HPV policy....cost effective???

When the long term and short term economic benefits of the implementation of Canada’s current position on HPV vaccination are examined, it quickly becomes clear that this is simply not cost effective policy. Economist and epidemiologist Hans Kreuger, employed by the BC Cancer Agency found that with the introduction of Gardasil in British Columbia in 2005, 54 million dollars were saved in cancer treatments over 26 years. However the cost of the vaccine is approximately 373.6 million, resulting in the government of Canada being no where close to breaking even.
Furthermore in order to vaccinate the 5 million women, who are recommended to receive the vaccination by the National Advisory Commission on Immunization, the government would have to commit 2 billion dollars for the vaccine alone. This does not include the cost of health care professionals, equipment, and education surrounding the vaccine. The federal government’s commitment of $300 million to the HPV vaccination program would therefore only cover 750 000 of the 5 million women recommended to be vaccinated. With the provincial governments of Canada already in need of increased healthcare funding from the federal government the provinces are unlikely to have access to the financial resources to cover the remaining women. From an economic perspective the policy of providing the HPV vaccine to all girls and women at risk for cervical cancer is clearly not financially feasible.

** all information recieved from the Canadian Women's Health Network http://www.rcsf.ca/PDF/CWHN_HPVjuly30.pdf

Victory for Women’s Health or Triumph of Aggressive Marketing?

If you’ve been watching TV lately, you have more than likely seen the HPV Vaccine commercials that seem to run on every channel, on every commercial break. Merck Frosst, the makers of the HPV vaccine, Gardasil, are so interested in their own commercial interests it is difficult to tell whether or not this is a victory for women’s health or a victory of aggressive marketing. Is this a health story, or a business story?

As previously mentioned, Merck Frosst makes the only approved HPV vaccine available, and it has much riding on a successful launch and maitenence of this vaccine. Merck also makes Vioxx, the painkiller that has been withdrawn from the markets because it has been linked to heart attacks and strokes and is facing major legal costs because of these links. Gardasil is estimated to give Merck annual sales of $2 billion U.S. or more by 2010.
In order to create a public enthusiasm for the vaccine, Merck needs to convince daughters, mothers, fathers, and caregivers that this vaccine is a necessity, which is a hurdle in itself given the controversy surrounding the issue. Though, somehow it has succeeded in many ways.
In regards to selling the idea to the public, Sheila Murphy, spokeswoman for Merck, explained how difficult it is for Merck explain Gardasil to the masses: "The fact that a virus causes cancer, in this case anogenital cancers, is a big paradigm shift for many people," she said, adding, "When I started working on the Gardasil team, I didn't know that HPV was the reason I was having a Pap test. We are working with individuals and groups who share our desire to improve the wellness of Canadian women by communicating information on HPV. We are using all the channels of communication open to us to get the message about our cancer-preventing vaccine out."

Is Sheila Murphy implying that Pap tests only test for HPV? Because that is beyond false. As we have already stated, cervical cancer is a rare occurrence in Canada, and we already have a very effective prevention method – Pap tests! In the past five decades, regular Pap testing has contributed to an 80 per cent reduction in cervical-cancer deaths. I highly doubt that these mass methods of communication about HPV and cervical cancer are to improve the wellness of Canadian women; rather, it is for Merck Frosst to bank billions of dollars on our gullibility. My concern is that this hype about HPV and a ‘cervical cancer vaccine’ is going to make young girls and women think that they don’t need to get Pap tests – they still do! Scary thought.

In is interesting to note that in 2006, before the vaccine was even approved, Merck financed information campaigns featuring actresses expressing surprise about the cause of cervical cancer and promising to tell other women (these commercials ran in Canada and the U.S. – the “Tell Someone” campaign). These commercials could not mention the vaccine as it hadn’t been yet approved by the FDA. Merck Frosst has been instilling fear in Canadian’s about HPV for years, so that as soon as their vaccine became available, people would be so worried about their daughters, they would run to get it.
When the FDA finally approved the vaccine in June 2006, a full scale ad campaign began. It hasn’t been difficult for Merck to rely on various doctors and women’s groups to promote the vaccine in Canada, without difficulty. For example, a spokeswoman for the Society of Obstetricians and Gynecologists of Canada told the Citizen that Merck gave the doctors' group a $1.5-million grant to educate people about HPV. This website, (http://www.hpvinfo.ca/) does not mention Merck but serves the purpose of “educating” people about the HPV/cancer link.

