Thank you very much, Deputy Presiding Officer, and I'm pleased to open this debate today on expanding the use of the human papilloma virus vaccine, which was the first to be developed to be used against cancer. In anyone's book, that is a major development. To a certain extent, of course, we are taking advantage of that major development because it is offered to young women at the moment and to men who have sex with men. But we're not yet providing this vaccination to adolescent boys, despite the clear evidence of the effectiveness of this vaccine in preventing serious cancers, including head and neck cancers. Using this vaccine more broadly would also enhance the protection for women against cervical cancer.

I'll turn immediately to the Government amendment, which more or less says that they will reject the findings of Cancer Research UK and every oncologist in the country, as far as I can see, and will wait for the Joint Committee on Vaccination and Immunisation recommendations instead. But I have no doubt, if truth be told, what that recommendation will be, which poses the question: why wait? But I do think that it is not only fair but also important to return to the earlier JCVI recommendation not to roll out this vaccination more broadly, and why they made that recommendation, because it does raise some fundamental questions, I think. Are the methods that we currently have of analysing cost-effectiveness—nobody doubts the clinical effectiveness—are those methods truly appropriate for this age?

The previous rationale of the JCVI for not expanding this programme was that they believed that the benefits of vaccination would be expanded to boys in any case, as vaccinating many young women would provide herd immunity for boys too. But we believe that this conclusion is deficient for many reasons, and I will go through them. It is based on the assumption that a very high level of girls would receive the vaccination—something that unfortunately isn't the case because of the huge variations between various groups, and it is something that could be put at risk by one scare story about a vaccination, as we do see appearing in the press from time to time. It assumes that the responsibility for providing herd immunity and the prevention of sexually-transmitted diseases should be placed on the shoulders of girls and women. Why not argue, for example, that a boys-only vaccination programme would be sufficient in providing this defence to girls and women? Thirdly, there are far too many women and girls, as I was saying, that haven't been vaccinated and can transfer the virus to boys and men who would have been protected if they had been vaccinated themselves. Fourthly, the view of the JCVI was based, it appears, on heteronormative presumptions, namely that every man is heterosexual. I think this is recognised partially by the decision taken in due time to extend vaccination to MSM. That was a decision taken separately. It is concerning and it could also be dangerous only to provide vaccinations to men who are willing to reveal their sexuality, and by assuming that this isn't a problem the JCVI shows the need for greater equality training in the health sector.

Vaccinating boys, as I say, would provide higher levels of herd immunity among women and girls, so there would be benefits to women and girls from the vaccination of boys. The evidence of efficiency in preventing other cancers has also been strengthened since the original analysis, and it's important to note that, and it's likely to become even stronger over time. If the vaccine wasn't already in use, then I think the conclusions of the JCVI on introducing a mass programme across the board for girls and boys would be different. If it were to be introduced anew now, then I'm sure that it would be provided universally.

Finally, in considering the outcome of the cost-efficiency evaluation, I believe that there is a grave underestimation of the cost-efficiency of introducing a vaccination for boys. The reason for that is that I believe that the benefit doesn't come until much, much further down the line. The cost is paid now, of course, in providing the vaccination, but it's possible that the cancer won't be prevented for 50 years. Now, I fear that the processes of measuring cost-efficiency are failing to deal with that kind of delay in outcomes, and I think the JCVI itself notes these outcomes and the fact that, in a way, their hands are tied, because in their interim analysis they say this: