Controversy still surrounds HPV shot for girls

Officials happy 60 per cent taking part in Toronto; blame misinformation for lower rates elsewhere

Nov 23, 2007 04:30 AM

Living Reporter

More than half of parents in the Toronto area are accepting the province's offer to vaccinate their daughters in Grade 8 with Gardasil to prevent infection with the human papillomavirus.

But four out of 10 girls are going without the vaccine, reflecting the controversy surrounding the shot, including concerns about safety, appropriateness and morality.

HPV is a sexually transmitted infection that is the leading cause of cervical cancer. In August, Ontario announced a controversial $39 million vaccination program for all Grade 8 girls to fight the disease. The first of three doses was dispensed this month.

Ameeta Mathur, manager of communicable disease control for Toronto Public Health, said she is encouraged with the participation rate of 60 per cent in Toronto schools. "We had actually planned for 50 per cent uptake this year because this is the first year and we didn't have time to prepare much to launch it."

Toronto is above average in participation rate, said Dr. Ian Gemmill, medical officer for Kingston, Frontenac and Lennox & Addington Public Health. The median for the province is 51 per cent, with a range of 40.7 per cent up to 70 per cent, with two out of three regions reporting, he said. At the lower end of the range is Halton Region.

"The uptake has been 45 per cent," said Dr. Bob Nosal, medical officer of health for Halton Region. "Out of 3,050 girls eligible, 1,352 took it." The rate is 35 per cent in Catholic schools and 49 per cent in public schools, he said.

Gemmill is surprised and disappointed by the number of parents across Ontario opting not to vaccinate their daughters. He blamed misinformation. "We were hoping for a much greater intake because it is a safe and effective vaccine." Criticism and questioning of the vaccine in articles in Maclean's magazine and the Canadian Medical Association Journal may have been a factor in the lack of acceptance, he said.

But McGill University epidemiologist Abby Lippman, author of the CMAJ article says, "we asked legitimate questions that remain unanswered. It's not fair to suggest we've been fear-mongering."

There has also been criticism of the lobbying by Gardasil manufacturer Merck Frosst to implement the expensive vaccination program. Merck & Co. last month reported a 63 per cent gain in earnings and raised its profit forecast for the year in part because sales of Gardasil more than doubled.

But the high cost of the vaccine $400 for each series of three shots is the reason its proponents are surprised by the low acceptance.

"I expected the uptake would be closer to 100 per cent. When we introduced the hepatitis B vaccine in the mid-1990s, the uptake was 89 per cent and here's an infection much more common," said Gemmill.

Nosal is also surprised and disappointed by the low rate of acceptance in his region.

"What is unfortunate is that there is a pot of money for this vaccine and the uptake is not occurring," he said. "We have all kinds of Grade 8s not taking advantage of the vaccine, yet I can tell you there would be hundreds if not thousands in high school who would. And the only way they'll get it is to pay for it out of pocket and it's not cheap."

Both Halton region and Toronto will allow Grade 8 students to opt into the program during the second round of shots in January.