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HPV Vaccine Funded in Canada

Country: 
Canada
Partner Institute: 
Canadian Policy Research Networks (CPRN), Ottawa
Survey no: 
(10)2007
Author(s): 
Torgerson, Renee and Margaret MacAdam
Health Policy Issues: 
Pharmaceutical Policy, Access, Remuneration / Payment
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no
Featured in half-yearly report: Health Policy Developments 10

Abstract

Health Canada approved a vaccine that protects against the human papilloma virus, or HPV, in the summer of 2006. The federal government has subsequently allocated $300 million (Cnd) in the 2007 federal budget for provinces and territories to support the launch of a national human papilloma virus vaccine program to protect Canadian women against cervical cancer and other health issues related to the HPV including genital warts.

Purpose of health policy or idea

About half of all sexually active women between ages 18 and 22 in North America are infected with the Human Papilloma Virus (HPV) which can lead to cervical cancer. In Canada the incidence of cervical cancer is 7.5/100,000, down from 15.4/100,000 in 1976 (Canadian Cancer Society). The purpose of this initiative is to assist provinces and territiories to provide free vaccinations to girls to help protect them against cervical cancer and the occurance of genital warts.  

The only approved vaccination for Human Papilloma Virus (HPV) in Canada is Gardasil, approved by Health Canada in the summer of 2006 for females between the ages of 9 and 26. Gardasil has been shown to be effective against HPV types 16 and 18, which are responsible for a majority (70%) of cervical cancers, and strains 6 and 11, which cause the vast majority of genital warts. It may also help to prevent vulvar cancer, and precancerous lesions.  

The most vulnerable populations, immigrant, Aboriginal, low income and rural women, are often unable to access the vaccine, mainly due to the high costs: the  HPV vaccination requires three injections over six months, for a total cost of about $400. Public funding may enhance the accessibility of the vaccine for all women, but for the vulnerable groups in particular.

Main points

Main objectives

In the summer of 2006, Health Canada approved the vaccine Gardasil manufactured by Merck Frosst to help prevent cervical cancer, genital warts, and precancerous lesions caused by the Human Papilloma Virus (HPV) among Canadian women. $300 million was set aside in the 2007 federal government to launch a nationwide vaccination program to reduce the incidence of cancer of the cervix. The vaccination is  approved in Canada for females between the ages of 9 and 26.    

The group especially recommended for receipt of the vaccine by the provinces are girls between 9-13, ideally before they become sexually active. It will be up to the provinces and territories to decide who should receive the vaccine, and whether to make it available at no cost.

Type of incentives

Financial incentives to the provinces to make the vaccine widely available to girls between 9-13. Several provinces (e.g. Nova Scotia, Newfoundland and Labrador, British Columbia, Ontario) have decided to move forward with the voluntary vaccination of school age girls. For instance, in the fall of 2007, the Ontario government will offer free vaccines to an estimated 84,000 girls in Grade 8.

Groups affected

Canadian girls between 9-13

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Characteristics of this policy

Degree of Innovation traditional rather innovative innovative
Degree of Controversy consensual controversial highly controversial
Structural or Systemic Impact marginal marginal fundamental
Public Visibility very low very low very high
Transferability strongly system-dependent system-dependent system-neutral

Political and economic background

The 2007 federal budget provided $300 million for per capita funding of the vaccine Gardasil to be allocated to the Canadian Provinces and Territories to support vaccination of girls and young women against the HPV virus.  

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no yes no no

Origins of health policy idea

The funding initiative was developed based on a recommendation of the National Advisory Committee on Immunization of the Public Health Agency of Canada on the merits of the vaccine and following evidence that the high costs of vaccination were preventing its adoption by individuals and by publically-funded health programs of the provinces and territories.  

Initiators of idea/main actors

  • Government
  • Providers
  • Civil Society
  • Scientific Community
  • Private Sector or Industry

Approach of idea

The approach of the idea is described as:
new:

Stakeholder positions

After the announcement was made that the federal government would make funding available for use of the vaccine by the provinces and territiories, the promotion of the vaccine became controversial in Canada, with some medical professionals arguing that the introduction of the vaccine needs to be more evidence based (Lippman et al, 2007; Canadian Women's Health Network, 2007) while others, such as the Public Health Agency and Health Canada's National Advisory Committee on Immunization (NACI) stating that there is enough supporting evidence to move forward with a vaccination program for girls who have not yet become sexually active.   

The common ground is that the vaccine needs to be part of an overall strategy around healthy sexual behavior and lifestyle choices (e.g. smoking cessation) and access to primary care, including a regular Pap test. However, according to the Canadian Women's Health Network (2007), accessibility to primary care is hindered by the absence of female health care providers, time constraints, costs (direct and indirect) of getting services, childcare, language and literacy differences, lack of knowledge, cultural differences, safety concerns (history of childhood sexual abuse and/or history of abuse at the hands of healthcare professionals), and health care providers' attitudes towards cervical cancer.  

Another point of contention seems to be the exclusion of males from the mass vaccination procress. Vaccinating males would curb the vector of the virus (Canadian Women's Health Network, 2007). 

Another key area is the role of lobbying efforts by Merck Frosst, which manufactures Gardasil, the only approved vaccination against the HPV virus.  