In addition to having to convince the public, Merck has also had to convince lawmakers of the vaccine’s importance and value. Just before Flaherty announced funding for the vaccine in the 2007 budget, Merck hired Ken Boessenkool, a former aide to PM Stephen Harper, to lobby the federal government; Boessenkool is employed by Hill & Knowlton, a giant public relations and lobbying firm
In Ontario in 2007, on behalf of Merck, two lobbyists were hired to lobby the provincial health ministers and others on: “the proposed policy decision to support a childhood immunization program for HPV and funding related thereto." Both men work for Hill & Knowlton, and interestingly enough, one of them (Jason Grier) was the former executive assistant to Health Minister George Smitherman.

All in all, Merck Frosst has used the media to its full advantage, not for the advantage of women's health. CWHN warns that “Media and marketing claims about the impact of HPV prevalence are very misleading and the naming of Gardasil as the ‘cervical cancer vaccine,’ implying the vaccine eliminates all cervical cancer, is incorrect. The marketing of Gardasil ... has made it difficult for there to be reflective discussions between parents and children, health care providers and their clients, as well as among the public and policy makers, about the nature and meaning of HPV and of vaccination.”

Page, Shelly. Everything you wanted to know, but were afraid to ask. Ottawa Citizen. April 29, 2007.

Is the HPV Commotion Having a Negative Impact upon Sexual Health Education?

As mentioned previously, the HPV vaccine is implemented for women ages 9-26. Most provinces choose to implement the vaccine around the onset of puberty. Puberty is an extremely critical time for women, due to hormonal changes, adjustments to bodily and self image and more. At this time, women are vulnerable to eating disorders; low self esteem and drug abuse. This is more evident in women who go through puberty at an earlier age. So what does this have to do with HPV?
Earlier, we mentioned how the HPV vaccine has a negative impact upon sex education programs. The guidelines for Canadian sexual health outline two goals: 1. to help people achieve positive outcomes (e.g. self-esteem, respect for self and others, non-exploitive sexual relations, rewarding sexual relationships, the joy of desired parenthood); 2. to avoid negative outcomes such as unwanted pregnancies and STI’s. The reality is that the second goal is emphasized much more within the classroom and sex is introduced as fearful. The current HPV commotion has since been added to this fear, tying sex to cervical cancer.
Problems associated with the onset of puberty can be addressed and taught within the classroom, if sex education programs would attend to the first goal of the Canadian guidelines for sexual education. HPV vaccines are currently being implemented within schools with little explanation as to why these women need it, except for the fact that it “prevents” cervical cancer (only 4 strands that is). Current sex education programs are, in fact addressing physical pubertal changes, but ignoring the emotional aspects mentioned above, while simultaneously eliciting fear in young girls through the implementation of the HPV vaccine. The 300 million dollars Harper and the rest of the Conservative government have funded to the HPV vaccination, should invest some more money on workshops for improving women’s emotional well-being. Workshops on self-esteem are extremely crucial to achieving goal number one. The relatively low instances of cervical cancer in Canada indicate that 300 million dollars should therefore be allotted to other emotional hardships facing young women at this critical age.

Critical analysis of the impact of HPV policies on the agency of young women

From a liberal feminist perspective, the current HPV policies on vaccinating young girls do not promote the agency of young women to make independent self aware health choices. As previously blogged, the vaccine is being distributed by individual school boards, resulting in a permission slip arriving home for parents of young girls ages nine to thirteen to sign. However, the vaccine which is said to prevent HPV is not a school trip requiring a permission slip; it is a serious health decision which should be made by the young woman of which it affects. As the long term health consequences for the vaccine are not known at this time, especially concerning this age demographic, and the likelihood of contracting HPV is linked to VERY personal lifestyle decisions (concerning condom use, pap testing, partner choice etc), the choice to get the vaccine or not to get the vaccine are extremely individual. These decisions can not be made by a mother and father, but must be made by the individual who will be most affected.
The decisions young women make regarding their own sexual health must be educated choices. If Canadian policy has dictated that girls are old enough to be vaccinated for a largely preventable sexually transmitted disease, than these girls must also be old enough to be thoroughly educated about the implications of the vaccination. The existence of permission slips which give this decision into the hands of well meaning parents does not result in women having control over their own sexual choices through education. Instead the sexual agency of these girls is given away. Giving away a young woman’s right to make decisions which pertains to and may permanently affect her own sexual choices, is therefore a blatant disrespect to women’s sexual rights.

