Thousands of Canadian teens and parents deciding whether to accept HPV vaccine
Reported September 16, 2007
TORONTO (CP) – Kristin Peterson has no qualms about getting her 13-year-old daughter vaccinated against human papillomavirus, or HPV.
Peterson only wishes that Evangeline, who started Grade 9 this month in Toronto, could get the vaccine through the publicly funded program Ontario and three other provinces are rolling out this month.
The Ontario government is offering the expensive vaccine to girls in Grade 8 only, with no catch-up program for Grades 9 through 12. And that means Peterson will have to shell out several hundred dollars to have her family doctor vaccinate Evangeline.
“I think it’s my responsibility. I do,” she says, noting her daughter’s aunt had cervical cancer.
But not all parents of eligible girls feel as confidently disposed towards the HPV vaccine being offered in Ontario, Nova Scotia, Newfoundland and Labrador and Prince Edward Island this year. (Other provinces and territories are still deliberating whether and when to implement a program.)
There’s a buzz of uncertainty as parents study information packets and release forms that would give public health officials the go-ahead to administer the three-shot vaccine to girls in Grade 6 in P.E.I and Newfoundland and Labrador, Grade 7 in Nova Scotia or Grade 8 in Ontario.
Early, aggressive lobbying by vaccine manufacturer Merck and Co., parent company of Merck Frosst Ltd. Canada, and the unexpectedly quick decision by Ottawa to funnel $300 million to provinces and territories for school-based HPV immunization programs, have left a cloud of suspicion over this vaccine.
Commentators muse aloud about why an HPV vaccine made it onto the publicly funded list so quickly and whether the machinations of Big Pharma – Merck has been locking up sales before a competitor’s vaccine hits the market – or the federal Conservatives, still seeking majority government status, have run roughshod over the interests of teenage girls.
“There is no epidemic of cervical cancer in Canada to warrant the sense of urgency for a vaccination program,” several researchers wrote in a widely discussed commentary published last month in the Canadian Medical Association Journal.
The Canadian Cancer Society estimates that 1,350 women will be diagnosed with cervical cancer this year in Canada and 390 will die of the disease.
Questions such as how long the vaccine protection will last and how well it will work in young girls remain to be answered, noted the team, led by McGill University epidemiologist Abby Lippman. They also raised the concern that the vaccine may create a false sense of security in girls, leading them to ignore the need for safe sex and regular Pap tests for cervical cancer detection.
“It is time to take a breath and reflect on what we know and what we don’t know, and to develop a plan based on solid, reliable evidence that adds value for everyone,” they argued.
Others have questioned the side-effect profile of the vaccine. To date, most reports suggest mainly mild reactions typical of other vaccines. But if a new vaccine carries a risk of one-in-a-million type adverse reactions, that will only become apparent after millions are injected with it.
“There’s no reason to think that there’s going to be rare, serious adverse events from the vaccine that haven’t come up so far in the clinical trials, but you never know until the data’s in,” says Dr. John Schiller, a senior investigator with the U.S. National Cancer Institute and one of the inventors of the vaccine.
Still, for others there are enough answers to proceed.
“The science is there,” says Dr. Robert Strang, Nova Scotia’s chief public health officer. “It’s been approved by the federal government and NACI (National Advisory Committee on Immunization) and the money is there.
“In Nova Scotia, we were able to bring the key people around the table for implementation and so there was no reason not to go ahead this year.”
Dr. David Williams, Ontario’s associate chief medical officer of health, is bemused that people feel the decision to add HPV vaccine to publicly funded programs is rushed.
He says the public health community has been watching the progress of these vaccines for years as they’ve made their way through the various stages of clinical trials – the same types of clinical trials that preceded licensure of other new vaccines against chickenpox or Prevnar, the pneumoccocal vaccine.
“They all had the same rigours of scientific research required for both FDA (the U.S. Food and Drug Administration) and also for the bureau of biologics of Health Canada to license them,” said Williams. “So that’s why it’s odd that they say this one is much more rushed.”
Dr. Joan Murphy worries the debate is losing sight of the fact that clinical trials suggest both Merck’s Gardasil and the yet-to-be licensed Cervarix, made by GlaxoSmithKline, are highly effective at preventing infection by two of the strains of HPV that are responsible for more than 70 per cent of cervical cancers.
“You try to give your kid a good diet so he’ll be healthy when he’s 30 or 40 or 50, don’t you?” says Murphy, who chairs a task force on cervical cancer prevention for the Gynecological Oncologists of Canada. “You try to plan for health in the future. “This is no different. It’s just that it’s about sex – and bugs.
“My colleagues and I treat women with cervical cancer all the time,” continues Murphy, who is head of gynecological oncology at Toronto’s University Health Network. “And it’s heartbreaking, especially when there’s a poor outcome, to know that it likely didn’t need to happen.”
Interestingly, Schiller isn’t troubled by the debate. He understands that parents would feel more comfortable about this vaccine if it had already been used in millions of people.
“That’s just human nature and it’s a reasonable approach to have,” says Schiller who, along with research partner Dr. Douglas Lowy, did much of the early stage development of the HPV vaccine.
The U.S. government, which employs Schiller and Lowy and which holds the patent for the vaccine, licensed it to both Merck and GSK. As inventors, Schiller and Lowy receive limited royalties as set out by government regulations.
“Our cap is so low that they wouldn’t have to hardly sell anything for us to reach our cap,” Schiller explains. “We really don’t have a big vested interest in it.”
He sees a benefit of debate on the vaccine, saying it is putting the issue of HPV and cervical cancer on the public’s radar screen.
“We couldn’t be, overall, more pleased,” Schiller admits. “There’s never been a vaccine against a sexually transmitted vaccine that’s even worked middling and this is working great.
“In terms of the disease end point, it’s virtually 100 per cent. And the other thing is there’s a lot of debate about all this sort of stuff, but the bottom line is . . . the majority of U.S. families – and my assumption is Canadian families – will adopt this vaccine and accept it.”
