2M-5359, in the name of Ken Macintosh, on cervical cancer and the human papilloma v...
Motion debated,
That the Parliament welcomes the licensing of the first vaccine against strains of the human papilloma virus (HPV) responsible for around 70% of cases of cer...
Mr Kenneth Macintosh (Eastwood) (Lab):
Lab
I thank all the members who are present for the debate and the 50 or so members who have signed the motion on cervical cancer and the human papilloma virus. ...
Shona Robison (Dundee East) (SNP):
SNP
The member will be aware that the Joint Committee on Vaccination and Immunisation—I hope that I have got the name right—will have its next meeting on 14 Febr...
Mr Macintosh:
Lab
I agree whole-heartedly. The member has identified one course of action on which we can press the minister.The JCVI has still to decide on the vaccination pr...
Christine Grahame (South of Scotland) (SNP):
SNP
I congratulate Ken Macintosh on securing this very important debate and on his commitment to the cross-party group on cancer. I do not know whether Shona Rob...
Eleanor Scott (Highlands and Islands) (Green):
Green
I am happy to speak in this debate on an issue that I think is going to become a medical hot topic. The first paragraph of the briefing that members have rec...
Dr Jean Turner (Strathkelvin and Bearsden) (Ind):
Ind
I thank Ken Macintosh for securing such an important debate.A lot of good words have already been said, and from the practical point of view of having done c...
Mr Macintosh:
Lab
Does Jean Turner agree that, although the cervical cancer screening programme has been dramatically successful in reducing the number of deaths and in reassu...
Dr Turner:
Ind
Ken Macintosh is right, and I think that it was mentioned that familiarity sometimes breeds contempt. People can just come along and get their smear, but the...
Mrs Nanette Milne (North East Scotland) (Con):
Con
I will be fairly brief because a lot of what I was going to say has already been said. I am pleased to have the opportunity to speak, and I add my congratula...
Ms Maureen Watt (North East Scotland) (SNP):
SNP
I will be brief, because most of what I wanted to say has already been said. I, too, thank Ken Macintosh for bringing the debate to the chamber. As others ha...
The Deputy Minister for Health and Community Care (Lewis Macdonald):
Lab
I, too, thank Ken Macintosh for his opening remarks and for bringing this debate to the chamber, and I thank members for their constructive contributions on ...
Ms Watt:
SNP
Are any programmes specifically designed for women from ethnic minorities? I know that they find it particularly difficult.
Lewis Macdonald:
Lab
Yes. I recognise, as has been said by a couple of members, that among certain groups that is an issue. Boards recognise that and deal with it on a case-by-ca...
Meeting closed at 17:44.