HPV: A female problem?

Currently, only girls and young woman can receive the Gardisil HPV vaccine. This has led to many people wondering, why are only girls targeted, can't boys spread and get HPV as well? As mentioned earlier in our blog, HPV has been viewed as a strictly female problem. While it's true that men can't get cervical cancer, they can still get HPV and they can still spread it to women. Therefore the vaccine should be available for both boymales and females.

Gardisil is being heavily marketed as the anti-cancer vaccine for women, much less than it is being marketed as an STI vaccine. So it automatically is seen as a vaccine for females. Apparently, in 2009, Gardisil will be available for boys, although the primary reason for this would be to slow the risk of cervical cancer. Currently, there is no screening test for HPV for males, the only way of knowing whether a boy/ man has HPV is if they have genital warts.

One mother had this to say about the possibility of vaccinating her sons: "You don’t want to say it’s just the girls’ problem. But my sons won’t contract cervical cancer. And genital warts are treatable. I’m very skeptical. What risks will I expose them to?”.

A competing vaccine, developed by GlaxoSmithKline to protect females between the ages of 10 and 55, is currently being reviewed. The company is studying its vaccine, Cervarix, in boys as well as girls in Finland. Cervarix does not protect against genital warts. Boys are being included in the trial to see whether vaccinating them will help eradicate cervical cancer.

Another mother was quoted in a New York Times article saying, "If there was a vaccine that sons could get that would get rid of breast cancer, most parents wouldn’t hesitate. But cervical cancer is the ‘sex cancer. ” If the Gardisil vaccine does in fact become available for boys, or if the Cervarix vaccine is approved, will there be enough incentive for boys and young men to get vaccinated? Or will HPV still be seen as a female problem?

Reference

Hoffman, Jon (2008). Vaccinating boys for girls sake?. The New York Times.

Cervical Cancer = Polio Epidemic?! I don't think so.

Ottawa has provided the country a whopping 300 million dollars to buy Gardisil to vaccinate young girls against HPV. The last time a Prime Minister made a decision like this was in the 1950s, during the polio epidemic. There is no epidemic of cervical cancer! In fact, according to the Canadian Cancer Statistics, approximately 400 women were anticipated to die of the disease in 2006, making it not even fall within the top 10 cancers that kill women.
The following are the percentage of estimated deaths from selected cancers in Canada, female, 2008:
Lung 26.3
Breast 15.2
Colorectal 11.6
Pancreas 5.6
Ovary 4.9
Non-Hodgkin Lymphoma 4.0
Leukemia 2.9
Body of Uterus 2.3
Brain 2.1
Stomach 2.1
Multiple Myeloma 1.8
Kidney 1.7
Bladder 1.5
Esophagus 1.2
Oral 1.1
Cervix 1.1

To see a chart showing incidence and deaths of cancer in women please go to http://www.cancer.ca/British%20Columbia-Yukon/About%20cancer/Cancer%20statistics/~/media/CCS/Canada%20wide/Files%20List/English%20files%20heading/pdf%20not%20in%20publications%20section/Canadian%20Cancer%20Society%20Statistics%20PDF%202008_614137951.ashx ( Page 15)

Cervical cancer can be deadly, but this is rare and uncommon in Canada. Invasive cervical cancer takes a progressive course that can be halted at one of various stages (CWHN).
Cervical cancer is often first detected by abnormalities by routine Pap smears (rarely do women experience obvious symptoms). If detected early, and the abnormal cells (dysplasias) are removed entirely, cervical cancer will not develop. Repeat testing and treatment is recommended for cervical cancer screening, as are smoking cessation and safer sex practices.
It takes on average 10 years for an untreated cervical dysplasia to progress and become progressive, invasive cervical cancer (CWHN). Cervical cancer is preventable and deaths from it can be avoided through detection and treatment at an early stage. Those women who do die from cervical cancer often either:
-Don’t have access to primary care and discover the disease at a later state or
-Are not given proper follow up after the discovery of an abnormal Pap result.

