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Parents of girls across the country are in the midst of making a decision: whether or not to vaccinate their daughters against HPV.

The vaccine program, rolled out at lightening speed after Ottawa announced a $300-million funding packages for participating provinces, is considered controversial by many.

Over the next few weeks, girls in specific grades will be offered the drug for free - with parental consent - in Ontario, Nova Scotia, P.E.I. and Newfoundland. The rest of the provinces have either delayed their programs until next year, or announced no decision.

If it lives up to its potential, the vaccine will significantly reduce the incidence of a cancer that kills more than one Canadian woman every day, and often leaves those who survive it unable to have babies; according to trials, it 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.

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, as well as their own moral qualms about dosing girls as young as 10 years old with protection for an STD.

Dr. Deborah Money, associate professor at the University of British Columbia and executive director of the Women's Health Research Institute, has answered reader questions to help you understand the virus and the vaccine.

Your questions and Dr. Money's answers appear at the bottom of this page.

Dr. Money is an associate professor at the University of British Columbia and is the head of the division of maternal fetal medicine at the Children's and Women's Health Centre of British Columbia. Most recently, Dr. Money has been appointed executive director of the Women's Health Research Institute.

She is an obstetrician/gynaecologist who obtained fellowship training in infectious diseases at the University of Washington. She returned to UBC in 1994 and developed a clinical and research program in Ob/Gyn Infectious Diseases with research focussed on viral pathogens in women and in pregnancy, specifically HIV, HPV, Hepatitis C and genital herpes. She was the Associate Director for STD/AIDS Control for BC Centre for Disease Control from 2001 to 2002.

She is currently the chair of the Infectious Diseases committee for the Society of Obstetricians and Gynaecologist of Canada (SOGC), and the SOGC liaison member on the National Advisory Committee on Immunization (NACI). In addition, Dr. Money is on the executive committee of the U.S. Infectious Diseases Society of Obstetrics and Gynaecology (IDSOG).

Editor's Note: globeandmail.com editors will read and allow or reject each question. Questions may be edited for length, clarity or relevance. HTML is not allowed. We will not publish questions that include personal attacks on participants in these discussions, that make false or unsubstantiated allegations, that purport to quote people or reports where the purported quote or fact cannot be easily verified, or questions that include vulgar language or libellous statements. Preference will be given to readers who submit questions/comments using their full name and home town, rather than a pseudonym.

Melisa Tammi-Cheah, Toronto: I'm a 43 year old mother of two who recently celebrated her 19th wedding anniversary. On my annual medical visit this year with a new GP, he recommended that I get the HPV vaccination. When I questioned the need for this in my age category he replied, "it couldn't hurt." I will not hesitate to vaccinate my daughter when she turns 10, but is there really any indication that the vaccine is effective or necessary for my age group? Are there other GPs recommending it to all of their female patients?

Dr. Money: A commonly asked question: There are no published studies showing the benefit of this vaccine in women over 26 years old. There are ongoing studies that will be available shortly. This vaccine is most designed to benefit girls and women before sexual exposure to this vaccine. For women in stable, ongoing monogamous relationships, there is no proven benefit yet. I presume that given the very good safety profile and the theoretical benefit if one is to be exposed in the future, I suspect some health care providers are recommending this for women in your situation. I personally would say that the best benefit is for your daughter.

Rasha Mourtada, Globe Life web editor:The following two questions are somewhat related, so Dr. Money has chosen to answer them together.

Wendy Schmidt, Vancouver: Before I submit my daughters for this vaccine, I need information on the transmission of the virus. Does a man carry this virus for life if he is infected? Is it possible for men to be vaccinated?

LG, Calgary adds: Why are boys not being vaccinated when they can contract genital warts from HPV exposure?

Dr. Money: Great questions - boys and men do carry this virus and can develop genital warts as a result of infection with types of this virus. Men and women can be infected with this virus and then apparently "clear" the virus from their genital skin surfaces. This virus is transmitted from skin to skin from men and/or women via direct genital contact.

Men and boys could be vaccinated and the only reason they are not part of the programs planned or recommended in Canada is that when these vaccines were being developed and tested, the vast majority of studies were conducted in girls and women.

This was because the disease (cervical cancer) that the vaccine was designed to prevent, is only in women. We do have the direct information on the ability of the vaccine to prevent infection with the vaccine types in girls and women but this information is lacking in boys and men. We do know that boys' immune systems respond to the vaccine equally to girls but we don't know if it prevents infection in them. This led the Canadian National Advisory Committee on Immunization to limit the recommendation for use to girls and women. There are ongoing studies in boys and men and if they show benefit in preventing infection the recommendation will be adjusted accordingly.

Mark Adamson, Calgary: I have two daughters in their early 20s. Both have abnormal cervical cells, from the last pap smear my oldest now has cancer cells that she needs removed. My question is, is it to late to have them both vaccination now? I only wish I had the choice 10 years ago that the current crop of pre-teen parents are dithering with now!

