CALGARY - Government HPV vaccine programs for girls have been rolling out across the country for more than a year now, but they're still a tough sell for some Canadians.
All 10 provinces as well as the Yukon have implemented programs to provide the Gardasil vaccine which protects against four strains of human papillomavirus (HPV), the primary cause of genital warts and the agent behind about 70 per cent of cervical cancer cases.
Governments have embraced the vaccine, but some parents, social commentators and religious leaders have weighed in with concerns about its long-term safety and efficacy. This has left a number of parents with reservations about whether to have their daughters vaccinated.
"A couple of the mothers I have talked to decided they were going to wait a little longer as far as the research but if it's really effective they say they may vaccinate their daughters in the future," explained Kathy Young of Regina, who has stepdaughters, aged 12 and eight.
"I have two little stepdaughters whose mother passed away from cancer so we are doing our best to promote a healthy lifestyle and anything like an HPV vaccine when it comes along, we are not going to miss a chance to take it," she said.
An average of 65.7 per cent of eligible young women in British Columbia have been vaccinated while in Alberta and Manitoba it ranges from 50 to 55 per cent. In Ontario, the participation rate is slightly lower.
"We're at 49 per cent and we're actually pleased with that," said Andrew Morrison, a spokesman for the Ontario Ministry of Health and Long-term Care.
"The goal of the program is to decrease the number of future cases of cervical cancer so that's 40,000 more Grade 8 girls that have protection against the two highest risk types of HPV that can lead to cervical cancer," he said.
But the vaccination rate has soared in the Atlantic provinces and in Quebec. About 80 per cent of eligible girls are receiving Gardasil in Prince Edward Island and Nova Scotia.
Newfoundland and Labrador has recorded 83 per cent compliance. And in Quebec, which offers it free to girls aged nine to 17, the number is even higher. In 2008, 84 per cent of nine-year-old girls in Quebec received the vaccine and in the 14-and-15 age group, the figure hit 87 per cent.
"In Quebec I think it has to do with the way people view immunization programs. People trust and believe in them because they're beneficial to health," said Dr. Ian Gemmill, chief medical officer for Kingston, Frontenac and Lennox and Addington Public Health.
"Ontario and West? I don't think we have that situation. It makes me wonder if there has been an unfounded lack of confidence in vaccination programs. Unfortunately there's a willingness in this day and age to believe there is a spectre of danger."
Health departments in New Brunswick and Saskatchewan failed to provide any figures in the early stages of their programs.
It's estimated that about 1,350 women contract the sexually transmitted virus each year in Canada while about 400 women die of cervical cancer annually. It is the second most common type of cancer for women between the ages of 20 and 44.
"The opposition is frustrating and I think people tend to underestimate the impact of cervical cancer," said Dr. James Bentley, chief of obstetrics and gynecology at Dalhousie University and president of the Society of Canadian Colposcopists.
Bentley said those opposed to the vaccine are members of the anti-vaccine lobby, are among those who don't think it has been studied enough or those parents who believe their children aren't going to be sexually active.
"That is a naive point of view. You have to remember that hepatitis B vaccination, which we all accept now, is a sexually-transmitted virus as well," he added.
"But people have their children vaccinated for hepatitis B and don't have a problem with that - it just took it a while to get it through the system."
Dr. Prafull Ghatage, a gynecologist at the University of Calgary's Faculty of Medicine, said the benefits of the vaccine are quickly apparent.
"To prevent one episode of genital warts we need eight patients to be vaccinated. We need 324 patients to be vaccinated to prevent one case of cervical cancer and the numbers needed to prevent one death from cervical cancer is 729," explained Ghatage, quoting from a 2007 article in the Canadian Medical Association Journal.
"Compared to other vaccinations the numbers needed to prevent one death from influenza is 5,000," he said.
Epidemiologist Abby Lippman of McGill University in Montreal remains opposed to the programs but realizes it's not feasible to cancel them.
"Everybody's jumped on to this bandwagon and I still don't know why. There is nothing I have seen that would encourage me that we have any urgency," said Lippman.
"I'm not going to say at this point it's gotta stop but I will say I think someone has to do a careful review of why the decisions were made the way they were."
Religious and moral beliefs have also contributed to some parents rejecting the vaccine. One Ontario Catholic school board voted against allowing the vaccine while in Manitoba six private schools opted out for religious reasons
Ten Catholic school districts decided to stay out of the program in Alberta after the province's six bishops said that allowing the vaccine would promote sex among young people.
"It's a partial solution that doesn't talk about the emotional, spiritual, the psychological fallout from what we might call sexual promiscuity and it doesn't advocate sexual restraint," said Calgary Bishop Fred Henry, who also questions the safety and effectiveness of the vaccine and feels he has been made "a scapegoat" for his opposition to it.
"The vaccine itself is not inherently evil but as a Catholic institution we should not be undercutting our own message and our own attempt to try and deal with the real cause. The whole cause has to deal with a total sense of reality and not with a little vaccine or a condom or something of that particular nature."
