en Good Reasons to Be Concerned about the
Human Papillomavirus (HPV) Vaccination Campaign
This document is a translation and adaption of an information brochure prepared by the Federation du Québec pour
le planning des naissances with assistance from Women and Health Protection and the Canadian Women’s Health
Network.
On September 1, 2008, the Government of Quebec introduced a new vaccination program against the human
papillomavirus (HPV) in hopes of reducing rates of cervical cancer. Vaccination will be offered free of charge in
schools to all female fourth-graders (age 9) as well as to third-year female high school students (age 14). GardasilTM,
the vaccination that will be used in the campaign, will also be offered free of charge to young women under age 18
who no longer attend school and to those considered to be at increased risk (see boxes below for details). Parents of
girls under 14 will have to give permission to vaccinate their daughters on signed consent forms.
Although this announcement has been favourably received in some circles, the Fédération du Québec pour le
planning des naissances (FQPN), along with many women’s, teachers’, nurses’ and youth organizations, have
expressed serious reservations regarding the campaign. Some of our main concerns are outlined in this document.
1. There is no HPV epidemic. It is difficult to understand why the government is rushing to roll out a universal
vaccination campaign when the prevalence and mortality rates of cervical cancer have been consistently
declining over the past decades due to the introduction of Pap testing. (1) In Quebec, cervical cancer affects
about 280 women every year, 75 of whom will unfortunately die of the disease. Ranking 13th on the list of
new cancer cases diagnosed among Quebec women, rates of cervical cancer are way below those for
breast cancer and lung cancer; on average, these will strike 5,900 and 3,400 women, respectively, every
year.
Prepared by the FQPN in October 2008 Ten Good Reasons to be Concerned about the HPV Vaccination Campaign. Translated and
adapted by Women and Health Protection and the Canadian Women’s Health Network 2
2. The vaccine does not provide full protection. The GardasilTM vaccine does not protect women from all
HPV types associated with cervical cancer or genital warts. It is directed specifically against two types of
HPV which account for approximately 70% of cases of cervical cancer, and two types of HPV which account
for about 90% of cases of genital warts. Thus, even if vaccinated, women will still need to get regular Pap
tests and protect themselves against various sexually transmitted infections (STIs).
3. A false sense of security. We are concerned that vaccination could create a false sense of security and
that this might lead women to skip Pap tests or to engage in unsafe sex. Pap tests remain essential, even
after vaccination, as do safe sex practices. We support the recommendations of the Comité sur
l’immunisation du Québec to assess the impact of vaccination on the regularity of Pap test practices among
vaccinated women, as well as their practices with sexual partners.
4. We know which women are most at risk of developing cervical cancer. The vast majority of women who
are diagnosed with cervical cancer haven’t had a Pap test within five years, or had an inadequate follow-up
after an abnormal test result. Often, inadequate access to the health care system is to blame, especially
among women from impoverished communities, indigenous women, women living in remote areas,
immigrant women and older women. Cervical cancer deaths are closely linked to adverse socio-economic
conditions and lack of access to screening programs is one of the main factors linked to mortality from this
form of cancer.
Cervical cancer incidence and mortality rates have been declining for many decades, largely due
to widespread regular use of Pap test screening, whereby malignant as well as pre-malignant
lesions can be detected early and treated. Recent announcements by some provinces to institute
vaccination of school-aged girls with the HPV vaccine will further reduce incidence and mortality
over the longer term, but will not eliminate cervical cancer. The continuation of Pap screening is
still a necessary and important part of preventive health care.
— Canadian Cancer Society, 2008, p. 27
5. Screening remains essential and needs improvement. To have access to Pap testing, a woman first
needs access to a family doctor. This remains far from optimal in the province of Quebec, with the rate of
participation in Pap screening in this province the lowest in Canada. More specifically, over 725,000 women
over the age of 18 have not been tested in the past 3 years, or indeed, have never had Pap tests. There are
no provincial directives regarding Pap testing in Quebec, nor is there a formal follow-up system for women
whose tests are abnormal. Thus, our cervical cancer prevention strategy should focus primarily on improving
access to and the quality of testing for all Quebec women. Although public health officials acknowledge that
Prepared by the FQPN in October 2008 Ten Good Reasons to be Concerned about the HPV Vaccination Campaign. Translated and
adapted by Women and Health Protection and the Canadian Women’s Health Network 3
screening programs need improvement, no concrete measures or new budget have been announced to
support them.
