Island doctors want province to cover cost of HPV vaccine

By LOUISE DICKSON - Times Colonist staff October 29, 2006 page A2.

Island doctors want the province to pay for a new vaccine to protect girls from genital warts and cervical cancer, a disease which kills 400 Canadian women each year.

But the human papilloma virus or HPV vaccine, approved by Health Canada for females aged nine to 26 years, costs about $400 dollars for three doses.

“My greatest fear is that those who can afford the vaccine will get it and those who are at greatest risk will not get it,” says Dr. Frank Jagdis, a Victoria pediatrician and infectious disease specialist. I realize it’s a complex decision and health care dollars are precious, but every­one deserves to be protected. That’s the principle of public health.”

Each year in Canada, 1350 women will develop cancer of the cervix. The HPV virus, which is transmitted through sexual activity, causes 100 percent of all cases.

At some point in their lives, 50 to 70 per cent of all sexually active women will contract HPV. Most women clear the infection within a few weeks or months. But in a relatively small number of peo­ple, the virus will remain, causing benign warts or cervical cancer or vaginal can­cer. In North America, pap smear screen­ing programs have decreased cervical can­cer by about 75 per cent. Worldwide, however, cervical cancer is the second-most frequent cancer with a mortality rate of 50 per cent.

Victoria physician Dr. Darcy Nielsen is concerned about high risk women in the First Nations and street populations who don’t get regular pap smears.

How we should proceed with immu­nization is a huge issue,” says Nielsen, who has had two patients in their thirties die of cervical cancer. The government is being lobbied like crazy to make this vaccine available.”

The National Advisory Committee on Immunization is reviewing scientific evi­dence for the new vaccine. It expects to publish its recommendations by the end of 2006. Provincial health officer Dr. Perry Kendall says B.C’s communicable disease advisory committee will study the vaccine carefully and make recommen­dations to the provincial government on whether or how to proceed with immu­nization by the spring of 2007. Some issues to consider are whether boys, who spread the disease, should be immunized as well, and whether two doses would work as well as three and be more cost effective.

Administering the HPV vaccine doesn’t mean sexually active teenagers don’t need condoms, Kendall observed. And it doesn’t remove the need for continued screening for cervical cancer.

Since 2003, the B.C. government has introduced 11 new or expanded vaccine programs including Meningococcal C, Hepatitis B and chicken pox, largely because of a three-year $300-million national immunization strategy by the for­mer federal Liberal government which ends this year.

“If that program is not continued, some provinces may have to cut back on existing vaccination programs and funds may be very scarce for HPV,” say Kendall.

The vaccine is already available in Victoria through doctors and pharmacists. It protects against about 70 per cent of cervical cancers and 90 per cent of genital warts.

In an ideal world, the province should immunize girls in the school at age nine, before they are sexually active, says Jagdis.

If we could immunize the girls before the onset of sexual activity, we would be protecting them against two of the most important cancer-producing stains of HPV,” he says.

Studies show 13 per cent of girls have intercourse be age 14 or 15 and 28 percent of 15 to 17-year-olds have had sexual intercourse at least once.

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