Four Provinces Set to Begin School HPV Vaccination

Nova Scotia has instituted a province-wide HPV vaccination program for 12-year-old girls, the first province to provide the controversial vaccine under the federal government’s $300 million funding program. Female students in grade 7 will be offered the HPV vaccine in the 2007-2008 school year as part of the province’s schoolbased vaccination program. The vaccine will require parental consent.

Provincial governments in Newfoundland and Labrador, Ontario and Prince Edward Island have also stated they will begin vaccination programs in the 2007-2008 school year. PEI and Newfoundland and Labrador will begin voluntary vaccination of grade six girls this fall, while Ontario will offer the vaccine to girls in grade eight.

Promoted as a cancer-preventative, the HPV vaccine Gardasil is designed to offer protection against four strains of the Human Papilloma Virus, two that are know to cause cervical cancer and two that cause genital warts. Health Canada approved the vaccine in July 2006.

The HPV vaccine has been strongly opposed by members of the medical community, pro-life groups and concerned parents over issues including a short trial period, unexplained side effects, lack of research into the vaccine’s effectiveness and safety for young girls, and concern that immunization for HPV may encourage sexual irresponsibility in teenage girls by creating a false sense of safety.

The vaccine was tested over a relatively short period of time, raising concerns that hidden side effects may still emerge. Among the side effects already recorded have been several instances of neurological problems including seizures, paralysis and Gillian-Barre Syndrome. Two deaths followed immunization, both caused by blood clots.

The vaccine’s limited range of effectiveness has also been a source of concern. With more than 100 strains of HPV—over 40 of them suspected to be carcinogenic—Gardasil targets just four strains that account for about 70% of potentially cancerous infections. The remaining 30% will require pap tests for diagnosis, followed by appropriate treatment. Furthermore, the vaccine is only effective for a five-year span, which may leave girls vulnerable to infection at an age when teenage sexual activity is most common.

Gardasil has not been adequately tested on girls under the age of 16. The National Advisory Committee on Immunization, which recommended immunization for girls aged 9-26, acknowledged the lack of testing and said estimates of the vaccine’s effectiveness for girls age 9 13 were based on results for the older cohort of girls age 16-23.

“GardasilTM is recommended for females between 9 and 13 years of age, as this is before the onset of sexual intercourse for most females in Canada, and the efficacy would be greatest. While efficacy of the vaccine in this age group has not been demonstrated, the immunogenicity bridging data implies that efficacy would be high.”

The HPV vaccine was produced by the pharmaceutical conglomerate
Merck & Co.

Merck’s Canadian subsidiary, Montreal-based Merck Frosst Canada, lobbied aggressively for a federal policy that would implement vaccinations for all girls between the ages of nine and thirteen.

An editorial in the July edition of the Canadian Medical Association Journal criticized the rush to implement the vaccine, pointing out that most of the research on Gardasil has been funded by Merck & Co. The Canadian Women’s Health Network also issued a cautionary evaluation on the push for HPV vaccination. The CWHN pointed out that currently about 400 Canadian women die each year from cervical cancer, a number the organization said was tragic, but one that did not constitute an epidemic. The group’s report suggested Merck Frosst’s ad campaign had triggered a general panic over HPV infections in the country, saying, “the ads may generate excessive fear by obscuring the fact that cervical cancer affects a relatively small number of women and is rarely fatal in Canada and the US.”