HPV vaccine: why aren’t Canadians buying in?

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Publication Date: 
Mon, 2013-06-03

As a sexual health educator and women’s health advocate, what concerns me is the allocation of funding for a massive vaccine program supposedly to prevent cervical cancer and genital warts through the prevention of HPV; but this strategy remains to be proven, even though the vaccines certainly do prevent infection. Women’s health advocates questioned this funding at the outset, asking why the vaccine was privileged over other means of primary prevention of transmission of the virus, and the secondary prevention of cervical cancer.

Prevention – old school

Condoms (male and female) are an effective barrier to HPV for the parts of the body they cover. Surprisingly, it took several years for Government of Canada literature to clarify their usefulness in preventing HPV transmission. Some local health units in Ontario still maintain condoms are not very effective; or they ignore condom use altogether as a means of prevention (see fact sheet). This inadequate information is a barrier to obtaining informed consent when infection “prevention” is made synonymous with “vaccination.”

Another approach for preventing cervical cancer has been to encourage young people to postpone higher risk sexual activity. Progressive sex education offers alternatives to vaginal intercourse for heterosexual teenagers who want to explore their sexuality with a partner through kissing and touching. The rationale is cervical immaturity. It takes until at least age 18 for stronger (and protective) squamous cells to replace more vulnerable columnar cells on the cervix. A third form of protection suggested by some public health agencies is not smoking, because nicotine can be a factor in the development of cervical cancer.

Some might consider these prevention strategies ineffectual in comparison with vaccines. However, this does not explain the urgency to implement the nation-wide vaccine program in 2007.

Selling vaccines as prevention

Two vaccines were approved by Health Canada for use against HPV infection: Merck-Frosst’s Gardasil in 2006 and GlaxoSmithKline’s Cervarix in 2010. Gardasil protects against four types of HPV:  6 and 11, which cause the majority of wart infections, and 16 and 18 which are linked to most cases of cervical cancer. Cervarix protects against types 16 and 18. (There are other HPV types associated with cervical cancer that are not covered by either of these vaccines).

Messages to the public from both pharmaceutical companies and public health advocates about what this protection means are often oversimplified. The standard argument goes like this: Women needlessly die from cervical cancer. Cervical cancer can be prevented by vaccinating young girls. Warts are ugly and stigmatizing and their treatment is costly. Warts can be prevented by vaccination.

The Society of Gynecologists and Obstetricians of Canada (SOGC) created HPVinfo.ca to “spread the word not the disease.” The site provides information on signs and symptoms, health complications and risks, prevention and treatment. Yet, they stigmatize warts and, like other agencies, present the prevention of HPV infection as cancer prevention.

The early provincial ads in Ontario (Girl Talk showed young women discussing the vaccine:  “Actually, I’d rather get a needle than get HPV. Did you know that three out of four kids will get HPV when they grow up and HPV is the main cause of cervical cancer?”

Ads from the pharmaceutical companies used scaremongering and parental guilt in their key messages. For example, the “One Less” campaign implied that parents who did not allow their daughter to be vaccinated were bad parents, similar to flu vaccine campaigns. And yet, current science calls that strategy into question as well.  

Do HPV vaccines live up to their promise?  

In December 2011, Canadian researchers Lucija Tomljenovic and Christopher A. Shaw published an essay online in the Annals of Medicine stating that HPV vaccine policies were “at odds” with evidence-based medicine. They conclude that vaccination policies need to be more evidence based and that women need to be fully informed of benefits and risks before having the vaccine. In a Medscape Medical News article, Roxanne Nelson,  writes about the essay and summarizes the researchers’ statements:: “Both vaccines very effectively prevent persistent infections with high-risk HPV types 16 and 18 and the associated cervical [lesions]” in young women who have never had HPV. However, “even persistent HPV infections caused by high-risk strains generally do not lead to precursor lesions in the short term or to cervical cancer in the long term.” With up to 90 per cent of HPV infections resolving spontaneously within two years, even among those that remain, only a small proportion progress to a malignancy. Even high-grade cervical lesions (cervical dysplasia) can resolve over time.

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