The UK’s national public health and sexual health clinical bodies still recommend the 4CMenB vaccine for gonorrhoea. If you have already had your first dose, it is recommended that you get your second dose to complete the course.
A recent Australian study, called GoGoVax, found that the 4CMenB vaccine did not prevent gonorrhoea among men who have sex with men who were at higher risk of infection. However, despite the findings from this study the vaccination programme in the UK is set to continue.
In this article we explain why the UK’s national public health and sexual health clinical bodies still recommend the vaccine if you are eligible.
Why has UK advice not changed immediately?
The UK vaccination programme was introduced following advice from the Joint Committee on Vaccination and Immunisation, known as JCVI. This advice was based on observational or real-world evidence suggesting that the 4CMenB vaccine could offer around 30% to 40% protection against gonorrhoea. The JCVI also used modelling evidence that suggested that vaccinating gay and bisexual men at higher risk, even with a vaccine that offers moderate protection, could have a large impact on a population-level and save the NHS millions of pounds.
The vaccine is licensed for and will offer direct protection against meningitis and meningococcal disease. It is a safe vaccine and has been used in the UK routine immunisation programme for babies to prevent meningococcal disease since 2015. The bacteria which cause meningitis and gonorrhoea are closely related, so the vaccine may also offer some protection for gonorrhoea. The evidence used by the JCVI showed declines in gonorrhoea amongst people who participated in meningitis and meningococcal disease vaccination programme various countries across the world. Observational studies can help show how a vaccine might work across a wider population, although it can be harder to prove cause and effect.
GoGoVax was a different type of study. It was a randomised controlled trial, which means specific participants were randomly assigned to receive either the vaccine or a placebo. This type of study is very useful for testing whether a vaccine protects individuals under controlled conditions.
In simple terms, the difference between the two sets of evidence is that GoGoVax tested whether the vaccine protected specific individuals in a trial setting, while the JCVI considered evidence about how the vaccine performs in real-world conditions, and how it could perform if offered to those most likely to get gonorrhoea in the UK.
The JCVI keeps all vaccination programmes in the UK under review. The JCVI will review real-world evidence from the UK’s gonorrhoea vaccination programme when more information becomes available, alongside the findings from GoGoVax.
What do we know about the GoGoVax trial?
GoGoVax is important new evidence, but there may be reasons why its findings do not fully reflect the impact that the UK vaccination programme could have.
For example, most participants in the GoGoVax trial had previously had gonorrhoea before entering the study. Scientists do not yet fully understand how the vaccine might protect against gonorrhoea, and it is possible that previous or current infection could affect how well the vaccine works.
Experts will consider the GoGoVax findings alongside UK monitoring – including an ongoing evaluation of the programme – as more information becomes available.
How can a vaccine with modest protection still help?
A vaccine does not need to prevent every infection in individuals to have a useful public health impact.
Even if the vaccine gives only modest protection to each person, it may still help reduce the overall number of gonorrhoea infections if enough people are vaccinated. This is sometimes called population-level protection.
This means the vaccine may offer two possible benefits: it may reduce your own chance of getting gonorrhoea, and it may also help reduce transmission in the wider community.
What should I do if I am offered the vaccine?
Deciding whether to get vaccinated is a personal choice. If you are offered the vaccine, you may wish to discuss it with a sexual health professional, who can help you think about your own situation and whether vaccination is right for you. If you have already had your first dose, it is recommended that you get your second dose to complete the course.
The vaccine should be seen as an extra layer of protection. Even if you are vaccinated, it is still important to:
- use condoms where appropriate
- have regular STI tests
- seek advice if you have symptoms
- get tested and treated promptly if a partner tells you they have an STI.
The UK Health Security Agency (UKHSA) will continue to monitor how well the vaccination programme is working in the real world. These findings will be shared with JCVI, which will review the evidence and consider any next steps for the programme.
What should I do if I am not offered the vaccine?
If you are eligible for the vaccine and your clinician or clinic has not proactively offered it, you should still be able to access it if you request it.