Dr. Money: Yes - I wish we had the vaccine 10 years ago too and why, in my view, it would be a mistake to wait any more years! Although the main approach for your daughters at present is to have their pre-cancer or cancer cells treated as recommended, the vaccine might have some benefit for future exposure to other vaccine types. Because the currently licensed vaccine has four of the types that infect the genital skin/mucosal surfaces, if you are already infected with one it will not help with that one, but can prevent infection to others. In other words, it may help for future exposures, but will not help with the current abnormal cervical cells.

Debbi MacArthur, Canada: Dr. Money: I have two daughters 13 (grade 8) and 16 (grade 11) and am trying to decide if they should be given the vaccine. Does the vaccine last for only 5 years? If the vaccine is just for five year time why rush getting my daughters done at such an early age? It would be better to wait until they are a little older and going to become sexually active. If the vaccine lasts for just five years, can they be vaccinated again?

Dr. Money: The information that we have on this vaccine is that it is a truly preventative not a treatment vaccine, so we want to have young women vaccinated before they are ever exposed.

A number of Canadian studies have shown that many Canadian girls have had sexual exposure by 14 years of age. Based on this information (recognizing that each young woman is different) the public health approach has been to recommend the vaccine prior to Canadian sexual exposure to ensure protection and not deny the benefit of the vaccine to especially at risk girls. The long tradition in Canada of publicly funded vaccine programs is to offer the maximum benefit to the most people irrespective of their background. The vaccine's protection may last for a long time, but the published studies only go to 5 years at which point vaccine protection levels are stable, we will have information from large long term follow up studies in the next five to 10 years which will tell us if an extra (booster) dose of the vaccine is needed or if protection is very long lasting. It could be life long - we just don't know yet. The good news is that the information from these women will be available at least 5 years before the first girls in the Canadian school programs will need to know. It is definitely better for young women at ages 13 and 16 to be vaccinated now before they anticipate sexual exposure.

Ann Clark, Mississauga: How many females were in the test trials for this drug? What exactly are the side effects of this drug, no matter how small? Why the big rush to vaccinate school girls of such a young age, not giving the parents a chance to look into all the facts?

Dr. Money: There were over 20,000 females in the trials of this vaccine and the side effects were remarkably minimal. As would be expected and desired (meaning the body is reacting) there are local side effects which include (pain, swelling and redness at the injections site). In these trials half the subjects got placebo, meaning that side effects can be compared between those who received vaccine and those who did not. There were no serious side effects (meaning severe enough to be seen by a doctor or in hospital) that occurred more in the vaccine group than placebo group. This was also true for the deaths of several women during the course of the trials which were due to road traffic accidents, suicides and complications of childbirth as would be expected in any large number of women of this age followed for several years.

The Public Health Agency of Canada and the individual provinces' vaccine recommendations are based on careful scientific review and a desire to be timely and responsive to new prevention opportunities. If any parent feels they do not have enough information they need to pause and get this information to their full satisfaction. There are a number of web sites that can be accessed for accurate information - these include the website for the Public Health Agency of Canada and the Society of Obstetricians and Gynecologists of Canada .

Lynda A, Toronto: I have heard that the vaccine will only immunize women against a few strains of HPV. Wouldn't this create a false sense of security for women who get vaccinated? (They may not think that they need pap tests anymore, leading to more cases of cervical cancer). Also, why is it that there is an age window for this vaccine? I am 29 and it seems it is too late for me to receive it.

Dr. Money: Excellent points - the vaccine only protects the person against the strains that the vaccine contains which are not all strains of HPV that can infect a person. The company developing this vaccine started with a vaccine composition that includes two types (16 and 18) that protect against 70% of cervical cancer and 2 types (6 and 11) that protect against 90% of genital warts. You are correct in presuming that this means that 30% of cervical cancer-causing types, are not protected against and that this very much means that women must continue to have pap smears. We truly hope that we are informing any girl/woman receiving the vaccine that this does NOT mean that they do not need Pap smears and we are trying very hard to get that message out to all of the public. This is not the end of Pap smear screening.

As for the age range - that was related to the age range chosen for the large scale studies done prior to licensure. There are ongoing studies in groups greater than 26 years old and we will await this information. For yourself, you would have a slightly lower immune response compared to a 26 year old but this is not likely substantive. It is not too late for the vaccine, but you will only be protected against strains (types) that you have never been exposed to, and we cannot tell what these are at present. In other words, the benefit of the vaccine for you is unproven at present.

Wilma Verhagen, Toronto: What makes this vaccination more effective in preventing the spread of the HPV virus and genital warts than using a condom, which prevents the spread of HPV, STDs and HIV? It seems to me that condoms are much cheaper, more effective and accessible for BOTH males and females regardless of age. Could it be that a needle is easier for parents to explain to their adolescent daughters than discussing the importance of safe sex through the use of condoms?

