breakthrough

A vaccine to prevent the human papilloma virus, or HPV - the virus responsible for most cervical cancers - has been approved by Health Canada.

HPV is said to infect half of all sexually active women between ages 18 and 22 in North America. In most women, the virus clears up on its own, but if the infection persists, it can lead to cervical cancer.

"Until now, we have only been able to react to the effects of HPV in women," said Dr. Guylaine Lefebvre, president-elect of the Society of Obstetricians and Gynaecologists of Canada. "Now we are talking about preventing most of the serious diseases caused by HPV."

This year in Canada, nearly 1,400 new cases of cervical cancer are expected and approximately 390 women will die from the disease.

Montreal-based Merck Frosst Canada Ltd. said its vaccine, called Gardasil, is approved for females between nine and 26 years of age to prevent:
Cervical cancer.
Vulvar cancer.
Vaginal cancer.
Precancerous lesions.
Genital warts caused by HPV.
The vaccine will be available in Canada by the end of August through Canadian doctors and pharmacists.

U.S. regulators approved the vaccine in June, at a cost of $360 US for a course of three treatments.

Ideally, the vaccine would be given to children before they become sexually active and face exposure to the virus.

After the U.S. announcement, Canada's advisory committee on immunization started discussing whether to employ Gardasil in school-based vaccine programs.

"The issues now are not medicine and science," said Dr. Simon Sutcliffe, who heads the Canadian Strategy for Cancer Control. "They are practical, logistical and ethical issues about population vaccination."

Since the vaccine doesn't prevent infection from all strains of HPV, women would still need to get a Pap test to screen for the virus.

It will be up to the provinces to decide who should receive the vaccine, how to deliver it, and how to pay for it.

While the vaccine has been approved in the US as well, it is currently administered very rarely, because the anti-sex crowd believes use of the vaccine will encourage sexual activity in minors.

This article from Slate describes how that opposition disproportionately effects low-income girls and women - the same women who are at greatest risk for cervical cancer, because they lack access to regular PAP smear screenings.

Another problem is how to get the vaccine to the women and girls who need it most - poor, uneducated women and those in the developing world. "None of us are going to be happy if the only women who get the vaccine are the same women who are already getting regular screens for cervical cancer," John Schiller, one of the vaccine's inventors, told me at his National Institutes of Health laboratory. The Vaccines for Children program, a Clinton-era entitlement, will probably make the vaccine available for free to poor children in the United States. But social conservatives like Focus on the Family leader James Dobson have opposed making vaccination mandatory, believing vaccination might lower barriers to teen sex.

In a roundabout way, this prudery may keep the vaccine out of reach of poor girls. Research and experience have shown that only mandatory-vaccination laws - which typically increase vaccination rates by 10 to 15 percent - get even cheap vaccines to the poor. Given the politics, state legislatures and public health boards may shy from requiring HPV vaccine for middle-school entry. Even mainline medical ethicists like Richard Zimmerman of the University of Pittsburgh have argued that "it seems unreasonable to mandate that an adolescent or college student who plans lifelong abstinence for religious or other reasons be vaccinated."

The answer may be to require HPV vaccination for children while explicitly allowing parents with strong beliefs to exempt their kids. This would recognize that mandatory vaccination campaigns work not by dragging refuseniks kicking and screaming to the medical clinic, but by forcing the issue for people who have to take the bus or borrow a ride to get to the doctor. Most states already allow some kind of religious or philosophical exemption for those who oppose other vaccines for their children.

I'll be interested to see how the vaccine is administered in Canada - who gets it, and when. One thing's for sure, access to the vaccine won't be based on income level. A fundamental difference if ever I saw one. (Fanboy strikes again.)