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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.

Goals and Recommendations: Education  An Enriched Sex Education Program

It is vital that young women understand what and why they are injecting Gardasil into their bodies. As mentioned previously, young women are being taught what they are injecting into their bodies (vaccine preventing HPV), but are not given a full understanding as to why (Why are they preventing HPV? What exactly is HPV?) Our goal is to inform sex educators the importance of teaching the facts of HPV towards young men and women. It is vital that an enriched sex education program exist in order to focus not only on HPV, but on ALL sexually transmitted infections. There is a high incidence rate of STI contraction during adolescence, and sex educators need to inform both male and female students about their consequences. HPV is not the most lethal STI, and other diseases such as HIV need to be emphasized immensely. Moreover, similar to family doctors, we recommend that sex educators stress the importance of yearly pap tests and its connection to HPV and other STIs. It is common among adolescent girls to switch to a female doctor in order to increase their comfort levels during this time period. Sex educators should provide information as to where to receive a pap test and provide several contacts (including female family doctors), if they have trouble searching for a family doctor.

Presently, our society is more open-minded towards sexual practices compared to several decades ago. We cannot ignore the fact that young adolescents engage in pre-marital sex. We want sex educators to refrain from abstinence education, and enforce the use of condoms for practicing safer sex. Condoms should be available at all times within the school. Finally, we want sex educators to be honest with adolescents. We do not want sex educators to say, “sex is bad, because you can contract and transmit STI’s and/or get pregnant.” Sex educators should address why the media portrays sex as positive, and admit the pleasures associated to sex. An enriched sex education program such as this, will give adolescents the true facts regarding safe sex, benefits of sex, consequences of sex (HPV, other STI’s) and finally methods of prevention, and pap tests. Finally and most importantly, it will give parents and young women the proper education to make an informed decision towards Gardasil.

Goals and Recommendations: Education --> Who Will be Targeted?

A major argument reiterated throughout this blog stresses the lack of education pertaining to HPV as a sexually transmitted infection. We argued that parents and young women are not properly educated about HPV, making it unfair and unjust to implement its vaccine. Decisions concerning Gardasil have been made strictly surrounding the prevention of cervical cancer. Nonetheless, HPV vaccination programs have been designed to educate parents, but not in a proper manner. For example, in Toronto, grade 8 females are given an information package to take home to parents. This “educational package” includes the following:

- A letter outlining the HPV program
- Fact sheet on HPV vaccine
- Consent form
- Pamphlet (translated into 12 languages)

The information package outlined above provides information concerning the vaccine only. But, what if someone has never heard of HPV? The pamphlet may provide important facts; however, it does not guarantee that parents and children will actually read it. Our goal is to further educate parents, young women, and sex educators about all the facts concerning HPV as a disease, in order to guarantee an informed decision.

We want to begin by targeting parents who feel uncomfortable towards Gardasil due to their misconception of HPV. For example, many parents part of the Catholic School Board believe that the implementation of Gardasil will lead to an increase in young women’s promiscuity. Our goal is to eradicate this myth, and provide proper education and facts regarding HPV, because in reality one can still contract the disease even if he or she is not sexually active. Next, we want to target all parents and young women concerning what is HPV, and inform them about alternative approaches to cervical cancer prevention (pap tests). Finally, we want to ensure that family doctors stress to their female patients the importance of yearly pap check ups. We want to educate family doctors and gynaecologists the importance of maintaining prompt contact with their patients regarding pap test results.

Goal: Pap Tests for all!

Another goal we have for our policy on HPV is that there be free Pap tests available for all women. So many women fail to get tested each year for a number of different reasons. Some do not have a family doctor, some do not have access to a clinic or hospital as they live in rural areas or are marginalized in the community (this may be due to poverty, being an immigrant or refugee, being Aboriginal, etc.). Also, many women simply are not educated on the importance of getting a pap test, or what a pap test actually does.

