HPV Vaccine for Girls Oversold?

Victoria author and massage therapist Julie Paul's daughter will soon be eligible for the human papilloma virus vaccine. But with questions remaining unanswered about safety and whether the vaccine really will prevent cervical cancer as the provincial government claims, Paul's daughter won't be getting the shots.

This week Health Minister George Abbott announced the vaccine will be available for free next year to every girl entering Grade 6 or 9. The $39-million push to immunize B.C. girls against HPV using Merck Frosst Canada Ltd.'s vaccine Gardasil is part of a national campaign that got a big push from Merck lobbyists last year.

Health observers said it is odd the provincial government is saying the vaccine prevents cervical cancer, when that is still unproven. The claim makes the government, which has been arguing that financial sustainability should be a principle of the health system, appear more like a pharmaceutical marketing firm than the provider of evidence-based health care.

"It really struck me we're testing these things on our children," said Paul. She's read a lot about the vaccine, she said, and she remains unconvinced it's a good idea. "It just confirmed a lot of my beliefs about the risks involved . . . To me the risk is greater than the benefit at this point. I just feel like it's a bit of a gamble."

Paul acknowledged she may be more critical about vaccines than most parents are; her eight-year-old daughter hasn't had any vaccines yet. Still, she said, despite health officials' cheerleading, many of the parents she talks with are doubtful about this latest push. "My peer group generally does not support it."

Marketing claims

To Victoria drug policy researcher Alan Cassels, the British Columbia government's announcement of funding for the vaccine sounded more like pharmaceutical marketing than sober public health policy. The announcement made claims that are yet to be proven, said Cassels, the author of two books on drug marketing, including The ABCs of Disease Mongering.

The headline read, "New Vaccine Program to Protect Girls Against Cancer" and Health Minister George Abbott called it "an opportunity to vaccinate against the vast majority of cervical cancers in women." He added, "We want parents and students to know that this vaccine protects girls and women from cancer."

The thing is, said Cassels, while it takes decades to develop cervical cancer, the trials for Gardasil were held over just two or three years. It's too soon to say if the vaccine actually prevents cancer, he said. "There were no cancers prevented in any of the clinical trials. I can say that with a certain amount of confidence."

He compared using the vaccine to taking a cholesterol-lowering drug. For most people taking such a drug, the important thing is whether or not it prevents heart attacks and strokes, not whether it lowers their cholesterol. "I think that's the same question we need to be asking about the vaccine . . . . It's still not a slam dunk in terms of what you're really doing it for."

The outstanding questions do bring B.C.'s motives into question, he said. "If you're going to say point blank, 'this vaccine prevents cancer,' you're misleading the public," said Cassels, who has an 11-year-old daughter who he will discourage from taking the vaccine. "Why would you do that? The headline, it's like a slogan. Why would public health officials be repeating a slogan that isn't true?"

Federal money

Provincial Health Officer Perry Kendall said providing the vaccine is good public health policy. The link between the virus and cervical cancer is clear, he said. "You don't get cervical cancer unless you've had a long standing infection with human papilloma virus."

There are 100 or so strains of the virus, he said, but two of the four strains in the vaccine are related to 70 per cent of cervical cancers. Preventing the virus should also prevent the cancers, he said.

The B.C. spending is part of a $300-million federally funded campaign to give Gardasil to young women. Kendall said the province's $39-million share has paid for some research and will fund the vaccination program for two years. After that the province will fund the campaign itself, he said. It costs over $400 for the three shots necessary to protect a person against the virus.

The national campaign met some skepticism in health circles when it was announced in March 2007, just eight months after Gardasil was approved. It remains the only HPV vaccine on the market, though GlaxoSmithKline has a competing product in the approval stages.

An August 2007 article in the Canadian Medical Association Journal said it is too soon to launch into a $300 million vaccination campaign. The authors wrote, "A careful review of the literature, including that submitted by the manufacturer with its application for approval of Gardasil, reveals a sufficient number of unanswered questions to lead us to conclude that a universal immunization program aimed at girls and women in Canada is, at this time, premature and could possibly have unintended negative consequences for individuals and for society as a whole."

Lobbying push

The Toronto Star drew connections in an Aug. 16, 2007 article between vaccine maker Merck Frosst Canada Ltd. and governments in Ottawa and Ontario. The company hired public relations firm Hill and Knowlton "to push the immunization strategies using some well-connected lobbyists," the Star said.

They included former policy adviser to Prime Minister Stephen Harper, Ken Boessenkool, as well as Bob Lopinski and Jason Grier, who had been high-level staff in Dalton McGuinty's Ontario government. Lopinski and Griers tasks included pushing the HPV immunization program and getting it funded.

In B.C., the company has also actively lobbied many politicians, including Health Minister George Abbott and Premier Gordon Campbell. The company has seven people registered as active lobbyists, including a former aide to Abbott and other Liberals, Steven Vander Wal. Vander Wal left the government in 2006 to work for Hill and Knowlton.

According to documents filed with Elections BC, Merck has given over $11,000 to the B.C. Liberal Party since 2005.

More screening needed

In B.C. there are 143 cases of cervical cancer a year, and 55 deaths from it, according to the province's announcement. The number has been falling for years, largely because pap tests detect cancers early enough that they can be treated successfully.

"It's a proven technique for detecting early cervical cancer," said Cassels. But many women -- predominantly those who have low incomes, who are aboriginal, immigrants or live in rural communities far from health facilities -- never get the test. Rather than provide the vaccine, Cassels said, the province would be better to increase its efforts to make sure every woman gets screened.

And while the government calls the vaccine "safe," Cassels said there have been deaths associated with it. "The whole risk question is still a question mark," he said. "Vaccines are never 100 per cent safe."

In tests of Gardasil a certain number of people did get sick after being vaccinated, said Kendall, but there was no clear cause. "There's no reason to believe [the illnesses] are caused by the vaccine," he said, adding he believes it is safe. "It met the standard of other vaccines we've implemented."

Kendall said the screening program will continue; at the very least it will still be needed to pick up the 30 per cent of cervical cancers related to other strains of the virus. About 75 percent of women get regular pap tests, he said, and the B.C. Cancer Agency is making efforts such as a mobile screening program to make it more available.

Of the 500,000 women who get a pap test each year in B.C., he said, around 8,500 will get an "abnormal" test back. Vaccination should cut that number, he said, and the worry that goes with it.

Low uptake predicted

Those who want the vaccine will doubtless appreciate the help paying for it, said NDP health critic Adrian Dix. It's not clear, however, how it became a priority for the federal and provincial governments amid so many demands on the health care system, he said. People with various illnesses and needs will want to know, he said, "How Merck Frosst got such quick action on their proposal when others have to wait."

In Ontario, which was one of the first provinces to adopt the campaign, fewer than 50 per cent of those eligible chose to accept the vaccine.

Kendall said the aim in B.C. is for 90 per cent to take it. "I don't know if we'll get there. I hope so."

Author Paul said she doubts even 50 percent of the parents she talks to think the vaccine is a good idea. They won't encourage their daughters to get vaccinated, she said.

"My feeling is the population in B.C. is a hell of a lot more skeptical," said Cassels. "I think the uptake's going to be very low."

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• New Concerns over HPV Vaccine
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• The Media Doctor Is In
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• What Should We Pay for Drugs?
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