Not since the Salk vaccine was triumphantly unveiled in 1955 as the miracle drug that would end the scourge of polio has there been as much hoopla surrounding a vaccine as there is today about one that is being touted for having the potential to eradicate cervical cancer.
Nor has there been in the ensuing five decades a vaccine that has been such a lightning rod for social controversy and political grandstanding.
Unlike polio, where children were dying and crippled in large numbers and immunization stopped an epidemic in its tracks, cervical cancer develops slowly and the positive or negative effects of a vaccine for human papillomavirus (HPV), which can cause cancer of the cervix, will not be seen for decades.
There remain many unanswered questions about the vaccine: Will it actually prevent cervical cancer or just prevent infection with some strains of the virus? Will it confer long-term protection or will booster shots be required? Should boys be vaccinated?
How many doses are needed – three, or just two? And will the arrival of a competitor to the Gardasil vaccine, called Cervarix, bring down prices?
Scientists have hailed Gardasil as everything from the greatest advance in women's health since the pill to a monstrous experiment on a generation of young girls. Conservative politicians – despite claims from their core constituency that the vaccine will encourage licentious teen sex – have embraced the drug as a means of bolstering their street cred, and winning women's votes. The more liberal politicians – traditional supporters of public health measures like immunization – have railed about a Big Pharma conspiracy to ram Gardasil down our collective throats with sleazy lobbying and slick tug-at-the-heartstrings marketing.
Regardless of your take, the fact remains that since polio, no vaccine has gone from regulatory approval to mass use in government-funded programs with such dizzying speed.
Health Canada approved Gardasil on July 18, 2006. The National Advisory Committee on Immunization gave the vaccine a thumbs-up on Feb. 15, recommending that all girls between 9 and 13 receive the drug. Then the Canadian Immunization Committee, a federal-provincial-territorial body whose role is to determine that vaccines that are effective and cost-efficient are made available equitably to all Canadians, set to work to determine if the expensive new vaccine should be publicly funded and included in routine school-based immunization programs.
But on March 19, during his budget speech, Finance Minister Jim Flaherty short-circuited the scientific and economic discussions by announcing $300-million to kick-start an HPV vaccination program.
Ottawa's move stunned public health officials, as well as the provinces. They were thrilled by the money, particularly for a vaccine that the public was clamouring for, but alarmed by the manner in which the decision was made.
“Aside from the polio vaccine in the fifties, it was the first time that the federal government made a direct medical decision,” said Noni MacDonald, an infectious disease specialist and professor of pediatrics at Dalhousie University in Halifax.
“This has caused a lot of us in public health and medical circles to flinch,” she said.
The discomfort was made even greater when Ontario Premier Dalton McGuinty announced last week that the province will undertake mass HPV vaccination of Grade 8 girls at the beginning of the school year. Again, the breakneck speed of implementation is noteworthy.
Yet, in Toronto as in Ottawa, these scientific and pharmacoeconomic debates, not to mention the necessary public health logistical planning, appear to have been overtaken by the desire to score political points with soccer moms. (Ontario voters go to the polls in October.)
Sandra Pupatello, the Ontario Minister of Women's Issues, dismissed the criticism, saying her government was practising good public policy, not political opportunism.
“There has never been an issue around women's health that has had this level of unanimity. It wasn't a difficult decision.”