Women who lack access to regular Pap screens are often those women living in poverty, immigrant and refugee women, women living with disabilities, women who have experienced sexual trauma/abuse, Aboriginal women, and women living in remote areas. According to CWHN, women who have sex with women also tend to be under screened (health care providers incorrectly assume they do not need to be tested. Other barriers to access to PAP screens are the lack of female health care providers, time constraints, costs, childcare, language and literacy differences, lack of knowledge, cultural differences, safety concerns etc.

“Missed opportunities” should not be a reason for developing cervical cancer, or not catching it early enough. A vaccine cannot fill the gap that has been created for those who are not regularly screened for cervical cancer through Paps. Those who are vaccinated will still need routine Pap testing; and if Pap testing is what can identify and prevent cervical cancer, is this not something we should be promoting at the same level we are promoting the HPV vaccine??
Are young girls who are receiving the vaccine going to think they are fully protected against cervical cancer (when really they are protected from only 4 strains of HPV)? Will they then decide it is not necessary for them to get Paps, which can not only detect cervical cancer but numerous other STIs, diseases and abnormalities?

CBC Video

This is an interesting video from CBC in which some key speakers give their opinions on the HPV Vaccination program in Canada.
Included are: Dr “Vinita Dubey” Toronto Associate Medical Health Officer, Dr “Guylaine Lefebvre” President, Society of Canadian Obstetricians and Gynecologists, Dr “Francois Bertrand” Merck Frosst Spokesman, McGill University Professor “Abby Lippman”


Check it out at www.cbc.ca/national/blog/video/healtheducation/a_parents_dilemma.html

HPV in Canada - Variations Accross the Country

Gardasil is a licensed HPV vaccine in over 80 countries. It is the first HPV vaccine to be approved for us in Canada. In 2007, HPV vaccinations were only available in the following provinces: Ontario, Newfoundland and Labrador, Prince Edward Island, and Nova Scotia. In March 2007, the federal government announced a $300 million funding for three years in support of the HPV vaccine. $117 million of the funds were allocated to Ontario and the rest for were distributed among the other three provinces.
HPV testing and access across Canada, varies across the country. For example, the age for vaccination varies. Nova Scotia targets girls in grade 7, Ontario targets girls in grade 8 and Prince Edward Island begins to vaccinate young women in grade 6. Other provinces such as Manitoba, Alberta and Saskatchewan, British Columbia and New Brunswick and Quebec do offer the HPV vaccination; however, it is not funded by the Government. These provinces recently began implementing HPV vaccination programs, however they are publicly funded. Manitoba and Saskatchewan offer a publicly funded vaccine program for grade 6 girls only. Alberta is targeting grade 5 girls, so they can administer the Hepatitis B and HPV vaccination simultaneously. Beginning next September, girls in grade 9 will be eligible for the vaccination for a three year period in order for girls’ presently in grades 6, 7, and 8 to “catch up” and receive their vaccination as well. Quebec has begun vaccinating girls in grade four, and will allow them until the age of 18 to be immunized for free. British Columbia offers vaccinations for girls in grades 6 and 9 and New Brunswick offers vaccinations to girl in grade 9.
I think it’s interesting how at present, all of Canada is implementing Gardasil, while the majority of the country initially felt sceptical about it. Why do you think the government of Alberta and Manitoba changed their views towards Gardasil? With all the information we have presented with you so far, do you believe they support Gardasil because it’s truly effective?

Canada's Policy History on Vaccinations

The history of mandatory vaccination within Canada against diseases such as smallpox, measles and Hepatitis B are inconsistent with Canada’s current HPV policy. Measles and smallpox were among the first diseases to result in public health immunization laws. However, while this Canadian policy serves as precedent for current HPV public health campaign, the nature of the diseases differ significantly. Both measles and small pox can be transmitted by an air bourn route, which significantly decreases individual agency in fostering prevention. Making sexually safe lifestyle choices (including getting tested for STIs regularly, and having safer sex) which is a crucial component in HPV prevention are irrelevant to preventing smallpox and measles; therefore increasing the necessity for widespread vaccination.

In addition, an analogy has often been made by public health officials and policy makers between the widespread hepatitis B and the new HPV vaccine program. Since the early 1990s a school based universal vaccination program targeting children 9-13 has been enforced in all provinces and territories in Canada. Numerous similarities between HPV and Hepatitis B exist, as Hepatitis B is most commonly transmitted through sexual contact. However differences remain which make Hepatitis B an imperfect example when applied to HPV vaccine. Nearly a third of all incidences of Hepatitis B are contracted during childhood making vaccination of children a viable solution. Historically Canada has not vaccinated girls through the school system for sexually transmitted diseases. Therefore, advocating the HPV vaccine to girls and women under the pretense that this is consistent with Canada’s policy history is therefore irresponsible.

