Erika Klein wasn't worried that a vaccine against the human papillomavirus would encourage her 15-year-old daughter to engage in risky sexual behaviour. She decided against having her daughter vaccinated because she was not convinced it was necessary or safe.
"I worry about either long-term effects or side effects" of the vaccine, the Oakville, Ont., resident says, adding she believes her daughter would be better protected from HPV – and a variety of other sexually transmitted infections that are not covered by the vaccine – through proper sexual education. "It's not just about getting a shot and being protected. It's about … her being empowered with the right information."
Klein's hesitations reflect the concerns of other parents who are reluctant to give their daughters the HPV vaccine. Although a major U.S. study this week challenged an oft-cited argument that the vaccine makes girls more sexually active, the possibility of sexual promiscuity is actually low on the list of many parents' anxieties about the injections.
The study, published in the journal Pediatrics, examined the medical records of nearly 1,400 girls for up to three years after they were immunized. The researchers found those who received the HPV vaccine were not more sexually active than girls who did not get the shots.
But for many parents, their biggest fears revolve around not having enough information about the vaccine, feeling rushed to make a decision about whether their children should get it, and questions about its safety. Some are skeptical about Big Pharma's push to promote their vaccines. (The two HPV vaccines authorized for use in Canada are Gardasil and Cervarix.)
According to the Public Health Agency of Canada, it is recommended that girls, ages nine to 13, receive the HPV vaccine, which protects against certain types of the human papillomavirus that cause cervical cancer. Since HPV is a sexually transmitted infection, the vaccine should ideally be administered to girls before they become sexually active, the agency says.
Yet as many as 30 to 40 per cent of girls eligible to receive the vaccine do not get immunized.
In Ontario, which offers the HPV vaccine to all Grade 8 girls, the immunization rate increased to 59 per cent in 2010, up from 51 per cent in 2007. (Updated statistics are expected to be available at the end of this year.)
In British Columbia, close to 70 per cent of Grade 6 girls were immunized during the 2010 to 2011 school year. And in Alberta, which offers the vaccine starting in Grade 5, roughly 60 per cent of eligible girls received the vaccine each school year.
Ingrid Littmann-Tai, a mother of two girls in Calgary, says she did not have her eldest daughter immunized against HPV when it was offered in Grade 5, partly because she was leery about whether she needed it at such an early age. Now that her eldest is in Grade 8 and her younger daughter is in Grade 5, she feels increasing pressure from doctors and other parents to have them both vaccinated, but she still has some doubts about it. Littmann-Tai says she feels overwhelmed by the number of vaccinations, from chicken pox to influenza, her girls are already urged to receive.
"I'm not one of those anti-vaccination people; my kids had all their vaccines when they were [young] and everything," Littmann-Tai says. "I'm just a little concerned that every time there's a new vaccine, it's like, 'Okay, well, let's inject your kids with this now.'"
She adds that Grade 5 seems too early to be immunizing children against sexually transmitted infections. "It's not like I'm burying my head in the sand and saying [the risk of contracting sexually transmitted infections] is not going to happen eventually for her, but Grade 5 just seems so young," she says.
An earlier U.S. study released this year had suggested some girls who receive the vaccine think they are less at risk for other sexually transmitted infections. Meanwhile, some Canadian Catholic schools, including the Calgary Catholic School District, have declined to offer HPV vaccines to students, in part, over worries that it may send implicit messages condoning early sex.
In an e-mail on Tuesday, the Calgary Catholic School District said its board of trustees has not changed its position on the vaccine and declined further comment.
Dr. Ian Gemmill, medical officer of health for Kingston, Frontenac and Lennox & Addington Public Health, says he is "a little discouraged" that roughly 40 per cent of young females in Ontario are still not taking advantage of the primary prevention measure. He added that the current immunization rate is not high enough to reduce the spread of infection to the non-immunized. "I don't think 60 per cent is going to cut it. You're going to need higher immunization rates for that to be able to make a difference," he says.
Gemmill notes that while he recognizes safety is a major concern for parents, the HPV vaccine is safe and does protect against cervical cancer. He encourages parents to seek out information before making their decisions.
"It's clear from all the evidence that's coming in that the HPV vaccine is a safe and effective vaccine," he says."I hope that all that combined will help young women and parents make the decision to take the vaccine because there's so much to say about the positive side: It's safe, it's effective, it'll prevent cervical cancer, and guess what? It's free…. So you might as well take advantage of it."