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Policy Barriers in equalizing the vaccine

Difficulties or barriers we may face in attempting to equalize access to the vaccine is the conception that having 60 per cent of women vaccinated against HPV will afford males "herd protection." While vastly inaccurate, not to mention sexist with clear implications of affording men and boys exemption from worrying or protecting themselves or their partner against HPV, this mentality is prevalent when addressing whether parents or boys themselves will choose to be vaccinated.


In addition, Merck like all drug companies, is a powerful organization which have proved traditionally stubborn in response to public protest. As Merck in particular is a privately operated company which generates mass revenues which are not directly linked to the individuals who purchase their drugs, they are not obliged to be particularly responsive to the outcries of the Canadian public at large. This could prove to be extremely stagnating as we seek to equalize access to the HPV between the genders within our time frame, as opposed to theirs.

Polcy recommendations: equal access for boys and girls to the HPV vaccine

In addition to an altered education program and public health campaign which promotes sexual health as a responsibility of both genders, we recommend the HPV policy be altered to increase and equalize men and boys’ access to the HPV vaccine. In order to address the gender implications of this policy we would contact the Canadian Women’s Health Network whose views on the HPV vaccine are similar with our own. In contacting the Canadian Women’s Health Network we would attempt to form an alliance with them, and as a team, encourage the public to submit letters to Canadian Ministry of Health. These letters would lobby the federal government to impose immediate pressure on Merck to file an application asking the U.S. Food and Drug Administration to evaluate the testing of Gardasil on boys and men age 9 to 26. Following an exhaustion of all long term and short term side effects we, along with the Canadian Women’s Health Organization, and the supportive Canadian public, would impose pressure on the Canadian government and drug company Merck to include males equally in their vaccination policies. Merck appears interested in including boys in the distribution of the vaccine. However, two years have passed since policies surrounding HPV were implemented in schools across Canada. We along with our allegiances would therefore work to impose pressure on the government and Drug Company to ensure this occurs in a timely fashion.

Another potential ally in this process (other than the Canadian Women’s Health Network) is Dr. Harald zur Hausen, the 72-year-old German scientist who created the vaccine and was named as the Nobel Prize winner for medicine. Hausen is an avid supporter of vaccinating girls as well as boys. When speaking to 400 researchers and health specialists in Toronto in late October t at the MaRS Centre on College St. he recommended mandatory HPV vaccination for males as well as females. He stated it would be a show of "gender solidarity." As Hausen is clearly a well respected expert within the topic of the HPV, and has access, through his organized lectures to hundreds of influential health care professionals, researches, in addition to media, he could prove to be a valuable ally for us in equalizing access to the HPV vaccine.

Goals and objectives- Equal responsibility for men and women

Goals and objectives of policy reform surrounding HPV which specifically address the gendered implications of this policy must be considered to foster policy improvement. Sexual education programs which specifically address HPV providing a factual representation of the risks for girls and boys, which is not currently being practiced within schools universally, is an essential. As a result of the improvement of programs, both boys and girls should be cognizant of the risks of poor sexual health, vaccination, and the importance of preventative measures for themselves, their gender and their possible partners. This should result in males and females having more information about sexual health tools which include preventative methods and the vaccine

In addition, the final goal of policy reform should be to take sexual health out of the realm of only women’s health. Sexual health as a women’s health issue only is perpetuated by the testing and marketing of the HPV vaccine to women only. This, as previously mentioned occurs despite the reality that males can contract spread HPV as well. The overall conception of sexual health as a female issue must be deconstructed using the policy around the HPV vaccine as a tool. Through policy reform, making safe sexual health choices for yourself and your partner to avoid contracting, and spreading HPV should be seen by young girls and boys as the equal responsibility of both genders.

Goals and objectives- Empowerment through information and equal access

As stated by the Canadian Women’s Health Network, “At this point there are more questions than answers surrounding girls, women, cervical cancer and the HPV vaccine.” I would therefore logically conclude that more answers are needed before the Canadian government proceeds with their current bombardment of one sided issues on the female public. Improvement and careful consideration of effects should be at the primary goal of policy makers who are evaluating the current government policy on the HPV vaccine. In order to improve the policy specific goals and objectives must be predetermined.

With the new plethora of resources including preventative measures and vaccinations, girls now have access to more choices concerning their sexual health than ever before. It is the responsibility of this policy to ensure that all girls including marginalized populations are made fully aware of these choices. In addition, zero pressure should be exerted by the government, within schools, and by health care professionals to try to convince girls to get the vaccine. A primary goal of the HPV vaccine policy and subsequently the new choices made available by information surrounding HPV and the vaccination should be to leave girls feeling empowered by information. Such information can therefore lead girls to make educated choices.

In addition, a primary goal of the HPV policy is to increase boys and mens' current access to the HPV vaccine, offering males the same programs as females. As there are no biologically known reasons why a vaccine can not be implemented for men and boys to protect themselves and others against HPV, a goal of the new policy should be equal access. This objective is supported by many health care professionals as well as the creator of the HPV vaccine Dr. Harald zur Hausen, (who is not financially connected with the vaccine’s makers). In refusing to test the vaccine on boys and men, sexual health was treated as a women’s only issue. In 2008 this is a ridiculous implication which must be rectified immediately when new goals and objectives are created for policy reform.