We will touch upon the educational component in a different blog, but we would like to stress the importance that women need to know what a pap test is, why they should get one, and where and how they can get one. We propose that all women should have the right to getting tested, and they should be able to do so once a year, for free. Women should be able to go to clinics or hospitals, and those who are marginalized or live in isolated areas should have access to testing sights. This may mean once a year running a clinic on native reserves, or in rural areas. Also, women should have the right to getting the results from their tests in a simple and timely manner. We understand that testing does take time, and their is a waiting period for results, we just want to make sure that abnormal pap tests are always reported.

Ensuring that all women receive pap tests would be extremely beneficial in reducing the spread of HPV, as well as cervical cancer. If a woman does test positive for HPV, she can be made aware of the infection, prevent infecting anyone else, and receive treatment. We believe that freedom and power is in knowledge.

Goal and Recommendation for new policy: Access for all girls

Currently in Canada, girls in grades 7 or 8 are able to recieve the HPV vaccine for free in their school, as long as their school board has chosen to accept the Gardasil vaccine. What happens to those girls who do not have access to the vaccine for free in their school like their peers? Many Catholic school boards for instance, have rejected the policy, and said the vaccine has no place in their schools. Many parents and childen who attend Catholic schools may be ok with this, as it may fit with their morals and values, however this isn't the case for everyone. There are girls who attend these schools who do want the option to get vaccinated for free, so there need to be places for these girls to go. We propose having the vaccine available in clinics or at doctors offices for free, or at least at a reduced cost. If a girl is of the target age, that is the age in which the province has decided to give out the vaccine for free in schools, and cannot get the vaccine at school, she should have the same rights as her peers.

This raises the issue of whether or not the school is the best place for vaccines. We believe that the school is a good place for those who may not have a family doctor, or have access to a clinic or hospital, as the school is a place that is available to everyone. However, we also feel that a girl should have the option to go to her doctors office to receive the vaccine for free, if she chooses not to get vaccinated at school. The doctor, or a nurse, would be able to give the girl more education, and more time to discuss her options. Funding for all of this would have to come out of the funds that each province recieved for the Gardasil program, and it would have to be redistributed, ensuring each girl of the target age would have access to free or reduced cost vaccination.

Recommendation: Research

If the HPV vaccine is going to continue to be given to young girls, research is needed on its efficacy and outcome expectancies.
The government has clearly not taken into account the fact that Merck Frosst does not even know yet how effective the vaccine is and whether or not another shot will need to be given to young girls 5 years or so after their first round of shots; this is just asking for the government to provide more funding in the future for a vaccine that may not even be 100% effective.
Additionally, the research that has been done on the vaccine itself is insufficient. Instead of Merck Frosst doing it’s own testing, comparisons of different vaccines carried out in “government supported research programs, free from any conflict of interest” needs to occur. In order to effectively make health care decisions, and evidence based policy decisions, research needs to show that the vaccine is in fact, cost effective and overall effective enough to be given to girls 9-26 across the board. The original testing of the vaccine only tested around 1200 girls, this number is clearly too low and testing needs to be expanded to more girls across all ages.
Before implementing a nationwide vaccination program, the long term side effects of Gardasil need to be discovered. Currently, they are “waiting” to see if there are any long term side effects from the HPV vaccine; using young Canadian women as guinea pigs.
Research findings also need to be available to the public in order for young women and their families to make informed, evidence based decisions and be aware of all possible short term and long term side effects.

