Correspondence

HPV immunisation programme: introduction of Gardasil® 9 letter

Published 27 July 2021

NHS England - NHS Improvement Regional Directors

NHS England - NHS Improvement Directors of Commissioning

NHS England - NHS Improvement Directors of Public Health and Primary Care

NHS England - NHS Improvement Heads of Public Health Commissioning

NHS England - NHS Improvement Heads of Primary Care

NHS England - NHS Improvement / Public Health England Screening and Immunisation Leads

Clinical Commissioning Groups Clinical Leaders

Clinical Commissioning Groups Accountable Officers

General Practitioners

Local Medical Committees

Local Authority Chief Executives

Local Authority Directors of Public Health

For information:

Chief Pharmacists of NHS Trusts

NHS Foundation Trusts

NHS Trusts

27 July 2021

Changes to the vaccine of the Human papillomavirus (HPV) immunisation programme

Dear Colleague,

This letter provides information about forthcoming changes to the HPV immunisation programme. This letter is aimed at health professionals who are responsible for commissioning and delivering the programme. We encourage you to share this guidance with all those who are involved in delivering the national HPV vaccination programme in your area.

Main points about the changes to the programme:

1. Change to the vaccine: the vaccine supplied for the programme will change from Gardasil® to Gardasil® 9 during the 2021 to 2022 academic year. Public Health England (PHE) 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, which will occur at some point between late 2021 and early 2022. 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 men who have sex with men (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. Further details on supply can be found in Annex A.

2. Further detailed information and guidance for healthcare professionals is set out in Annex A.

3. Details on ImmForm vaccine coverage data collection are set out in Annex B.

4.  Annex C includes information on vaccination records and data capture.

5.  Available programme resources to support the change have been set out in Annex D.

6. Annex E includes a question and answer sheet to help you deal with questions that patients and their parents may ask about these changes.

If you have any queries about the content of this letter, please contact immunisation@phe.gov.uk

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. Due to the COVID-19 pandemic and the closure of all educational settings from 23 March 2020, the delivery of the 2019 to 2020 programme was paused. This had a significant impact on HPV vaccine uptake with 64.7% of year 9 females completing the 2-dose course in 2019 to 2020, compared with 83.9% in 2018 to 2019. HPV vaccine coverage for the priming dose in 2019 to 2020 was 59.2% in year 8 females (compared with 88.0% in 2018 to 2019) and 54.4% in year 8 males.

In June 2020, NHSE-commissioned, school-aged immunisation providers 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.

Deborah Tomalin

NHS England and NHS Improvement, Director of Public Health Commissioning and Operations

Dr Mary Ramsay

Public Health England, Head of Immunisation