Lastly some groups are concerned that widespread availability of the vaccination can lead to a weakening of parental responsibility to educate their children about sexual activity.

Actors and positions

Description of actors and their positions
Government
Public Health Agency of Canadavery supportivevery supportive strongly opposed
national Advisory Council on Immunizationvery supportivevery supportive strongly opposed
federal governmentvery supportivevery supportive strongly opposed
provincial governmentsvery supportivesupportive strongly opposed
Providers
Society of Obstetricians and Gynecologistsvery supportivevery supportive strongly opposed
The Society of Gynecologic Oncologists of Canadavery supportivevery supportive strongly opposed
Council of Medical Officers of Healthvery supportivevery supportive strongly opposed
The Federation of Medical Women of Canadavery supportivevery supportive strongly opposed
Civil Society
The Canadian Cancer Societyvery supportivesupportive strongly opposed
GOC Task Force on Cervical Cancer Prevention and Controlvery supportivevery supportive strongly opposed
Institute of Marriage and Familyvery supportiveopposed strongly opposed
Canadian Women's Health Networkvery supportiveopposed strongly opposed
Scientific Community
Researchersvery supportiveopposed strongly opposed
Private Sector or Industry
Merck Frosstvery supportivevery supportive strongly opposed

Influences in policy making and legislation

Canada's federal government 2007-2008 budget included $300 million to be distributed to the provinces and territories to fund the new HPV vaccination to reduce cervical cancer rates in Canada.

Legislative outcome

success

Actors and influence

Description of actors and their influence

Government
Public Health Agency of Canadavery strongvery strong none
national Advisory Council on Immunizationvery strongvery strong none
federal governmentvery strongvery strong none
provincial governmentsvery strongvery strong none
Providers
Society of Obstetricians and Gynecologistsvery strongstrong none
The Society of Gynecologic Oncologists of Canadavery strongstrong none
Council of Medical Officers of Healthvery strongstrong none
The Federation of Medical Women of Canadavery strongstrong none
Civil Society
The Canadian Cancer Societyvery strongstrong none
GOC Task Force on Cervical Cancer Prevention and Controlvery strongstrong none
Institute of Marriage and Familyvery strongweak none
Canadian Women's Health Networkvery strongweak none
Scientific Community
Researchersvery strongweak none
Private Sector or Industry
Merck Frosstvery strongstrong none
Society of Obstetricians and Gynecologists, The Society of Gynecologic Oncologists of Canada, Council of Medical Officers of Health, The Federation of Medical Women of Canada, GOC Task Force on Cervical Cancer Prevention and Control, Merck FrosstPublic Health Agency of Canada, national Advisory Council on Immunization, federal governmentThe Canadian Cancer Societyprovincial governmentsInstitute of Marriage and Family, Canadian Women's Health Network, Researchers

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

The funding for a mass vaccination of girls was provided in the 2007-2008 federal budget. There were no obstacles noted in any of the literature, though several medical professionals (e.g. Lippman, 2007) have argued that the introduction of a mass vaccination program is premature and more evidence is needed around its long-term effectiveness and its effectiveness when given with other immunizations. The provinces are responsible for implementation; some (Ontario for example) are further ahead than others.

Monitoring and evaluation

The intended consequence of this policy change would be a reduction of the incidence of cervical cancer among Canadian women through the control of some strains of HPV. Formal monitoring would be done through provincial and federal Medical Officers, and the Public Health Agency of Canada.

Review mechanisms

no formal plans for review have been announced

Results of evaluation

NA

Expected outcome

It remains debatable how effective the vaccination program will be because the current focus is on girls between the ages of 9-13 and there is very little research evidence on the effectiveness and long-term consequences of the vaccine on girls of that age. Moreover if the effect of the vaccination is to reduce the use of Pap tests among young women, other strains of HPV which can lead to cervical cancer could go undetected. Under the best of circumstances there will be a reduction in the incidence of cervical cancer and genital warts among Canadian women with no serious side effects attributable to the vaccine. Some researcher suggest that more would be accomplished if the $300 million in federal funds had been allocated to increasing access to Pap tests.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable four system more equitable
Cost Efficiency very low high very high

There are no reports as yet on the impact of the funding initiative. The expected impact is that it will improve quality, reduce equity issues in accessing the vaccine amongst young girls but not among older teens and young adults, and perhaps improve cost efficiency. 

References

Sources of Information

  • Lippman, A., Melnychuk, R., Shimmin, C., and Boscoe, M. "Human Papillomavirus, Vaccines and Women's Health: Questions and Cautions." Canadian Medical Association Journal 177(5): 484-487. 2007.
  • Canadian Women's Health Network. HPV, Vaccines, and Gender: Policy Considerations. Winnipeg, 2007.
  • The Society of Gynecologic Oncologists of Canada. GOC Responds To Public Concerns Regarding HPV Vaccine And Cervical Cancer Prevention, 2007.

Author/s and/or contributors to this survey

Torgerson, Renee and Margaret MacAdam

Suggested citation for this online article

Torgerson, Renee and Margaret MacAdam. "HPV Vaccine Funded in Canada". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/ca/b10/2