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In a classroom at Westheights Public School in Kitchener, Ont., nurse Mary Hall swabs the arm of a Grade 8 pupil, preps the syringe and runs through her checklist. Feeling well? Yep. Allergies? Nope. Not pregnant? Giggle, no.

“Do you know what this is for?” she asks casually. “For breast cancer?” the girl in the chair guesses.

“For cervical cancer,” Ms. Hall corrects, not for the last time that morning. “Do you know where your cervix is?” She drops her glance, pointedly: “Down there.”

The girl turns her head away from Ms. Hall, and dramatically mouths the word “ouch” when the needle goes in. In the hallway outside, the next batch of 12- and 13-year-olds in ponytails and sneakers are packed onto a bench, as if awaiting detention. They are too stressed to talk, and a few are about to burst into tears – a lot of nerves for a vaccine that may spare them from a life-threatening cancer.

But that's how young they are, which is why parents across the country are now hurriedly researching, debating – and sometimes rejecting – the wisdom of lining up their daughters for the needle.

On this day, nearly all of the 72 Grade 8 girls at Westheights will receive the HPV vaccine – a drug that studies show will give them immunity to a sexually transmitted virus that could some day grow into cancer. The school is one of the first in the country to begin administering the vaccine. Over the next few weeks, however, girls in specific grades will be offered the drug for free – with parental consent – in the rest of Ontario, Nova Scotia, PEI and Newfoundland. The rest of the provinces and territories have either delayed their programs until next year, or announced no decision.

For many Canadian parents, the vaccine program is controversial. It was rolled out in lightning speed after Ottawa announced a $300-million funding package for participating provinces. If it lives up to its potential, the vaccine will significantly reduce the incidence of a cancer that on average kills more than one Canadian woman every day, and often leaves those who survive infertile. According to trials, the vaccine, marketed by Merck Frosst Canada Ltd. under the name Gardasil, provides nearly full immunity to four types of the human papillomavirus, which causes 70 per cent of all cervical cancer and 90 per cent of genital warts.

For many parents, it's a no-brainer: Anything that will protect their daughters from cancer, even one of the more uncommon types, is worth the risks. But at the same time, mothers and fathers are grappling with a fear of side effects, questioning the motives of a drug company that stands to make big profits and politicians who may be pandering for votes, and feeling a certain queasiness about dosing girls as young as 10 years old with protection for an STD. At the very least, the needle is making for some interesting – and awkward – family conversations.

They don't have long to mull it over: Once those consent forms come home this month in the four provinces with a program, families will have days to send them back. Adding stress to their decision is money. Parents who decline the school-based program and then change their minds, or choose to wait until their daughter is older, will have to pay for the vaccine themselves, if they don't have private insurance plans that cover it. That's roughly $400 for three doses over six months.

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John Sexton of Newmarket, Ont., began researching the HPV vaccine after he took his basketball-crazy 13-year-old daughter, Erika, to the doctor with a knee injury, and the physician recommended she get it.

“My first thought was there was no way I wanted to be dealing with this,” says the teacher and single dad, who has a son and two other daughters, aged 15 and 20. “At 13 and 15, you like to think your kids are pretty innocent. And this is not something you want them to have to worry about. And yet, as soon as you have a chance to reflect on it, you think, ‘Hey, this is a different age.' ”

He hasn't heard whether his Catholic school will be offering the vaccine yet, but either way, he plans to order it for his daughters. “If a doctor said, ‘I can give you a shot to help prevent cancer in your foot,' you wouldn't even think twice about it. But because it's dealing with sex, it's just a little more sensitive.”

But in Victoria, Alan Cassels, the father of a Grade 6 daughter, is relieved British Columbia has delayed its vaccine program for at least a year. “She's 10 years old,” he protests. “It's hard for me to imagine her going there.”

Mr. Cassels, a drug policy researcher at the University of Victoria, has a professional perspective on this issue, as well. He is uneasy about the massive marketing campaign, and wonders why provinces dealing with the same set of facts reached different conclusions.

“This leads me to start thinking that there are other considerations,” he says. “They are not about data. They're not about science. They are about politics.” He falls, he says, squarely in the “wait-and-see camp.” By the time his daughter is 14, he says, more will be known about the vaccine.

“The kids are so young,” he says, “and there are still some questions, and people don't think there's a cervical cancer epidemic.” In 2006, about 1,350 Canadian women were diagnosed with cervical cancer, which is often discovered early through annual pap tests; by comparison, more than 22,000 women were diagnosed with breast cancer.

“It's not like vaccinating your kids from polio,” Mr. Cassels says. “It's in a different category.”

The vaccine only works if it's given before patients are exposed to the four specific strains of HPV for which it provides protection. HPV is one of the most commons STDs, so medical experts have recommended giving the vaccine before girls become sexually active. Newfoundland and PEI have chosen Grade 6 girls to receive it.