HPV Vaccine in Toronto

After stirring up much controversy, a number of school boards have decided NOT to offer the HPV vaccine to their young students (for example The Red Deer Catholic Regional School Division).

Toronto Public Health (TPH) however, has managed to get both the Toronto District School Board and the Toronto Catholic School Board on board with the HPV vaccination program.

Following approval of the Toronto District School Board in August 2007 and the Toronto Catholic School Board in September 2007, TPH held three clinics at participating schools through the 2007-2008 school year, providing three doses of the HPV vaccine. Additional clinics (“catch up clinics”) were held during evenings and summer months, for those that missed the in school vaccinations.

In order for a young girl to receive the free vaccine, signed parental support was required. Grade eight females were given an “information package” to take home to parents. This “information package” included a letter outlining the program, a HPV vaccine fact sheet, a consent form and a pamphlet. As a side note, the fact sheet was translated into twelve languages and all materials were available online at www. Toronto.ca/health. How many parents fully understood this material with no concerns is unclear – and will we ever know? Grade eight teachers were also provided a letter and training packages on HPV for students.
Only upon REQUEST, did TPH sexual health educators provide HPV related education – which could be argued as being one of the most important aspects of this program; EDUCATION. However, this all-important education was only provided to 43 classrooms and a mere 51 teachers had training on HPV.

TPH offered the HPV vaccine to over 13 000 females in 432 public and private schools (with grade 8 classrooms). By July 2008 TPH had “achieved” an uptake of 61% for the first dose, 59% for the second and 52% for the third. As stated on their website, TPH is conducting a study to identify parents’ reasons for refusing the vaccination.
20% of students did not even return the form – so whether or not their parents even saw the consent form could be questioned.

While continuing to stay on top of things, TPH provided parents of grade 7 females with HPV info packages for the 2008-2009 school year. Posters, fact sheets and consent forms were to be distributed this fall 2008. Additionally, as I’m sure you are all painfully aware; a provincial mass media campaign is already under way - as are radio, print cinema and internet advertising.
Oh and don’t forget - TPH will be collaborating with school boards to provide teacher training and classroom instruction on HPV – WHEN REQUESTED. Should this not be mandatory with a vaccination program as controversial as that of HPV?

Toronto District School Board. Human Papillomavirus (HPV) Vaccination Program Update. September 4, 2008. Medical Officer of Health.

Ontario policy on HPV vaccination

In the fall of 2007, the Ontario government launched a 3 year, $117 million program to provide the HPV vaccine, Gardasil, to approximately 84 ooo grade 8 girls in schools. Gardasil is a 3 dose vaccination that has been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases, and about 99% effective in preventing HPV strains 6 and 11, which together with HPV strains 16 and 18 cause about 90% of genital wart cases, among women not already infected with these strains (Kaiser Daily Women's Health Policy Report, 7/18).

Grade 8 girls have been targeted for this program because the vaccine is most effective when given to girls before they have become sexually active. Also, grade 8 girls are believed to have a solid education and understanding of STIs and how to protect themselves, therefore they are mature enough to receive the HPV vaccine (www.HPVontario.ca).

The vaccine is completely free, and is not mandatory, but is however, strongly encouraged. A public awareness campaign was launched just before the program, to spread awareness. David Jensen, a spokesman for the Ministry of Health and Long-term Care, said the campaign is meant to inform girls and their parents about the importance of the new vaccine. The campaign is made up of television, radio, and print ads depicting young girls and their mothers discussing the value of the vaccine, as well as stats and information on HPV and Cervical Cancer. Parental consent forms are issued prior to the vaccination, however, if a girl wants the vaccination and her parents object, the girl will be able to override her parents and receive the vaccine (CBCnews.ca, 2007).

The program was given the go-ahead by Premier Dalton McGuinty, who said the Ontario government's decision is based on expert advice, and that it is sanctioned by the Public Health Agency of Canada, the National Advisory Committee on Vaccination, Cancer Care Ontario and the Canadian Cancer Society (CBCnews.ca, 2007). Much controversy has followed the decision to implement this program, such as should all school boards allow the implementation of this program? As well as, has enough testing been done on the Gardasil vaccine to ensure it is safe for all girls, and has no long term side effects?


