HPV vaccine: why aren’t Canadians buying in?

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Publication Date: 
Mon, 2013-06-03

Pap testing detects abnormal cells. A common abnormal result is Atypical Squamous Cells of Undetermined Significance (ASCUS). Or a woman may be diagnosed with a Low-Grade Squamous Intraepithelial Lesion (LSIL). Healthy non-smoking women under the age of 30 with ASCUS or LSIL are likely to see a subsequent normal Pap result. Because the benefit of screening younger women is so small, 2013 Canadian Pap test guidelines recommend starting at 25 and then continuing every three years. There have been a number of suggestions for the best way to integrate HPV DNA testing, including identifying the strain before regular Pap screening begins. This testing, as it becomes more available and integrated into the screening process, will reduce the number of unnecessary colposcopies and treatment, since it recognizes the high-risk strains of the virus. This too, will cost money.

The final question

Does current research support the continuation of the vaccination program?

The PHAC paper acknowledges that while the vaccine appears to be effective for 10 years, “only long-term surveillance of vaccinated populations can determine the population effectiveness of vaccination.”

They admit that “as with any vaccine recommendations, it should be noted that provinces and territories should consider additional criteria such as economic, local programmatic/operational, and societal factors when considering inclusion of [their] recommendations in publicly-funded immunization programs.”

Yet there is no national evaluation of the strategy, presumably because this massive experiment requires decades for results to be known and published. Public health strategies must be cost effective and address priority health needs. They must also consider “lost opportunity” costs—those programs that are unfunded because of others that are. Women’s health advocates have lobbied for decades for broader access to Pap screening, follow-up and treatment. With the advent of self-testing techniques, developing countries (as well as women living in remote areas of Canada) may at least see some improvements. 

What is shocking is that despite the absence of a global evaluation for the vaccine program for girls, the lobbying to vaccinate boys began in February 2012, when the Federation of Medical Women of Canada called on the federal government to cover vaccination for boys. In April 2013, Prince Edward Island decided to extend their program to Grade 6 boys. The SOGC applauded this move and wrote to the Ministers of Health of every province and territory in Canada to urge them to follow Prince Edward Island’s lead and include boys in their school-based programs starting in fall 2013. Yet, the most recent information published in the PHAC report about how vaccinating boys might affect cervical cancer rates reveals “there are currently no studies that directly demonstrate reduced transmission of HPV vaccine-types from males to females, or reduced cervical cancer, as a result of immunization of males.”

Canadians deserve honest, straightforward information about the prevention of cervical cancer. Relying on an expensive program that has yet to be evaluated is questionable at best.

Lyba Spring recently retired from Toronto Public Health and now runs Lyba Spring Sexual Health Education and Consulting Services in Toronto.

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