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Female physicians urge provinces to pay for HPV vaccine for boys

A group representing female doctors in Canada is calling on provincial governments to pay for HPV vaccine for boys.

The Federation of Medical Women of Canada said vaccinating only girls isn't fair, and it isn't using the vaccine to its maximum advantage.

"Both sexes contribute to the transmission of HPV. Both sexes are at risk of developing a variety of HPV-related diseases – including cancer. So it follows that both sexes should be protected. But currently, that's not the case," Vivien Brown, Toronto branch president, said on behalf of the organization.

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Dr. Brown's comments were contained in a statement released this week by the federation.

A federal government expert panel recently ruled there is strong evidence for use of the HPV vaccine Gardasil in boys and young men aged 9 to 26. The group also said there is strong evidence for its use in males 9 and older who have sex with other males. Nine is the minimum age for which the vaccine is approved for either gender.

The vaccine has been used for girls in Canada for several years, though acceptance rates have been lower than public-health officials would have liked.

In Ontario, data from 2009-2010 show that only 55 per cent of Grade 8 girls were vaccinated, even though the province pays for the vaccine, said Arlene King, the province's chief medical officer of health.

In British Columbia, the average uptake was about 66 per cent, said Perry Kendall, Dr. King's counterpart in that province.

Gardasil is one of two HPV vaccines. It protects against the four main disease-causing strains of human papillomaviruses. Those viruses cause genital warts and a variety of cancers: cervical, vaginal, vulvar, penile, anal, as well as oral and oropharynx cancers.

The other HPV vaccine is Cervarix, which protects against two major strains of the viruses. It is newer to the market and data on its effectiveness in boys have not yet been published. The expert panel, known as the National Advisory Committee on Immunization (NACI), recommended only Gardasil for boys in its January statement.

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Having a recommendation from the NACI is an important step in getting a new vaccine onto the schedule of vaccines that are publicly funded. But the recommendation by itself does not guarantee that provinces and territories will follow through and pick up the tab.

"There's a long process that is required to go from what I would call concept to community," Dr. King said.

That process includes doing a cost-effectiveness analysis, looking at "implementation considerations" – things like whether the system can handle the additional work – and figuring out a way to assess whether the program, if approved, is successful.

Another consideration Dr. King listed may be critical: whether there is public acceptance for the move.

Dr. Kendall also noted that the decision will be made in a broader discussion about a number of new vaccines that have come on the market or are expected to be brought to market soon. With public funds expected to be tight, will HPV vaccine for boys be a priority? Or might governments choose to pay for shingles vaccines for adults instead?

"It's competing with a whole bunch of other vaccines that are either here or in the pipeline. And there's limited, finite dollars in the health-care budget these days," Dr. Kendall said.

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For Ontario, an appraisal of the five-year-old HPV vaccine program for girls may help the province determine whether it wants to extend coverage to boys, Dr. King said. That review is currently under way.

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