References

Kaiser Daily Women's Health Policy (August, 2007). Ontario To Launch Program To Provide HPV Vaccine to Eighth-Grade Girls This Fall. http://www.kaisernetwork.org/daily_reports/rep_index.com


Ontario Ministry of Health and Long Term Care (August, 2007). Human Papilloma Virus Immunization Program. http://www.health.gov.on.ca/english/media/news_releases/archives/nr_07/aug/bg_20070802.html

www.HPVontario.ca

CBCnews.ca (August, 2007). Ontario's HPV program expert-approved: premier. http://www.cbc.ca/health/story/2007/08/02/ontario-hpv.html

Liberal Feminist Approach --> Sex Ed = Sex Negative

According to Balanko (2002), our experiences and understandings of sexuality have been shaped by sex education. Since the 1960’s, sex education programs in Canada have been promoting sexuality as fear-based. Sex education is taught in a sex-neutral or sex-negative manner, by solely focusing on the consequences and prevention of STI’s as well as unwanted pregnancies. It is extremely crucial to emphasize these notions, because it has a major impact on a student’s health, and well-being. However, liberal feminism, the perspective from which my blog is written, holds that current sex education programs focus too heavily on fear and do not give an in depth understanding of all aspects surrounding sexuality. They believe that sex education curricula taught within the Canadian education system has failed to address a woman’s right to sexual desire and the pleasurable aspects related to sexuality, or various behaviours, attitudes or identities associated with thus (Fine, 1988).
The recent development of the HPV vaccine (Gardasil) is just another example supporting this fear-based sex education. Were you aware about HPV prior to Gardasil’s release in 2006? The only reason I have any knowledge concerning HPV, is because I participated in a Human Sexuality course during my undergraduate career, and it was an elective. I was never forced to learn about HPV. When I was growing up, AIDS was the ONLY STI my sex-ed teachers had taught me about, besides the male and female anatomy. From my understanding, sex education programs continue to instil fear in its students, by educating them about the consequences of having sexual intercourse (STI’s and unwanted pregnancies) and new to the curriculum, offer an injection to prevent cervical cancer and some (NOT all) strands of HPV. A prevention for cervical cancer sounds like a miracle, doesn’t it?
On February 25th 2008, Karen Springen wrote an article, “Why are HPV vaccine rates so low?” One would think that with the “gift” of cervical cancer prevention, women would be rushing to their nearest family doctors, right? However, the high cost, and parents’ discomfort immunizing their children against a disease which is contracted through sexual activity are major reasons as to why women are not being vaccinated immediately. What I find interesting, is that many women lack knowledge and awareness about HPV. A study in 2007 found that only 40% of women in the United States heard of the HPV virus, and only half of them understood that HPV was the main cause of cervical cancer. More that a quarter of American women between the ages of 14-59 are estimated to have HPV, proving that women are not being properly educated. Assuming HPV is such a dangerous STI, most of the US population should understand its consequences, and should be encouraged to receive yearly pap tests at their family doctors. Sex education classes continue to educate women to fear sex, without the appropriate knowledge required for women to make an informed decision about what to put inside or outside of their bodies. The HPV vaccine is just another example of fear based policy around human sexuality within sex education.
Women have the right to make their own choices. Whether a woman wants to insert a penis, ingest a birth control pill or inject an HPV vaccination, it is her choice and her choice only. However, as a liberal feminist I believe that women have the right to a fully informed choice in order to aid their decision making.

