by TRACEY LINDEMAN

By month’s end, Canadian doctors and pharmacists will be armed with Gardasil, the first human Papillomavirus (HPV) vaccine—news that has some rejoicing and others asking serious questions.

According to Dr. Michael Shier, the chief of gynaecology at Toronto’s Sunnybrook Health Sciences Centre, the vaccine works best when administered to girls before becoming sexually active, at around nine years old. And if the post-marketing study proves successful, “It would be ideal to administer at infancy,” he says.

After five years of international clinical trials, Merck Frosst’s Gardasil has been proven effective, to varying degrees, at preventing the four most common strains of HPV as well as cervical, vaginal and vulvar cancers. In addition, women already infected with one form of HPV can get the vaccine to protect them against the others. Dr. Shier says this is big news for sexually active Canadians, 75 per cent of whom will contract HPV, a sexually transmitted infection that if left untreated, can lead to the aforementioned cancers, genital warts or other health complications. However, little information is available about Gardasil’s long-term effects or if re-immunization will be needed later on.

“I don’t know if we know enough about the vaccine to be jumping on it as the bandwagon for every young woman and every young girl,” says Dr. Abby Lippman of the Canadian Women’s Health Network and McGill’s Department of Epidemiology, Biostatistics and Occupational Health. Some concerns include girls practising unsafe sex because they think they’re safe from HPV and other STIs.

Lippman believes that with Gardasil comes the responsibility of teaching girls about their sexual and reproductive health, and that parents, doctors and the Quebec government should not forsake sex ed for quick fixes in the name of prevention.

“The vaccine is an interesting option but I think it has to be put into the context of how we teach young girls about sex,” she says. “We need really good sex ed, and if the schools can’t do it, let’s give the money to community [sex ed] groups like Head and Hands.”

Pap still paramount

According to Merck Frosst, about 620 Canadian women die each year from cancers caused by or related to HPV—cancers that are preventable, says Lippman, because regularly scheduled Pap smears allow physicians to detect and treat HPV infection before cervical cancer develops.

“No woman should be getting cervical cancer in 2006. Why are we not investing in primary care to make sure that all women are getting appropriately [scheduled] Pap smears?” she says. “That’s why women get cervical cancer—not because they didn’t have a vaccine, but because they didn’t have a Pap smear.” Either way, federal and provincial governments will evaluate Gardasil’s benefits and cost-effectiveness in public health coverage considerations. Sunnybrook’s Michael Shier predicts that most provinces will decide to provide the vaccine to women through provincial healthcare insurance, as the vaccine will cost less than dealing with new cases of HPV and cervical cancer.

“It’s a big help, but it’s not a panacea yet,” Shier says of the vaccine.

But Lippman urges women to evaluate the pros and cons of vaccines like Gardasil and other pharmaceuticals geared specifically toward women.

“I think there’s a long history of things that have come with a lot of hype that have not lived up to their reputation,” she says. “There have been a lot of mistakes made in the past, such as the pushing of Depo Provera on certain populations of girls and young women,” she says (Pfizer’s Depo Provera was approved by Health Canada in 1997 as an injectable form of birth control. In 2004, Pfizer admitted that the drug had serious side effects after women reported incessant bleeding, loss in bone density, severe weight gain and depression, among other effects).

“I think there are a lot of ways to deal with concern about [HPV] infection and about cervical cancer,” she says. “The vaccine may fit into it, but it is not the answer. There is never one answer.”