Recommendation: Addressing the Media

One area which needs to be addressed when thinking of a new policy for HPV (or sex education) in Canada is addressing the media.
The current “HPV information campaign” that has been introduced by Merck gives the impression that the Gardasil Vaccine presents ALL cervical cancer, and basically makes girls feel invincible. It instills fear in young women and their families, without even stating the true facts of the matter. If Merck were running a truly “educational” campaign, it would include that it is not only HPV that as a young women it is not only HPV that you need to be protected against, but rather, all types of sexually transmitted diseases; it would promote general sexual health. Merck’s Gardasil campaigns are clearly in the inestered for the company itself, rather than the health of young people across the country.
The way that Gardasil has been marketed has made it difficult for reflection between parents and children, health care providers and their clients as well as among the public and policy makers, about what HPV is and about the vaccination (CWHN).
A new policy would address this by instead, using the media to promote greater awareness of disease risk, safe sex, condom use, promote Pap tests, and would give the truth about HPV in relation to cervical cancer (more than is in the small print of Mercks current campaign).
The reality is that young women and men need to be educated on sexual health in general, and one way of doing this is using the media. As we can see from the success of Merck’s Gardasil campaign in promoting their vaccine across the county, the same effect could be had using the media to promost sexual health overall. Where are the ads encouraging young women to get Pap smears? Which can protect/identify more sexual health concerns than cervical cancer alone. Where are the ads promoting condom use? Which can prevent STIs and pregnancy. Instead of instilling fear about one STI alone, all aspects of sexual health need to be addressed in order for young women to be well informed across the board about sexual health issues.
It would be difficult to pull Merck’s commercials off the air, but if the government is willing to put aside $300 million for HPV vaccine, the government should be willing to set aside money to promote all aspects of health for young women.

Summing it up...

The HPV Vaccine has indirectly oppressed women by focusing on HPV as being a female only problem (and as we have discussed men can carry the disease as well). The current vaccination program that has been implemented by the government of Canada does not address the wider concerns that sex education should currently be addressing for males and females. In the next few blog we will talking about goals, objectives and recommendations for policy alternatives in Canada.

The HPV vaccination: A Continuation of Modern Oppression towards Women

The HPV vaccination is currently being implemented towards women ONLY. From my understanding, HPV is a sexually transmitted infection (STI) which is typically contracted via sexual intercourse. (Although it is likely to be transmitted within dyads of the same sex). Within heterosexual dyads, both men and women have equal probability of contracting HPV from one another. Similar to pregnancy, both males and females play a vital, and equal role; the egg and sperm needed for conception. It is evident, that men are just as likely as women to contract the HPV virus; yet in reference to the HPV vaccine women are being oppressed and men are being empowered. On the topic of HPV, why are men not being vaccinated, when obviously men partake in transmitting/contracting HPV as well? This is consistent with the cultural assumption that women will take birth control to prevnt pregnancy. Why is the only contraceptive available for men the condom? This in my opinion further empowers males.

There are two ways to view Gardasil and its implementation towards women. You could misconceive it as a miracle that has been developed to “prevent” cervical cancer, or, you could view it from my perspective; indirectly oppressing and targeting women as the “carrier” of HPV. It unintentionally conveys the message that women spread HPV while men do not. Apparently, an HPV vaccine for men is currently being tested and will be brought to the market as soon as it is ready. But, is this really going to happen? Male birth control is STILL in the process of being developed, while women have been utilizing it for half a decade already.

Presently, birth control (the pill) is an extremely popular contraceptive utilized by women. Besides unwanted pregnancies, it encompasses various benefits, such as menstrual cycle regulation, acne reduction as well as a decrease in menstrual pains (ie: backache, cramps etc.). However, birth control encompasses consequences, which in my opinion outweigh the benefits. Contrary to the HPV vaccine, the pill is associated with an increased risk of cervical cancer (primarily during its early stage). Moreover, the pill is associated with a slight increased risk in breast cancer as well. However, the Canadian Cancer Society noticeably states the links between the pill and cancer “so women can make an informed decision about their own health”, which HPV vaccination programs fail to address. As mentioned previously, male birth control is currently in the process of being developed; however, it is extremely “complicated” because men have the ability to fertilize (due to sperm production) 24/7 whereas women ovulate for 48 hours per month, which is much easier to regulate through the menstrual cycle. Although a male version of “the pill” is a very innovative idea, researchers wonder if men will actually utilize it due to its side effects (lack of libido, mood swings, weight gain etc. are associated with male birth control). What I find oppressive about this matter, is that these side effects are associated with the current birth control available for women.

