Editor's Note : How would you spend $300 million to best improve women’s and girls’ health in Canada? The HPV vaccination debate rages on

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In March 2007 the federal government announced $300 million to fund programs to vaccinate girls and women with the newly approved human papillomavirus (HPV) vaccine, Gardasil, produced by Merck Frosst.  This vaccine has been heralded by many as an effective way to prevent cervical cancer, and most medical bodies, practitioners and provincial and territorial health administrators greeted the announcement as good news.

But a closer look at research gaps and costs, and other policy considerations concerning a mass HPV vaccination program in Canada at this time caused concern among many experts in the women’s health community.  The Canadian Women’s Health Network (CWHN), with support from other organizations, such as Women and Health Protection, as well as a range of individual researchers and health practitioners from across the country, brought these questions and cautions to public attention in the summer of 2007. 

After examining closely the research available, we published a critical “Commentary” on the HPV vaccine in the peer-reviewed Canadian Medical Association Journal, and posted a larger policy paper on the topic on our website.  We also spoke freely to the media, raising our concerns.  Readers of Network may also remember an article on the topic in the previous issue, and our suggestion for a “wait and see” approach (see links to all articles in side-bar). 

The response to these initiatives was overwhelming.  We received multiple letters of congratulation and thanks for airing our concerns to both the medical and policy-development communities, as well as to the general public. We also received some pointed (and sometimes personal) and vociferous responses of disagreement from those who thought that raising concerns about the HPV vaccine publicly was doing a “disservice” to women’s health. 

The controversy was so much more than we had anticipated.  For several months we fielded multiple media calls daily, and they continue still.  We were also greeted with press releases issued by professional medical bodies, several provincial/territorial medical officers and ministers of health, and of course, from the manufacturer of Gardasil, that sought to discredit our viewpoint -- often without addressing the issues we raised -- and sometimes, even, to discredit the professional expe Springrtise of individual authors of our publications. 

This was a surprise given that most of our questions and concerns had already been raised at the Public Health Agency of Canada’s “Canadian Human Papillomavirus Vaccine Research Priorities Workshop” (November 2005; Québec City; www.phac-aspc.gc.ca/publicat/ccdr-rmtc/06vol32/32s1/index.html).  Adding our voices to the debate was meant simply to emphasize what continued to remain unknown since the workshop raised its important concerns, and to ask, given the budget allocation of $300 million for Gardasil: why rush into a mass vaccination program now?  Why not wait until the research is more extensive and comprehensive, and vaccination program goals are more clearly established?

We continue to stand by our position – and continue to question the wisdom of spending $300 million in taxpayer dollars for a vaccination program about which there remain many important unknowns.  This is particularly true when cash-strapped primary health initiatives with well-established rates of success in lowering cervical cancer rates could benefit from an influx of new monies to provide such things as Pap smear programs for under-serviced and vulnerable communities.  

But more importantly we stand by our right to raise questions and cautions, and to encourage informed discussion, where women’s and girls’ health is concerned.  We refuse to be silenced by critics – even (or one could say especially) those who have substantially more economic clout  (some from pharmaceutical coffers) and political resources than we will ever have.  

So many of these attacks seemed to challenge, less the issue, than our right to have a public voice on the issue, and nothing could be more dangerous.    

As informed individuals, and as an organization with a long track record in women’s health, we deserve to be heard, even when we have to stake that space aggressively against a wave of (institutional) criticism.  We have to continue to dare to speak, in other words. 

Of course, at the CWHN we’ve been working on more than just the HPV vaccine in the last several months, and this issue of Network demonstrates the range of pressing women’s health topics that continue to require thoughtful consideration. 

Mental health issues for women and girls will be a key focus in the coming year(s), given the recent federal announcement of the establishment of a Mental Health Commission for Canada and a national Mental Health Strategy, and so we’ve outlined some preliminary guidelines here for what we’d like to see in such a strategy.  The repercussions of health reforms, including the threat of private health insurance for already publicly funded and available health services, and the impact this will have on women and their families; issues around aging and health care needs and access; the long-lasting effects of child sexual abuse; and the need to turn our attention to cancer prevention, are just a few of the other important topics covered in this issue of Network.

As always, we welcome readers to please send us your thoughts and contributions to further issues of Network, and to consider joining us – as members of the CWHN -- in making sure women’s and girls’ health concerns are part of the national policy agenda!

Kathleen O’Grady
Director of Communications
Canadian Women’s Health Network