Dr. Money: This vaccine does not/nor was intended to replace the use and value of condoms to prevent sexually transmitted infections. Unfortunately, despite our collective best efforts, condom use is far from 100% but we still need to counsel in this regard.

In addition, this virus is not fully protected from transmission even with proper condom use because it is a genital skin to skin route of transmission, an area far greater than a condom will cover. As a result, it seems appropriate to use every tool that we have to prevent infection with disease causing viruses. In this case, the vaccine can at least prevent infection against two types that cause 70% of cervix cancer and 2 types that cause 90% of genital warts. This does not leave parents off the hook, they still need to talk about safer sexual practices. Maybe the conversation about whether or not to take the vaccine could be an opportunity for this conversation??

J Brownlee, Canada: I understand that the immune system can usually clear an HPV infection. Does exposure to HPV confer immunity to subsequent exposures of the same or other types of HPV?

Dr. Money: Surprisingly, natural infection, which seems to behave differently than the immune protection from the vaccine, does not necessarily prevent against re-infection with the same type. Having protection against one type generally does not confer protection to other types.

Curious Person, Canada: Hello, I am a 25 year old married woman and have had one sexual partner. I believe I am at a very low risk of contracting HPV. I am wondering if the vaccine is still something I should consider, especially given the fact that it's very new and there are conflicting opinions as to the long-term affects. Is the vaccine more useful for women at a higher risk of getting HPV?

Dr. Money: Although, minimizing the number of lifetime sexual partners is the best way to reduce risk of infection from sexually transmitted infections, one is always exposed not only to one's partner but potentially to every partner he or she has ever had and so on. This means that the only truly safe relationship is one in which both partners have never had sexual contact with another person. Although the main public health target for this vaccine are girls prior to any sexual exposure not knowing the nature and frequency of that exposure, but this vaccine can still be useful to older individuals and can protect against unplanned future exposures. This is a long winded way of saying — risk assessments are not generally very useful in this kind of infection and disease so getting the vaccine would be a very reasonable thing to consider.

Brooklyn Davis, Saskatoon: I am wondering what sample population the trials were carried out on (mice, etc) and the size of sample trial groups. I am also curious as to the reasoning behind the age of vaccination. Why are the vaccines being targeted to pre-pubescent girls? And what effect might this have on normal puberty?

Dr. Money: There have been over 20,000 girls and women worldwide in studies on this vaccine, approximately half which received active vaccine and half which received inactive placebo injections. The choice of age is to time the full three doses of vaccine in a school year, prior to the average age of onset of sexual activity in Canada, which is approximately age 14 years. There is no evidence or even scientific reasoning that would suggest that this vaccine would affect the onset of puberty.

Bernadette MacDonald, New Glasgow, Canada: I am wondering about the probability of passing on the strain of HPV that causes cervical cancer . Once a woman is diagnosed with HPV and cervical cancer how imperative is it that she inform past sexual partners. Also who is at great risk, female partners or female partners of males she has had sexual contact with?

Dr. Money: There are many different strains of HPV that cause cervical cancer and not many places in Canada regularly test for these. In fact, HPV testing has not been proven yet as the best way to prevent cervical cancer so the mainstay of prevention is Pap smear testing. If a woman is given a diagnosis of pre-cancer changes of the cervix (an abnormal Pap smear) or if she finds out she has a cancer causing virus, there is no need to inform sexual partners as the virus is so common and we have no treatment to get rid of the infection. The message is that any sexually active woman should be attending regularly for Pap smear screening. This virus is most easily transmitted from men to women, but women who have sex with women can also transmit this virus so gay women should also have Pap smear testing. (not sure if that is the question being asked here?)

Amanda Outingdyke, Portage la Prairie Canada: I saw a commercial for the vaccine that said it was for women ages 19-26. Why would there be any sort of age limit to receiving the vaccine - can't women of any age get cervical cancer? How does someone know if the vaccine is right for them?

Dr. Money: The age range recommended is related to the ages that were picked by the vaccine company in its large pre-licensure studies. This does not reflect the age at which women get cervical cancer. The progress from infection with a cancer causing strain of HPV, to persistent infection, to pre-cancerous changes in the cervix to cervical cancer usually takes decades, which allows for Pap smear screening to usually pick up the problem and permit treatment before cancer occurs. The goal of vaccination for any age, is to prevent HPV infection in the first place (at least to the types in the vaccine). This vaccine has been studied and proven effective for ages 9 to 26 but studies in over 26 year olds are not yet complete.

Rasha Mourtada, Globe Life web editor: Many thanks to Dr. Money for taking the time to participate in this discussion. To our readers, we're sorry we couldn't get to all of your questions.