Women are taking action and risking their bodies in order to prevent STI’s and unwanted pregnancies. They are ingesting or injecting hormones, and injecting HPV vaccines. How are men preventing these issues? I guess one could admit that condoms are mainly targeted towards men, even though female condoms do exist. However, as opposed to oppressing men, the condom gives men the power to choose to expose themselves to disease and/or impregnate a woman. The condom has none of the physical side effects associated with the pill and HPV. As far as I can tell in reference to birth control, and HPV the onus is on women to deal with all of the negative repercussions of their participatory role in sexual intercourse.

FREEDOM FOR WOMEN.

Throughout my blog I have analyzed what Canada’s current HPV policies means for and to women. As a result I have adopted a liberal feminist’s view, insisting on freedom as a fundamental right for women. However, in examining and often reexamining the surplus of issues associated with women, feminism and HPV I have been forced to redefine my own concept of freedom. Freedom for women has become an extremely convoluted subject within Canada in the year 2008 as women’s personhood is legally recognized, suffrage has been achieved, and freedom of choice has prevailed. With women having been granted these obvious rights, the oppression of women within Canadian society has become much more subtle. Canada’s position on vaccination of HPV has therefore become a microcosm for the implicit oppression which women face today.

Many complexities exist in attempting to truly understand what freedom means within the context of the HPV debate. Is freedom, as the public information campaign for the vaccination contends, ‘opening your eyes’ to cervical cancer and being ‘one less?’ or is freedom having the right to choose between vaccination or preventative measures such as pap testing, condom use, and partner choice? I, as a liberal feminist would argue for the later. True freedom within the twenty first century is found in women having the power of choice. The proponents of this vaccine would argue that this freedom is granted as women or more aptly the parents of young girls can deny their daughter the vaccine. However in evaluating if women are truly free within this choice I must question if all girls who choose preventative measures as their combatant against HPV have equal access to doctors for regular pap tests and condoms. Within Canada’s overwhelmed health care system, granting all women and girls, including marginalized populations access to sexual health tools, would be essential in giving women freedom in choosing whether or not to vaccinate themselves or their daughters.

Education and information surrounding the vaccine is also necessary should women be granted true freedom. Freedom to choose whether or not to vaccinate is NOT found in the current public health campaigns’ bombardment of advertisements on young women, which fail to address the scope of issues (which are discussed in prior posts but include the limited scope of the testing of the vaccine, the actual likelihood of HPV leading to cancer, the failure to vaccine young men, and the personal tools one can use to avoid contracting HPV or having it escalate to cancer. In educating women, that if they value their lives or their daughters’ lives and do not want to cope with the enormity of cervical cancer they should just get vaccinated, and ignoring ALL the other issues associated with the vaccine, women are not given the freedom to make an educated choice. Instead the politics of fear are used to push and pressure young women to assume the physical and often financial repercussions of the HPV vaccine for themselves and for their partner. Now where is the freedom in that?

Should there be a price on cancer prevention?

After some exploring I found that there are ways for women to get the HPV vaccine if they cannot afford the high price, and if they happen to not be in grade 8. There are some programs available for a fraction of the cost, while some even offer the vaccine for free, that is, if the woman qualifies. If a woman is uninsured, or her insurance doesn't cover the vaccine, she qualifies to get the vaccine at a reduced cost or for free. Merck, the company that makes Gardasil, even has a vaccine assistance program for women to receive the vaccine for free. However, women have to qualify first. You must be at least 19 yrs of age, be uninsured, reside in the US, and have an annual income of $20 000 or less for inds., $28 000 or less for couples, and $42 400 or less for a family of four. Apparently Merck does take case-by-case considerations for woman who are in special circumstances. There is also a vaccines for children program for youth under the age of 18, who do not have insurance, and qualify for Medicare. I am not sure if progams such as this exist in Canada.