The school curriculum and logistics also played a role in the provincial decisions: In Nova Scotia, the vaccine will be given to Grade 7 girls. In Ontario, Grade 8 girls will get it. So far it's only the girls: Boys can also get HPV, but testing is still being done to determine whether the vaccine works for them.

David Jensen, a spokesman for Ontario's Ministry of Health and Long Term Care, said that public health experts in the province advised the government to vaccinate girls in Grade 8 – they are more aware of STDs at that age, and their parents may be more open to discussing the subject with them.

At the same time, some parents have expressed concerns that the vaccine might promote early sexual behaviour, or unsafe sex, by making teenagers feel they don't need to worry about infection or disease any more.

“A little bit of me feels like it sends the message that it's okay to be sexually active,” says Tanya Johnson, who home-schools her Grade 8 daughter, Rochelle, in Etobicoke. Ms. Johnson has decided not to give her daughter the vaccine – home-schooled students in qualifying grades can get it for free at public schools in their neighbourhoods.

Religion and social values were factors in her decision, but she also doesn't feel the vaccine has been around long enough. “People should do their own research,” she says. “We can't just trust the medical community to know what's best for our children.”

In the United States, where at least a dozen states are considering legislation to make the vaccine mandatory among school-aged girls – unless parents specifically opt out of the program – a similar debate is raging about safety and morality.

To date, in Canada, no school has officially declined to offer the program. Some Catholic school boards, including Toronto, meet this week to decide how to handle it. This week, the Ontario Conference of Catholic Bishops distributed a memo to school trustees, to include with school information being sent home.

While emphasizing that parents have the final decision, the bishops' statement was critical of the school-based programs, suggesting that more research and public education is required. “The Bishops of Ontario regret its introduction without further opportunity for thorough study,” the memo said.

The bishops' response was baffling to Lamont Sweet, Prince Edward Island's deputy chief health officer, saying that although the long-range effects of almost all vaccines are unknown, the clinical trials on this drug were so positive it would have been “unethical” not to offer it in schools. “The degree of immunity has been absolutely astounding. I don't think anybody would have ever predicted that it would have this degree of benefit,” Dr. Sweet says.

At the Chatham Christian School in Ontario, head administrator Hilda Roukema says the parent board will make the final decision, but she plans to recommend against it. The school teaches abstinence, and saving sex for marriage. “We don't want to encourage our Grade 8 students to be sexually active,” she says. “My hunch is that we're going to say we're not going to do it.”

This attitude frustrates Marg Johnston, a mother in Kitchener whose 13-year-old daughter, Sydney, received the vaccine at school last week. She and her husband will pay out of their own pockets for her 15-year-old daughter, a Grade 10 student, to get the needle.

“Don't bury your head in the sand,” Ms. Johnston says. “At some point they are going to be sexually active. Even if your daughter is a virgin on her wedding night, what about her partner?”

For Ms. Johnston, having a relative diagnosed with cervical cancer in her 20s, and left infertile, clarified the decision. “How devastating for your life, and for your relationships,” she says. “If there is something to protect my children then I should.” How could she look them in the eye, she asks, if she said no and they got cancer down the road?

That's the same motivation behind Renee Mercer's decision to give her 11-year-old daughter, Courtney, the vaccine, when her school in Conception Bay South, Nfld., runs its clinic. She has a close friend who was diagnosed with cervical cancer when she was pregnant. She went on to have a healthy baby, but if that's a scare she can spare her daughter, the benefits outweigh the risks.

“I'm all for it,” she says. “I don't have any qualms.” When the consent form comes home, she says, she'll attempt a frank conversation with her daughter. “She's very reluctant to listen to anything right now because to her it's all gross.”

For Cathy Dandy, a Toronto school board trustee who worries the vaccine is being pitched as a “cure-all,” those family chats are especially important. Ms. Dandy's mom died 10 years ago of cervical cancer, and she plans to make sure her Grade 8 daughter gets the vaccine.

But she points out that women who take the vaccine are still advised to get annual pap tests because the drug does not protect them from all forms of HPV, and its true benefits will not be known for several decades. “I worry about the rush to it,” Ms. Dandy says. “And a misperception that something has been solved and we don't need to think about it any more.”

At Westheights Public School, 13-year-old Sara Potter is heading back to class sporting a Band-Aid on her left arm. “I don't really like needles,” she says. “I didn't really want to get it, but I knew I had to because it's a good idea.” She and her friend, 12-year-old Megan Burrows, who both generally understood what the vaccine was, agree that Grade 8 is a good time to do it. They laugh at the notion that their peers might be having sex. “You don't usually get sexually active by Grade 8,” Sara says.

And while parents may be stressing about the vaccine, most of the girls can be expected to forget about it once the needle mark vanishes. “They got to have juice and cookies and miss class,” Ms. Johnston says. “Those are pretty important things in a preteen's life.”