|Implemented in this survey?|
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.
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.
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.
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.
Canadian girls between 9-13
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
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.
|Implemented in this survey?|
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.
The approach of the idea is described as:
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.
|Public Health Agency of Canada||very supportive||strongly opposed|
|national Advisory Council on Immunization||very supportive||strongly opposed|
|federal government||very supportive||strongly opposed|
|provincial governments||very supportive||strongly opposed|
|Society of Obstetricians and Gynecologists||very supportive||strongly opposed|
|The Society of Gynecologic Oncologists of Canada||very supportive||strongly opposed|
|Council of Medical Officers of Health||very supportive||strongly opposed|
|The Federation of Medical Women of Canada||very supportive||strongly opposed|
|The Canadian Cancer Society||very supportive||strongly opposed|
|GOC Task Force on Cervical Cancer Prevention and Control||very supportive||strongly opposed|
|Institute of Marriage and Family||very supportive||strongly opposed|
|Canadian Women's Health Network||very supportive||strongly opposed|
|Researchers||very supportive||strongly opposed|
|Private Sector or Industry|
|Merck Frosst||very supportive||strongly opposed|
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.
|Public Health Agency of Canada||very strong||none|
|national Advisory Council on Immunization||very strong||none|
|federal government||very strong||none|
|provincial governments||very strong||none|
|Society of Obstetricians and Gynecologists||very strong||none|
|The Society of Gynecologic Oncologists of Canada||very strong||none|
|Council of Medical Officers of Health||very strong||none|
|The Federation of Medical Women of Canada||very strong||none|
|The Canadian Cancer Society||very strong||none|
|GOC Task Force on Cervical Cancer Prevention and Control||very strong||none|
|Institute of Marriage and Family||very strong||none|
|Canadian Women's Health Network||very strong||none|
|Private Sector or Industry|
|Merck Frosst||very strong||none|
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.
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.
no formal plans for review have been announced
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.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||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.
Torgerson, Renee and Margaret MacAdam