While I believe it's great that girls and young women who want to be vaccinated with Gardasil have the opportunity to do so without paying $360, I think it's unfortunate that there is such a high cost at all. I understand that pharmaceutical companies need to make some money, but it is sad that they make as much as they do. It's hard to comprehend the fact that a woman has to pay $360 to protect herself from cancer. Merck has reportedly made billions off of Gardasil already. And while they claim that most insurance companies do cover the vacccine, many people do not have insurance. Is it right that those to pay b/w $300-$500 to protect themselves? And for those who can't afford it, is it right that these women are denied protection?

Safe or Sorry?

“Shannon Nelson, an 18-year-old athlete from outside of Chicago, wonders about the vaccine. She got the HPV shot at the same time as two other vaccines. Within a week, she developed Guillian-Barre Syndrome (GBS), a mysterious autoimmune disorder that causes muscle weakness and paralysis. In Nelson's case, she developed paralysis that lasted for over two months. ‘ I couldn't sit up in bed, I could not lift up my arms,’ she recalls. ‘I appear recovered but I'm not.’”. – CTV.ca

I have a serious concern about the clinical trials of Gardasil. 1200 girls aged 9-15 years of age were enrolled in the clinical trials of Gardasil. Of these girls only ONE HUNDRED were nine years old, with the youngest being followed for a mere 18 months. And yet, the vaccine was deemed "safe", with minimal side effects. These one hundred girls represent the target age group for the HPV Vaccination. Shouldn’t there be clinical trials a little more comprehensive than this? How effective are the results of a clinical trial on 100 girls, when in reality, the vaccine is being given across the country to girls of different biological backgrounds on different medications. Who knows how it will affect nine year old over the other, in order to discover this, testing needs to look at more than 100 girls!
A policy of mass vaccinations has been approved based on this basic, short term trial. Who knows what long term effects may come along with Gardasil in the years to come for girls and women who have received the vaccine. No one will know until they actually happen because the clinical trials did not look at long term effects! Anyone remember Depo Vera (the birth control shot)? It had clinical trials too, and after thousands of girls got sucked into the idea they realized it decreased bone density in women (which is already a concern for many).
It makes me wonder when we are going to find out what effects Gardasil is going to have on girls in the years to come. Low bone density, birth defects, deaths? Who knows, because it hasn’t been tested over long periods of time. It is absurd that based on the weak data available, a policy of mass vaccinations has been developed for girls in Canada. Why are the girls always the guinea pigs? All “new” methods of birth control are developed for females; where are the products being using males as the guinea pigs??

The Contradiction Between Education and the Media: How Does This Implicate HPV?

Presently, there is a major contradiction between what is being taught in schools versus what is being portrayed in the media. Sex education within schools highlights the fears associated with unprotected sex. Such fears include STI’s (e.g HPV) as well as unwanted pregnancies. Typically, sex educators promote the use of contraceptives, benefits of sexual abstinence, and as of 2006, Gardasil, the HPV vaccination. However, the media portrays sex as positive and pleasurable, which gives young adults an opposing message concerning sex. It has a powerful influence among children and teenagers, because the average child/teen spends about 5.5 hours per day watching television, surfing the net etc. The media contains a vast amount of sexual content. A study conducted in 2001/2002 discovered the findings mentioned below:

Nearly 75% of all primetime television shows contain some sexual content.
For the top 20 teen shows, this figure increases to 83%

One of every seven shows includes a portrayal of sexual intercourse or
implied intercourse

Overall, only 15% of shows with sexual content mention any of the risks or responsibilities that are involved in having sex. When the shows involve
teen characters, this figure increases to one third. Forty-five percent of the
top 20 teen shows mention risks and responsibilities

An example which I believe most individuals are accustomed to by the media is the lack of demonstrating contraceptive use. When was the last time you witnessed a guy in a movie or tv show stop and say “wait a sec, I have to put on a condom”. The only movie I recall the man putting on a condom was in “Love and Basketball”. The media clearly poses a problem, for its young viewers. For this reason, sex education is an EXTREMELY significant way to address sexual issues concerning young adults. But, instead of addressing ONLY sexual fears, admitting the truths of the media can benefit young adults. It removes the confusion produced by the present contradiction between the media vs. education. Also, it raises awareness for young adults about the implications associated with unprotected sex as well as the pleasures associated with it, when taking extra precaution.