ideological issues surrounding the HPV vaccine

Due to the intense public information campaign which is currently taking place across Canada concerning the HPV vaccine, many Canadian women of all ages are evaluating their beliefs on a range of sexual health issues. Such issues include but do not exclude personal practices, past, partner choice, frequency of STI testing, and the often feared sexual practices of young people. However after being subjected to one too many HPV commercials and looking into the faces of one too many women who are preemptively opening their eyes to the dangers of HPV, I question, where are all the boys within the sphere of this debate?
This may seem like a ridiculous comment as boys or indeed men clearly are not borne with cervixes and thus, by defect, can not get cervical cancer. However, what these ads fail to illuminate is the simple fact that yes, boys too can get HPV and are ‘half of the equation when it comes to sex and therefore sexually transmitted diseases,’ as argued by Medline Plus an American medical organization. If infected with HPV boys are at increased risk for genital, throat, and anal cancers which are less common, but no less deadly. So this further begs question stated above, where are all the boys?
The simple answer is the vaccine was not originally tested on boys and can not be given to males at this time. The more complicated answer stems from asking why not? Why do Canadian health policies support the testing and distribution of a vaccine which can prevent the contraction, spread, and tragic death of girls and women from HPV, but not boys and men? Are these girls somehow contracting the virus alone through having sex with themselves? The answer to these questions is implicit within the Canadian ideology of women’s health.
Instead of addressing the issue from a gender neutral perspective, the HPV campaign is consistent with the ideology that sexual health is within the sole sphere of women’s health. This public information campaign implies that HPV is solely a women’s issue through omitting mention of both male and females’ equal responsibilities for preventing the virus through safer sex practices. The onus is therefore placed solely on women and now girls, to ensure that this virus does not affect their own, or their partners’ health. While HPV IS a health issue, it is not solely a women’s health issue. The issues aroused by the introduction of an HPV vaccine (personal practices, sexual past and partner choice, frequency of STI tests, and the sexual practices of young people) are issues that affect Canadian women and men. I therefore, consider it to be offensive and dangerous that they are not being portrayed by Canada’s current health policies as such.

Ethics of Gardasil in Schools

The Gardasil vaccine has sparked many controversial issues and debates. One in particular is the issue surrounding the role of sex education in schools. Sex education has always been a hot topic in the public education system, amongst both public and separate school boards. Whether or not children and adolescents should be taught about STIs, birth control, or even human anatomy at school, versus at home with their parents, has been widely debated. Often the role of religion comes into play here.

The vaccine was first proposed as a compulsory vaccine for adolescent girls in Michigan on September 12, 2006, only three months after the Food and Drug Administration (American) licenced the vaccine (Colgrove, 2007). The school system seemed like the simplest and easiest way to get the vaccine out to young girls, and school boards across North America have either been embracing or rejecting administering the Gardasil vaccine to their students. The reason many school boards have decided not to offer an HPV vaccine in their schools is because it goes against their values and belief systems, and it goes against everything they are teaching their students in school about sex.

In 2007, Texas governor Rick Perry signed an order requiring girls aged 11-12 to be vaccinated with Gardasil. Girls who do not get vaccinated are not permitted to enter the sixth grade (Hopkins-Tanne, 2007). Parents become outraged, claiming that providing the vaccine was giving approval of premartial sex. The state of Texas endorses a program of abstinence until marriage in school sex ed. classes (Hopkins-Tanne, 2007). Interestingly enough, despite the outrage this order caused, about 20 other states are considering bills to make Gardasil a requirement, which would give Merck, the makers of Gardasil, billions of annual revenue...just a side note.

Closer to home, the Ontario government has offered the HPV vaccine to all grade 8 girls in school, however some Catholic school boards have questioned whether the vaccination program promotes sexual activity amongst teens. When the Halton Catholic school board approved the program, the Ontario conference of Bishops urged the board to reconsider their decision, saying, "Infection with HPV...can only occur through sexual activity, which carries with it profound risks to a young person's spiritual, emotional, moral, physical health" (www.ctvnews.ca, 2007). A group of students on the Halton Catholic board council said they were upset when their voices weren't heard in the decision making process. They argued that they attend Catholic school for a reason, and are taught to practice abstinence before marriage, and that offering the HPV vaccine in their school is hypocritical and goes against the morals and values they are taught everyday (www.ctv.ca, 2007).

The Gardasil vaccine is meant to be available to all females ages 9-26. It is offered to students in school for free, which makes is available to everyone, no matter what their socio-economic status is. Issues arise when some girls are not provided with the vaccine in their school if their school board has elected not to participate for religious reasons. Is this fair for those girls? Also, what happens when this vaccine imposes on a girl's, or her parent's, religious values and beliefs? Does the HPV vaccine belong in the hands of school boards at all, or should it be in the hands of parents and their children, who better understand what is morally right for them? Upon the Texan governers plan to vaccinate all 11 and 12 year old girls, Focus on the Family, a conservation group in the US, issued a position statement saying, "Focus on the Family supports the widespread, universal, availability of HPV vaccines, but opposes mandatory HPV vaccines for entry to public school. The decision to vaccinate a minor...should remain with the child's parents/ guardians" (Hopkins-Tannes, 2007). Something to think about.

