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Ontario needs universal HPV vaccination, urges Toronto Board Of Health

Verdict still out on Gardasil, says province

WAITING GAME. "I'm concerned that the provincial government has been given money and they're not doing anything," says Toronto Board Of Health vice-chair Janet Davis. Credit: (Brent Creelman)

The Toronto Board Of Health wants the Ontario government to vaccinate all women between the ages of nine and 26 against the human papillomavirus (HPV), but the province says it won’t commit to funding until it receives a report from medical experts later this year.

HPV is a common sexually transmitted infection that causes genital and anal warts and almost all cases of cervical and vaginal cancer. HPV has also been linked to anal, penile and throat cancers that disproportionately affect gay men.

As yet, the vaccine, called Gardasil, has only been approved by Health Canada for use in women to prevent cervical cancer.

In March the federal government announced $300 million in funding to the provinces over three years on a per capita basis to implement HPV vaccination programs. Ontario’s share of the money is approximately $114 million.

Since the federal announcement, Nova Scotia, Manitoba and Prince Edward Island have announced vaccination programs, but AG Klei, a spokesperson for Ontario’s Ministry Of Health And Long-Term Care, says Ontario government health authorities want more information from medical experts before deciding if and how to launch a program, and how best to coordinate with other provinces.

“At this point Ontario hasn’t made a decision on a publicly funded HPV program,” says Klei. “We’re waiting for advice from our experts. We’re working with the other provinces and territories across Canada with the Canadian Immunization Committee to ensure that there’s a consistency and that’s something that all the provinces are a part of.”

Ontario’s sluggishness worries Rosana Pellizzari, director of planning and policy at Toronto Public Health.

“We look forward to an announcement, but we don’t have any indication that it’s coming any time soon,” she told the Board Of Health at a Jul 9 meeting.

Those concerns were echoed by Janet Davis, Board Of Health vice-chair.

“I’m concerned that the provincial government has been given money and they’re not doing anything,” she says. “It could address a serious health problem in the city of Toronto.”

The Board Of Health has not proposed guidelines for how a vaccination program would be implemented but initial efforts are unlikely to benefit queer men because Health Canada has not approved the vaccine for use in males.

Sheila Murphy, a spokesperson for Merck Frosst Canada, the Quebec-based company that manufactures Gardasil, says the company is researching the vaccine’s effectiveness on men but that it could be years before the results are complete.

“We have studies ongoing in men aged 16 to 26 and of course it includes bisexual and heterosexual and homosexual, so the whole gamut,” says Murphy. “I don’t imagine it will be [approved] for another three or four years. From a perspective of burden of disease it made sense to start with women.

“Anybody who works in public health says that to have the best public health, you need to immunize boys and girls because boys are the vectors of the virus, but we don’t have the studies to support the use in men,” she says. “We work in an area that is science-based. Even if it makes sense, if we don’t have the science to support it, the government will not allow us to distribute it.”

Murphy notes, however, that Gardasil has been approved for use in males in Australia.

Despite its unanimous call for a public immunization program, the Toronto Board Of Health also raised some questions about the vaccine.

Because Gardasil does not prevent all types of cervical cancer, the board says that sexually active women will still require regular pap smears even after they’ve been vaccinated against HPV. The board also noted that the duration of the vaccine’s effectiveness is not known past five years, so long-term observation of immunized girls may be necessary to find out if booster shots will be required.

At more than $400 per three-dose treatment, inoculating Ontario’s 1.5 million eligible women could cost more than $600 million. Millions more would be required annually to immunize girls turning nine, and for booster shots if they turn out to be necessary. The cost could double eventually if boys are immunized as well.

David McKeown, Toronto’s medical officer of health, says those costs could vary significantly.

“Unless [vaccination] is mandatory, it’s uncertain how many will take it,” he says. “Once there’s a large purchasing contract, the price tends to come down.”

The board also called on Merck Frosst to offer the vaccine at low cost to developing countries, where the vast majority of cervical cancer deaths are reported globally.