Policy: Accessibility for all girls and women

As mentioned earlier, we propose the creation of a policy allowing all women access to pap tests, as well as educating women on the importance of the pap test for their health. We recognize the challenges and barriers that will be presented, including funding issues, and criticism from certain cultural and religious groups. We also mentioned that we would form a relationship with the Womens Health Network, as they would be an excellent resource and ally.

Another policy we would like to implement regarding the HPV vaccine is to ensure that all girls and women have equal access to the Gardisil, or whichever other vaccines come out in the future. Currently the schools are the only place girls get get vaccinated for free, which is not inclusive for those who attend a school that does not support the vaccine. Also, the school may not be the best place for this vaccine as many parents, and students, have questions and concerns regarding the vaccine, and may not feel comfortable with the vaccine being in the school; rather, they would prefer going to their doctor or clinic, and still be able to get the vaccine for free. We believe that as long as the girl in the "target age", which in Ontario is grade 8, girls should be free to choose where they would like to get vaccinated, at school or at a clinic. That way, all girls are included.

In order to do this, we would need to speak with school board trustees, to get their imput and suggestions, as well as find out which boards are implementing the HPV vaccine.We could meet with parent groups, or conduct surveys to find out parents thoughts on the issue and what their concerns are. We would also have to meet with provincial health ministers, in order to get funding for clinics and doctors offices to carry Gardisil and vaccinate girls of the target age for free. Each girl would need a record of whether or not she has receieved the vaccine, just as they have records for other innoculations. Vaccines must only be given out by trained doctors and nurses, with signed forms from the girl's guardians. It is also important to note that the HPV vaccine is not mandatory, nor do we plan on making it mandatory. We feel mandatory pap tests are more important. Instead, this policy is meant to give girls more freedom and more choices to make the decision that is best for them.

Policy: Education - Potential Barriers?

Although we proposed that an enriched sex education program for young men and women would be beneficial, we may experience a few obstacles along the way. For example, parents and administrators of the Catholic School Board will pose a problem. They believe that vaccinating young women with Gardasil leads to promiscuous behaviours. Their belief stems from a religious standpoint, and lack of knowledge pertaining to the detrimental effects of HPV as a disease. They may agree to educate young men and women about HPV, because it instils fear and promotes sex as negative. However, it would be almost impossible for these individuals to agree to educating young adults about all aspects pertaining to sex, such as its pleasurable factors.

In addition, teachers may not feel comfortable talking about sexuality in a positive manner, due to their religious beliefs, embarrassment and lack of knowledge. We would have to hire specialized teachers to teach the enriched sexual education program. If teachers seem hesitant when they educate their students, students will not take into consideration the detrimental effects of STI’s and unwanted pregnancies.

Finally a potential barrier involves educating parents. How will we educate them about HPV? For young adults, they will receive a sex education program at school. However, if meetings are set up for parents regarding Gardasil and detrimental effects of HPV, how can we guarantee that they will show up? Sending notes home with students does not guarantee or raise parents’ awareness.

Policy: Education

In order to ensure an informed decision among young women regarding Gardasil, proper education must be enforced within the sexual education classroom. In order to attain this goal, we must speak to individuals’ in charge of the educational curricula. This process may involve approaching individuals at the federal, provincial and/or municipal levels.

Before contacting policy makers, we should advocate for an enriched sexual education program and raise administrators and parents’ awareness towards the lack of education regarding HPV. Next, we should contact principles of schools, and eventually contact the various chairs and directors of education, within each municipality. From there, we can contact the province’s ministry of education and present our goals and recommendations pertaining to a properly administered sexual education class.

Each province in Canada consists of a minister of education. For example, the minister of education in Ontario is Kathleen Wynne. One of her main roles is to issue the curricula taught within primary and secondary schools. In order to make changes to the sex education program, it would be beneficial to contact her or the deputy minister of education, Steve Marshall. We can also contact individuals’ part of the education system at a municipal level, by targeting specific school boards. For example, we can contact trustee members of the Toronto District School Board. 22 public school trustees are elected during the municipal elections, in order to represent public school supporters in the City of Toronto. Monthly meetings take place between the trustee members, and it would be beneficial to raise the trustees awareness towards the benefits of enriching the sex education program. Finally, it would be beneficial to contact the director of education (Toronto district) Gerry Connelly, in order to achieve our goal.

It would also be beneficial for us to collaborate with the National Council of Family Relations (http://www.ncfr.org/about/index.asp) In the past, they have reported many issues with sex education (ie: teachers discomfort with teaching these materials) and they can help us to get our voices and opinions heard.

Finally, the sexual education curriculum within schools is based upon the sexual education material presented by Health Canada. Therefore, we would have to contact the Minister of Health, Community Acquired Infections Division and the Centre Infectious Disease Prevention and Control. Here we could express our concerns with regards to Gardasil, and the educational program’s lack of information concerning HPV as a disease.