References

Colgrove, Dr. J. (December, 2007). The ethics and politics of compulsory HPV vaccination. British Medical Journal. 355:2389-2391

Hopkins-Tannes, Janice. (2007). Texas governor is criticised for decision to vaccinate all girls against HPV. British Medical Journal. 334:332-333.

CTV News. (September, 2007). Catholic School Board to vote on HPV vaccine.
Retrieved on September 29, 2008, from, www.ctvnews/2007918/hpv_debate.ca

Getting to know HPV...

What is HPV?

One of the most common sexually transmitted infections (STIs) in Canada is the Human Papillomavirus (HPV). There are a number of different types of HPV; each type leading to different health outcomes (Health Canada, 2007).

According to Health Canada, it is estimated that up to 75% of sexually active men and women will have at least one HPV infection in their lifetime, though only a small number of these cases would potentially go on to develop cancer (Health Canada, 2007).

HPV is often a scarily “silent” infection; many people with HPV will have no signs of infection and go untreated due to this. The majority of people with HPV infections have no symptoms and the virus goes away within a few years (Public Health Agency of Canada, 2007).

There is no treatment available which can cure HPV infection; though there are treatments for some of the symptoms.

What is the link between HPV and cervical cancer?

According to the Public Health Agency of Canada, persistent HPV infection (of the high risk types) is responsible for over 99% of cervical cancer (PHAC, 2007). For Canadian women aged 20 – 44, cervical cancer is the second most common cancer in women, second only to breast cancer; it is estimated that each year more than 400 women die because of it (PHAC, 2007). A link has also been found between vulvar, penile and anal cancer and HPV but these are still under investigation (PHAC, 2007).

HPV Prevention

Gardisil^TM (manufactured by Merck Frosst) is a vaccine approved for use in Canada, it protects against infection for two high risk types of HPV (16 and 18 - which cause approx 70% of cervical cancers) and two low risk types (6 and 11 – which cause approx 90% of ano-genital warts) (Canadian Women’s Health Network, 2007). The Gardisil^TM vaccine has been found to be safe within studies with the most common side effect being brief soreness at the site of injection (CWHN, 2007). Studies have indicated protection against HPV types for five years of follow up; studies are ongoing to determine if further immunization is required for vaccinated women to have protection beyond 5 years. Once given the vaccination, it is still possible to become infected with the less common types of HPV (which the vaccine does not protect against) (CWHN, 2007). Cervical cancer can also be detected by getting a Pap Test.

What role does the government play in all this?

The federal government has allocated $300 million in the 2007 federal budget for provinces and territories to support the launch of a national HPV vaccine program for females between the ages of 9 and 26(Health Policy Monitor, 2007). The purpose of the program is to assist provinces and territories in providing free vaccinations to girls (which will help protect them against cervical cancer, and subsequently genital warts).

Immigrant, Aboriginal, low income, rural and other vulnerable populations are often unable to access the vaccine (due to the fact that it has a total cost of about $400.00) (Health Policy Monitor, 2007). Public funding of the vaccine is meant to enhance the accessibility of the vaccine for all women, but in particular for the aforementioned groups.

It is up to the provinces and territories to decide who should receive the vaccine (and whether or not it will be provided at no cost).

References:

Canadian Women’s Health Network (CWHN). (June 2007). HPV, Vaccine, and Gender: Policy Considerations. Retrieved September 28, 2008, from http://www.cwhn.ca/resources/cwhn/hpv-brief.html

Health Canada. Human Papillomavirus (HPV). Retrieved September 28, 2008, from http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/hpv-vph-eng.php

Health Policy Monitor. (October 2007). HPV Vaccine Funded in Canada. Retrieved September 28, 2008, from http://www.hpm.org/en/Surveys/CPRN/10/HPV_Vaccine_Funded_in_Canada.html

Public Health Agency of Canada. (2007). Human Papillomavirus (HPV) Prevention and HPV Vaccine: Questions and Answers. Retrieved September 28, 2008, http://www.phac-aspc.gc.ca/std-mts/hpv-vph/hpv-vph-vaccine-eng.php#4