As mentioned previous blogs ago, women have the right to understand and know the facts about their body. Since the media usually portrays a woman as experiencing pleasure from sexual intercourse, the sex educator, in my opinion, should admit that women derive pleasure from vaginal stimulation, and yes, IT FEELS GOOD.

So, what does this have to do with the HPV vaccine??
Well, I have a problem with the media vs. education concerning the HPV vaccine. HPV is portrayed in the classroom as “deadly”, when in fact we all know this is false. From the research previously mentioned in the blog about cancer, cervical cancer does not have a very high incidence rate. And, in fact, since Gardasil only protects against FOUR HPV strands, it does not prevent ALL types of cervical cancers. Moreover, commercials within Ontario are telling women to “open their eyes” and rush to their nearest doctor if they are between the ages of 9-26 in order to receive the HPV vaccine. But, the biggest problem I have with this commercial is WHY? Where is the explanation? Is it left for classroom discussion? Is the media portraying, that sex is pleasurable, and that you should have sex WITHOUT a condom (because they never demonstrate that)? Also, is it implying that Gardasil, will in fact protect you against HPV and cervical cancer ?

I have “opened my eyes” and sex educators need to address the media’s effect on young people’s perceptions towards sex, including the good (pleasures), the bad (HPV) and the truth (What will Gardasil really do for you?)

Are schools really the best place for Gardisil?

The Canadian government, and in turn several provincial governement, have created a policy which distributes the HPV vaccine to girls in school for free. This allows many girls who could otherwise not afford this vaccine, a chance to protect themselves. However, it is up to the school board to decide whether or not they will provide this service in their schools, not the students. If a girl is interested in getting the vaccine, and her school offers it, she simply has to get a permission slip signed by her parents. What happens though, when a girl wants the vaccine, but goes to a school that does not agree with the policy, and has rejected the Gardisil vaccine? The Catholic School Board in Halton, ON, voted against providing the HPV vaccine to grade 8 girls in their schools (www.globeandmail.com). Halton trustees also voted to have the board increase its efforts to impress students that abstinence before marriage was an important feature of the Catholic faith (www.globecampus.ca).

Six out of twenty school boards in Alberta have also rejected the vaccine. These school boards believe that providing a vaccine for a sexually transmitted disease goes against the values and morals that the Catholic faith preaches to the students. Alberta Health spokeswoman Shannon Haggerty issued a statement telling parents not to worry, and that if their children attends a school which has opted not to provide the vaccine, they will not be forgotten. The provincial government is working to make sure their are alternatives for those girls, ie. a place where they can get the vaccine for free like other students their age, such as free clinics (http://ca.news.yahoo.com).

Is the school really the best place to distribute the Gardisil vaccine, or would free clinics be a better choice? One the one hand, the majority of girls attend school (with the exception of home-schooled children), therefore it would be a convenient location for them to get vaccinated. On the other hand, schools are not clinics, and different school boards teach different values and morals. If a girl from a Catholic school that has rejected Gardisil wants to get vaccinated, she may face a moral dilema, as well as stigma from her peers. If all girls had the choice to get the vaccine from a free clinic, perhaps this wouldn't be such an issue...

References
www.globeandmail.com (2008). Catholic school board rejects HPV vaccine.
www.globecampus.ca (2008). Catholic school board rejects HPV vaccine.
http://ca.news.yahoo.com/s/capress/081013/national/alta_hpv_backlash_1 (2008). Alberta tries to deal with Catholic backlash against HPV vaccine in schools.

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