Policy: Pap Tests for all Women

Pap tests are currently the only way to detect HPV in women. Women are supposed to get tested once a year from the time they are sexually active. This is crucial in reducing the number of HPV cases, and in and turn, the number of cervical cancer cases each year. The more women that are tested, the more chance there is of catching and treating HPV cases, and preventing cervical cancer. Unfortunatly, not all women are getting tested. This is for a number of reasons, but we are concerned with the fact that many women simply lack the money and resources to get a pap test.

We propose that pap tests be available to all women in Canada for free. Pap tests should be covered by the health care system, like other cancer and STI screening programs. Women who do not have access to a family doctor should have access to a clinic or hospital. This may require travelling clinics, or nurses and doctors who visit isolated and marginalized women living in rural areas or on native reserves a few times a year.

Women must be educated on need and importance of pap tests, and they need to know how they can go about getting tested. This can be done through campaigns in hospitals and clinics, and doctors should remind all women to get tested, just as women are reminded to get mammograms.

In order to introduce this policy, we would join forces with the Women's Health Network, which shares our values and they have knowledge and experience in the area of women's health, which would be greatly beneficial to us. We would need to seek the approval of provincial health ministers. This may mean having a trial in one or two provinces, with hopes of getting all on board. We could also start at a more local level, involving MPs who share our vision. That way we could see what parts of the policy work and what parts do not, and make necessary changes before going provincial or federal. Setting up an evaluation process would be necessary as well, especially if we are depending on funding from the government.We will also have to be aware of cultural and religious issues, as some groups may not welcome the idea of pap tests, and view them as unnecessary or envasive to women.

Policy: Research

Analysis beyond clinical trials is critical to ensure public safety. Warns Lippman: "What happens in the real world can be very different from what happens in the clinical research world," where girls are in a controlled environment, and get health examinations frequently to gauge any problems. "The real world is where we find out what really happens when you let a vaccine loose on a population."
What the public needs to understand is that even if HPV vaccination progs continue to develop and expand, the public needs to know that young women can still develop HPV infection and cervical cancer after being immunized. Harper, the HPV researcher at Dartmouth, tells of a yet unpublished study that shows that if females aged 12-26 who are vaccinated don’t go get pap tests after the vaccine, the rate of cervical cancer will go up compared to pre immunization rates.. "So there is significant danger in people feeling this vaccine offers them a force field protection," says Harper, "and that could actually rebound back to us because there are other HPV types out there and they're not going to stop causing cancer just because we've given a vaccine."

Research studies such as the one aforementioned will eventually come to light in the years to come. It is up to the government of Canada to conduct studies in order to determine if the vaccine that they are purchasing is safe in the long term for females across the country. Whether or not this will happen is probably going to be determined by how many adverse reactions are reported in the future. Unfortunately, pharmaceutical companies have the money and the power to lobby for the implementation of their vaccine – and it is not until it is too late, that the vaccine gets pulled off the market. It is up to the mass media campaigns to be honest and inform the public about the real issues related to HPV and cervical cancer and the importance of looking at both sides of the issue because to fund a research project against a major pharmaceutical company is next to impossible. The Candian Women’s health network would be an ally in this process however, as they will be sure to publish and stand behind any study or finding that goes against the mass acceptance of Gardasil as a ‘lifesaver’ for women all over the world.

Policy: Media

Merck Frosst obviously has the financial power to buy airtime on most Canadian television channels, as we see the commercial for Gardasil at all moments possible . There needs to be information campaigns, sponsored by the government (whether it be federal or provindical) that provide information about sexual health for both males and females. Media campaigns have experimented with key strategies to overcome the obstacles to providing reproducgtive health ervicse to targeted populations, and especially to reach youth. Motivational media campaigns must use clear, simple messages; multiple media channels; and positive images can increase awareness about the risks of being sexually active. They also must teach people, and youth in particular how to take preventive measures. Those who need ot be involved are members of the target audience as educators, coordinators, and program developers.
Sexual health campaigns will be most effective when working with and complemented by when by other activities at the individual, community, and policy levels. Additionally, the campaign needs to be sustained over the long term. The messages also need to have links to health services, hotline numbers, in order to be successful.
What needs to be done to create effective informative sexual health campaigns? Research to define campaign goals, selection of target audience, identify media channels and refine campaign strategy. Messages need to be tailored to speak to the audience member’s ‘world view’ and use credible sources and appropriate and understandable language. Exposure can be ensured by working with media gatekeepers and using cost effective approaches (radio, billboards, transit cards) as well as entertainment and news. The issues need to be framed in terms important to policy makers, therefore taking advantage of the agenda setting function of mass media. Furthermore, media and community strategies need to be combined to leverage program activity in the community. Behaviour change models can be applied by increasing awareness and increasing knowledge, teaching new skills and sustaining behavior change.
Keller, S.N. & Brown, J.D. (2002). Media interventions to promote responsible sexual behavior. Journal of Sex Research.