The HPV Vaccine Debate
June Tavenor-Brake, RN, BN
The Human Papillomavirus (HPV) is the most common sexually transmitted disease (STD) in the world. It is a highly contagious STD that can be passed between partners even with the use of condoms or without actual penetration. Estimates show that approximately 75 percent of Canadians will be infected with at least one of the four strands of HPV over their lifetime. For some, the infection will come and go without showing any symptoms. For others, the virus will lead to cervical cancer. Two HPV infections in particular are accountable for 70 percent of all cases of cervical cancer, which is the second most common cancer in Canadian women aged 20 to 44. The HPV virus has also been linked to vaginal, vulvar and anal cancers.
Gardasil, a three-dose vaccination manufactured by Merck Frosst Canada, has been endorsed by the National Advisory Committee on Immunizations (NACI) to prevent some HPV infections in women. The vaccine has been proven to provide 100 percent immunization against four particular strains of HPV, including the strains responsible for the majority of cervical cancers.
NACI recommends that girls aged 9 to 13 receive the vaccination before becoming sexually active. Women between the ages of 13 and 26 are also being encouraged to talk to their doctors about receiving the vaccine, even if they have already been sexually active because they may not have been exposed to one of the four strains contained in the vaccine.
In the United States, some states have implemented vaccination programs for HPV in grade 6, unless the parents opt out. A total of 24 states are looking at some form of mandatory immunization. This action has led to some controversy; What about the money? What about our morals?
The Money
Gardasil is a three-dose immunization. In Canada, the cost per injection is $120, for a total of $360. Because the drug is not included in the National immunization schedule, it has to be purchased at the consumer’s own cost.
The vaccine is currently being offered only to young women, even though men also contract HPV. This is largely due to the fact that all clinical trials of Gardasil have been performed on young females. However, there are some accounts of men opting to be vaccinated. So, the money concerns would obviously rise if all young people were to be included in a mandatory immunization program.
As with all immunization programs or health promotion activities in general, we must weigh the investment of treating people affected by preventable diseases now against the future cost. According to a 1998 report, treating all cancers in Canada cost the government $14.2 billion, coming in third behind cardiovascular and musculoskeletal diseases as the most costly ailments in the country. It makes you wonder if the same debate would arise if there was a new vaccine that prevented heart disease, or if costly new cars were designed that guaranteed people would never sustain injuries if in an accident.
The Morals
There has been some voiced opposition to the implementation of mandatory vaccination with Gardasil based on the belief that it will encourage young girls to become sexually active at younger ages. Parents are concerned that their daughters will falsely believe they are protected against all sexually transmitted diseases because they have had the vaccine. Some experts disagree. Sex educator Alix Bacon of Vancouver compared the concept to vaccinations for HIV or Hepatitis C: “we wouldn’t deny [those vaccines] to anyone. This way your [daughters] will be more protected if and when they choose to make a decision” ("Cervical Cancer Vaccine"). Many other experts agree that proper sex education will prevent any misconceptions by young women if vaccinated with Gardasil. Also, not all sexual encounters are consensual, and vaccination would also help protect against this unwanted exposure.
In the United States, this debate has led to some discussion on compromise. Some politicians have recommended that Gardasil be included as a mandatory part of the immunization schedule, but with parents having the option to opt their daughters out of this immunization in particular. However, some critics are concerned that this idea could set a precedent where parents want to opt out of other mandatory vaccines, such as polio or small pox, both of which have been eradicated since their introduction into mandatory immunization programs.
In Nova Scotia, a province-wide program to provide the vaccination—with the parental opt out—is expected to be in place by this fall. Similar programs are in development in PEI, with other provinces in negotiations with the federal government to help with funding of the project.
If you choose to have the vaccine or will have your daughter receive the vaccine, it is still important to practice health promotion behaviours. Even with this precaution, regular Pap Smear tests and physical exams by your family physician are still very important because Gardasil does not protect you against all HPV viruses or all other causes of cervical cancer. Other risk factors include becoming sexually active at a young age, multiple sexual partners during your lifetime, smoking, or suppression of the immune system such as after a transplant or with some inflammatory disorders.
For you parents, encourage open dialogue with your daughters. If you feel you cannot give the information you think your child needs or you are just too uncomfortable, try setting up an appointment with a doctor together or visit a planned parenthood or similar support program in your area. This will show your child that you are willing to talk to him or her about sex, but also allow you the comfort of having a professional lead the discussion. For more information about how to talk to your daughter about sex, see the reference links below.
References & For More Information:
"HPV Info." The Society of Obstetricians and Gynaecologists of Canada
"HPV vaccine no easy decision for parents." CTV News Online
"HPV Vaccine May be Here by Fall." The Daily News. hfxnews.ca
"P.E.I. girls to receive HPV vaccine." CBC Online
"Should HPV vaccinations be extended to young men?" The Globe and Mail Online
"Cervical Cancer Vaccine." CityTV
"What Causes Cervical Cancer?" The Canadian Cancer Society
"The human papillomavirus (HPV) and the HPV vaccine." The Canadian Cancer Society
"Economic burden of cancer in Canada, 1998." The Canadian Cancer Society
"Talking With Kids About
Sex and Relationships."
"Talking to Your Kids About Sex." Planned Parenthood
Other articles by June:
- Canada's "New" Food Guide (April 2007)
- Protecting Our Valued Health Care Workers (February 2007)
- Bah HumBUG? (December 2006)
- Birth Control and Cancer Risk: A Connection? (August 2006)
- Good Day Sunshine (June 2006)
- Is Canada ready for the Next Pandemic? (April 2006)
- An Apple A Day (March 2006)
- "I’ve been waiting for 3 hours!” -- Wait times in Canadian hospitals (February 2006)
- Private Parts: The implications for women’s health in the federal election (December 2006)
