Is mass HPV vaccination really necessary?

Gardasil, a vaccine that protects against certain strains of the human papillomavirus (HPV), was recently made available in Canada and is currently the subject of a major controversy. Two provinces have already announced they will offer the vaccine for free to young girls between the ages of 9 and 13. According to some Canadian experts however, it is premature to make this vaccine available for free. Here are some of their arguments.

Gardasil, a vaccine that protects against certain strains of the human papillomavirus (HPV), was recently made available in Canada and is currently the subject of a major controversy. Two provinces have already announced they will offer the vaccine for free to young girls between the ages of 9 and 13. According to some Canadian experts however, it is premature to make this vaccine available for free. Here are some of their arguments.

HPV is a virus that is transmitted during sexual relations and is the cause of approximately 75% of all cervical cancer cases. Although there are many types of HPV, only some of them are directly linked to cervical cancer. Most HPV infections are accompanied by mild symptoms that clear spontaneously, within one to two years. This newly introduced vaccine protects against HPV types 6, 11, 16, and 18. HPV types 16 and 18 are responsible for 70% of cervical cancer cases, and HPV types 6 and 11 cause 90% of genital warts cases.

Cervical cancer, all causes confounded, kills nearly 400 women each year in Canada. It is ranked as the 11th most frequent cancer, and the 13th most common cause of cancer-related deaths. The number of cases and deaths attributable to this cancer are in constant decline, although this trend has decelerated over the last few years.

Furthermore, invasive cervical cancer is a relatively slow-progressing cancer which generally responds favourably to treatments. In addition, a screening test is easily accessible to all women: the Papanicolaou smear test, commonly known as the Pap smear or Pap test. In fact, it is because of the prevalence of this test that the number of cervical cancer cases has declined so remarkably over the past decades.

Considering the currently available vaccine only protects against a few types of HPV, experts point out that women will still have to undergo regular Pap smear testing. And many worry that the vaccine might actually give a false sense of security, which could potentially bring about an increase in cervical cancer cases, not a decrease …

Additionally, because the vaccine has only recently been made available, the data on its innocuity and efficacy are still very limited. Will it be effective in the long-term? Will booster shots be required to maintain immunologic protection? These questions can only be answered over time. But in the meantime, it is important to know that this vaccine is the most expensive of all childhood vaccines, at a little over $400 for the three required doses. A massive pan-Canadian vaccination program would cost the healthcare system an estimated 2 billion dollars. With Canadian healthcare services already in crisis, is it wise to be investing this money in such a massive vaccination program?

The pressing question remains: should the HPV vaccine be offered for free? This is difficult to determine when you consider the huge amounts of money that will be invested, not forgetting the number of deaths linked to this virus. But if the final decision is left to the parents, not to the government, will it not become a vaccine only available to the richest members of society? And now that Ontario and Nova-Scotia have announced they will offer the vaccine to young girls for free, will Quebec follow suit? It all remains to be seen…

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