English: 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:
Welsh: Diolch yn fawr iawn, Dirprwy Lywydd, ac rydw i'n falch o gael agor y ddadl yma heddiw am ehangu y brechlyn feirws papiloma dynol, sef y brechlyn cyntaf un i gael ei ddatblygu yn erbyn canser. Mae hynny, yn llyfrau unrhyw un, yn ddatblygiad mawr. I ryw raddau, wrth gwrs, mae yna fantais yn cael ei gymryd o'r datblygiad mawr yna drwy fod y brechlyn yn cael ei gynnig i ferched yn eu llencyndod, ac i ddynion sy'n cael rhyw efo dynion. Ond nid ydym ni, eto, yn cynnig y brechlyn yma i fechgyn ifanc, er gwaethaf y dystiolaeth glir iawn o effeithlonrwydd y brechlyn yn atal canser difrifol, gan gynnwys canserau'r pen a'r gwddf. Byddai defnyddio'r brechlyn yn ehangach hefyd yn ehangu'r amddiffyniad i ferched yn erbyn canser gwddf y groth. Gwnaf i droi yn syth at welliant y Llywodraeth, sydd fwy neu lai yn dweud eu bod nhw am anwybyddu argymhellion Cancer Research UK a phob oncolegydd yn y wlad, cyn belled ag y gwelaf i, a disgwyl am argymhellion y Cyd-bwyllgor ar Imiwneiddio a Brechu yn lle hynny. Nid oes gen i amheuaeth mewn difrif beth fydd yr argymhelliad yna, sydd yn gofyn y cwestiwn: pam aros? Ond rydw i yn meddwl ei bod hi nid yn unig yn deg ond yn bwysig i ailedrych ar argymhelliad cynharach y JCVI i beidio ag ehangu'r brechlyn, a pham y gwnaethon nhw'r argymhelliad yna, achos mae o'n codi materion go sylfaenol, rydw i'n meddwl. A ydyw'r dulliau presennol sydd gennym ni o ddadansoddi effeithiolrwydd cost - nid oes yna neb yn amau'r effeithiolrwydd clinigol - a ydyw'r dulliau yna wir yn addas ar gyfer yr oes yma? Rhesymau blaenorol y JCVI am beidio ehangu'r rhaglen oedd am eu bod nhw'n teimlo y byddai lles brechu yn cael ei ehangu i fechgyn beth bynnag, gan y byddai brechu lot o ferched yn darparu amddiffyniad heidiol sylweddol i fechgyn. Ond rydym ni'n credu bod y casgliad yma yn ddiffygiol am sawl rheswm. Mi af i drwyddyn nhw. Mae e wedi'i seilio ar y rhagdybiaeth y byddai yna lefel uchel iawn o ferched yn derbyn y brechlyn - rhywbeth sydd ddim yn wir, yn anffodus, oherwydd yr amrywiad anferth yna sydd yna rhwng gwahanol grwpiau, ac yn rhywbeth sy'n gallu cael ei roi mewn peryg gan un stori ddychryn am frechlyn, fel yr ydym ni yn gweld yn ymddangos yn y wasg o bryd i'w gilydd. Mae o'n cymryd yn ganiataol y dylai'r cyfrifoldeb am ddarparu amddiffyniad heidiol ac atal heintiau sy'n cael eu trosglwyddo'n rhywiol gael ei roi ar ferched. Pam ddim dadlau, er enghraifft, fod rhaglen frechu bechgyn yn unig yn ddigonol i ddarparu imiwnedd heidiol i ferched? Yn drydydd, mae yna'n dal nifer sylweddol o ferched, fel roeddwn i'n ei ddweud, sydd ddim wedi cael eu brechu ac felly a allai drosglwyddo'r feirws i ddynion a fyddai, fel arall, wedi cael eu hamddiffyn petasent wedi eu brechu eu hunain. Pedwar: mi oedd yn farn gan y JCVI a oedd yn seiliedig, mae'n ymddangos, ar ragdybiaethau heteronormadol, sef bod pob dyn yn heterorywiol. Mae hyn, rydw i'n meddwl, yn cael ei gydnabod yn rhannol gan y penderfyniad a ddaeth maes o law i ymestyn brechu MSM, a hynny'n benderfyniad a gafodd ei wneud ar wahân. Mae hi'n bryderus ac mi allai fod yn beryglus hefyd i ddim ond rhoi brechlyn i ddynion sy'n fodlon datgelu eu rhywioldeb, a drwy dybio nad yw hyn yn broblem mae'r JCVI, rydw i'n meddwl, yn dangos yr angen am hyfforddiant cydraddoldeb ehangach yn y sector iechyd. Mi fyddai brechu bechgyn, fel rydw i'n dweud, yn darparu lefelau uwch o imiwnedd heidiol ymysg merched, sy'n golygu y dylem ni ystyried y budd ychwanegol i ferched yn benodol o frechu bechgyn. Mae'r dystiolaeth wedyn o effeithlonrwydd mewn atal canserau eraill wedi cryfhau ers y dadansoddiad gwreiddiol. Mae hynny'n bwysig i'w nodi, ac mae yn debygol hefyd o fod yn gryfach byth dros amser. Os nad oedd y brechlyn eisoes yn cael ei ddefnyddio, rydw i'n meddwl y byddai casgliadau'r JCVI am gyflwyno rhaglen gyffredinol ar draws y boblogaeth ferched a bechgyn siŵr o fod yn wahanol. Hynny ydy, petasai'r brechlyn yn cael ei gyflwyno o'r newydd rŵan, rydw i'n siŵr mae rhaglen gyffredinol fyddai gennym ni. Yn olaf, wrth ystyried canlyniad y dadansoddiad effeithlonrwydd cost, rydw i'n meddwl bod yna danamcangyfrif difrifol o'r gost effeithlonrwydd cyflwyno brechlyn ar gyfer bechgyn. Y rheswm, rydw i'n meddwl, ydy oherwydd nad yw'r budd yn dod tan ymhell iawn i lawr y trac. Rŵan mae'r gost yn cael ei thalu o roi'r brechlyn, pan o bosibl na fydd y canser yn cael ei atal am 50 mlynedd. Rŵan, rydw i'n ofni bod y prosesau o fesur cost effeithlonrwydd yn methu â delio efo'r math yna o oedi. Rydw i'n meddwl bod y JCVI ei hunan yn nodi'r problemau hyn, a'r ffaith bod eu dwylo nhw, mewn ffordd, wedi'u clymu, oherwydd yn eu dadansoddiad interim maen nhw'n dweud hyn: