Education, not vaccination, answer to HPV protection

A relatively tiny portion of the $1.35 billion in health-care spending introduced by the Conservatives in Monday's federal budget has begun to spark what could become a significant debate.

As part of the health spending package, the Tories announced they will provide $300 million for vaccinations to help prevent cervical cancer. Ever since the vaccine Gardasil was introduced as an effective drug to protect young, sexually active women from the human papillomavirus (HPV), which causes cervical cancer, arguments have emerged in both Canada and the United States about whether mass, mandatory inoculations are the best method of prevention.

HPV is the primary cause of cervical cancer, and Gardasil protects women against four strains of the disease. In February, Health Canada's National Advisory Committee on Immunization (NACI) declared the drug safe and effective, and recommended that all girls ages nine to13 in Canada be immunized. The NACI also said that even older girls and women (up to age 26) who are sexually active should receive the vaccination, because they may not yet have contracted HPV. However, the provinces are still years away from instituting such immunization programs.

While some groups, such as the Federation of Medical Women of Canada in Ottawa, cheer the move, others, such as researchers quoted in a recent Canadian Medical Association Journal article wonder whether there is enough long-term evidence to support mass immunization (current research only goes back five years, the CMAJ article says). Still others wonder about the cost (it's $404 per person for three injections). As well, some groups are concerned about the idea of forcing vaccines on young girls who may not be, or may not plan to become, sexually active.

Dr. Moira McQueen is director of the Canadian Catholic Bioethics Institute at the University of St. Michael's College at the University of Toronto. The institute's mandate is to boost Catholic research in the bioethics field in a way that is accessible to all Canadians, as well as being a link between the Catholic and educational communities. The Institute is against mandatory HPV vaccines. McQueen spoke with CBC News Online about alternate ways to prevent young women from getting HPV.

Q. Do you agree with the federal government including this funding as part of the 2007 budget?

A. Well, they're looking at it as a health-care issue. It's also something that has come into view fairly recently — the whole HPV vaccine — they also have to be current. I can appreciate that politicians do that. There is a double-edged thing — I hope they are concerned about health care for young women, but it's also reacting to something with a bit of a splash because it's current. But I would certainly say prevention of cervical cancer is important. I think there' s other ways to do it, and that's to abstain from sexuality and not get STDs in the first place.

Q. Many health-care professionals seem to be in favour of giving girls and young women these injections because they see it as a way of preventing the second most common cancer among women. In general, how do you feel about these vaccinations?

A. My [objection] is to mandatory vaccinations. If this is a volunteer thing — If people want their daughters vaccinated, even at a very young age, that would be their decision to make…But the idea of making it mandatory…it's the fact that there is federal funding in light of the possibility of cervical cancer down the road which is a real concern. There is a certain ethical responsibility there. People know what their behaviour is, and so if they're aware that they're either [sexually] involved or they're going to be, then that is a particular conscious decision for them. They should prevent things like that happening.

Q. Do you think that there could be a better use of the $300 million?

A. I don't know the breakdown of exactly the idea of how that money is to be used. But I would imagine education should be a major component quite apart from anything else. I think when you're talking about vaccines, we're supposed to know what we're getting and why we're getting it. Education [should] come first and then people decide after that. It seems to me it's always a much better idea that people have knowledge and they plan their life accordingly, rather than sort of react once the horse has bolted.

Q. What if the program is voluntary for young women, that is, if, say, parents wanted their 13-year-old daughter vaccinated because they were worried she might become sexually active?

A. My real problem really is this mandatory vaccination. I mean, [vaccinating] whole sectors of the population when in fact there may be some side-effects to this — you know, all the things we never know until we start doing these mass things [immunizations].

And there is a strong underlying assumption every single young person is going to be involved in sexual activity, and I think this is unfair to an awful lot of young people.

I think the volunteer thing is different if people know that they're getting involved in risky behaviour. If you're not protected, you're open to all sorts of possibilities.

It's not so much I would give it approval in that sense, because to use the word approval sounds to me sounds like it means it's OK for young girls to be involved in sexual activity anyway. What I am saying is … truly informed consent, to have real information about all the possibilities of that activity, I think that's really lacking and I think our young people deserve that protection.

Q. Are there other ways to encourage abstinence in young people these days? It seems as though they are bombarded by media messages encouraging them to be promiscuous. As well, many young people may not be getting proper support or information in terms of sexual activity from their families.

A. I think you're hitting on it. I think family life examples are the best.

The other thing that occurs to me sometimes is there seems to be certain expectations that young kids should be going out for sexual activity at a young age. I don't think there's enough discouragement there. These statistics of STDs out there are extremely high. The damage that will cause — in terms of long-term fertility and fidelity — require long-term thinking.

[Abstinence] doesn't mean you are saying no to sexual activity ever. You're just saying there's a time and place for everything. Going at it too early has not only bad results but certainly plenty of bad results.

The other thing I think, too, is emotionally there is a societal expectation that a girl will comply. It's amazing with all the feminism that some things don't seem to change. It seems ridiculous. We have an awful lot of work to do to keep young women more informed about self-esteem and all those very basic qualities of life rather than getting affected by societal pressure…You think, how can this be good for their emotional development?

Q. Are there some good role models out there?

A. There are some groups that go around and talk about abstinence so it doesn't sound like a bad word, a denial word. Instead, it should be something like preservation — just a more positive spin. That is what is really [needed in order for] these young women to have a bit more self-esteem. I think in the end, everyone really wants a positive relationship. Even with casual sex, I think that it's human nature that people are looking for something a lot more stable than that.