6. The vaccine is too recent. Because it is new, there are necessary limits on what we know of the vaccine
especially with regard to its long-term effects and efficacy. We do not know if protection will last beyond 6-
years, or whether booster shots will be needed. The possible impact of vaccination on the natural history of
HPV viral infection is also unknown. In Quebec, the vaccination of 9-year old girls will be implemented
according to an extended vaccination schedule that has yet to be approved in Canada and is still under
review. For students in Secondary 3, the vaccine will be administered along with the DTaP vaccine, and this
combination was not examined in the clinical trials that led to its official approval. So, like the Comité sur
l’immunisation du Québec, we believe that
Studies on the duration of protection, the efficacy of the vaccination in different
population groups, the efficacy of various vaccination schedules and the impact of the
vaccination, on both screening and on the transmission of HPVs, are needed.
— INSPQ 2007, p. 35
Given that there is now no epidemic of cervical cancer, the government could have waited a few more years
to obtain more data before rolling out a universal vaccination campaign.
7. A very expensive strategy. In Quebec, the HPV vaccination campaign will cost $50 million in the first year alone.
By means of comparison, Quebec invests only $20 million for the prevention of other STIs, despite the fact that
40,150 cases of chlamydia, gonorrhea and syphilis were declared in Quebec from 1996 to 2000. Chlamydia alone
was diagnosed in 12,500 people in 2006, with youth between 15 and 24 years of age especially affected. By focusing
only on HPV infections and by investing primarily in a new vaccine about which there are limited data, the government
appears to ignore expanding education and prevention strategies that include effective sex education programs so
clearly needed in schools. These approaches help prevent major sexually transmitted infections (STIs) whose rates
are either on the rise or remain very high
8. The vaccination campaign reinforces sexual stereotypes. The fact that only females will be vaccinated
reinforces the stereotype that sexual health is mainly a woman’s responsibility. This glosses over and neglects men’s
responsibilities regarding sex. Although cervical cancer is a woman’s disease, young men play a role in the
transmission of the virus, and may themselves experience HPV-related problems. The urgent public health priority
should be a broad-based information and sex education campaign to raise awareness among young men and women
regarding their sexual health.
Prepared by the FQPN in October 2008 Ten Good Reasons to be Concerned about the HPV Vaccination Campaign. Translated and
adapted by Women and Health Protection and the Canadian Women’s Health Network 4
9. The lack of critical information. Public awareness of HPV is still lacking. The many marketing strategies by
the vaccine’s manufacturer have garnered significant attention, but have blurred the lines between health
information and advertising. Public information is therefore neither complete nor impartial. It creates confusion,
using a fear-and-cheer format to create an unduly alarming scenario, in which every problem can be solved by
the vaccine. For instance, public information about HPV and the vaccination campaign itself focus on the high
incidence rate of the HPV infection rather than on the fact that the infection will clear up on its own within two
years in 90% of infected women, with no adverse consequences whatsoever. The question remains: How can
parents truly weigh the pros and cons of vaccination and make informed decisions concerning their daughter’s
vaccination?
10. Mobilizing already scarce resources. There is no doubt that a HPV vaccination campaign will require
extensive financial and professional resources, especially among school nurses who often already have their
hands full dealing with sexual education mandates in schools. Compared to other sexual health issues, the
required investment for this campaign appears to be disproportionate to the real burden of this particular disease.
Given the shortages of doctors and nurses, the uncertain future of our “cash-strapped” health care system and
the dearth of suitable sex education programs in our schools, should we really be investing in this costly
campaign, a campaign to prevent a form of cancer with declining incidence and mortality rates? It will take 20
years before we can truly answer this question, when the risks and benefits of the vaccination come to light and
cervical cancer rates are recorded.
Call to action
If you care about these issues as we do, please help us spread the word about this campaign. Please feel free to use
part or all of this backgrounder to alert your local publications, your members and your friends. If you organize any
activities around these issues, please let us know.
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