When it comes to public health, few issues are as pressing as the need to protect future generations from the devastating physical, psychological, social and economic toll of cancer. HPV vaccination offers safe and effective protection against nine types of HPV strains, including those most likely to result in cancer. Vaccines for HPV also offer an unprecedented possibility for public health: the potential to eliminate a type of cancer globally.
With a vaccination rate of over 90 per cent by 2030, the World Health Organization predicts we will be on the path toward eliminating cervical cancer within the next century. So why are efforts to increase vaccination uptake in Ontario falling short?
HPV infection is very common — three-quarters of all Canadians will be infected at some point during their lifetimes — and it can lead to cancer. HPV infection causes almost all cervical cancers and is a primary risk factor for head and neck (oropharyngeal) cancers. Additionally, 80 to 90 per cent of anal cancers, 40 per cent of vaginal and vulvar cancers and 40 to 50 per cent of penile cancers are caused by HPV.
In Ontario, a publicly funded HPV vaccine is offered to all students, boys and girls, through the school-based immunization program, but vaccine uptake remains strikingly low. Even before the pandemic, Ontario was reporting vaccination levels below 60 per cent, well below most provinces and many other countries, including Norway, Switzerland and Australia.
During the pandemic, reduced access to school-based immunization programs caused HPV vaccinations to fall drastically. In the 2020-21 school year, only 2.6 per cent of 12-year-olds completed the recommended HPV vaccine series through Ontario’s school-based immunization program. The latest data tell us that current approaches have failed to return students to pre-pandemic immunization levels. The numbers are startling — in the 2021-22 cohort of 12-year-olds, only 15.6 per cent completed the vaccine series on schedule.
These numbers mean that thousands of Ontario are children vulnerable to cancer. It’s clear that we need a new approach to address the barriers preventing Ontario from achieving life-saving vaccination thresholds.
First and foremost, the Ontario government must replace the long-outdated and broadly inaccessible system used to track vaccination records in the province. Today, parents looking for information about their child’s vaccination schedule, for example, cannot do so online or even with their child’s primary doctor.
Ontario’s Digital Health Immunization Repository is accessible only to public health units and is not set up to issue alerts or reminders when vaccine schedules are off-track. We can do better, as other provinces have, to ensure all health-care professionals have access to the information they need to offer life-saving cancer care to all Ontarians.
Next, Ontario must adopt a “once eligible, always eligible” approach for access to the publicly funded vaccine. Current eligibility windows, which cap access after Grade 12 for most populations, creates artificial and unnecessary barriers and does not align with other Canadian provinces or scientific evidence.
The Ontario Ministry of Health expanded eligibility up to Grade 12 in response to the HPV vaccination crisis during the pandemic, also allowing students who graduated in the 2019-20, 2020-21 and 2021-22 school years to receive missed doses. This is a step in the right direction, but does not do enough to address the financial, knowledge or access barrier that prevents many Ontarians, including those who missed vaccine doses due to illness or unanswered questions about the vaccine, to catch up.
Finally, it’s time for Ontario’s health-care providers to form a united front on HPV prevention and immunization. A recent global study revealed many health-care professionals globally don’t know enough about how vaccines work and the potential benefits. That’s a problem. We often rely on our health-care professionals to be reliable sources of information on immunizations.
Dental professionals are one group with the potential to make a significant impact on HPV vaccine uptake and in confronting the head and neck (oropharyngeal) cancer epidemic. Head and neck cancer can have devastating effects for patients, including disfigurement and loss of basic functions of life such as speech, eating and drinking.
There has been a rapid increase in the rate of oropharyngeal cancers associated with HPV, particularly of tonsils and base of the tongue. The average annual number of new cases of head and neck cancer in Canada is projected to rise by 58.9 per cent in 2028-2032 from 2003-2007. A “no wrong door” approach in which all health-care professionals, including dentists, are eligible to offer the HPV vaccine, is desperately needed to broaden access for patients seeking cancer protection in Ontario.
The impacts of Ontario’s HPV vaccination crisis won’t be felt today or next year, but our current trajectory puts us on a path to see significant increases in HPV-related cancers in 10 to 25 years. When that time comes, it will be too late to look back and wish we had done more. In a time when the risk for HPV-related cancer can be significantly reduced with a simple, safe and effective vaccine, that’s unacceptable.
With bold, collective action, we can change course to save thousands from cancer and reduce the burden on our health-care system. But only if we act now and think differently about the solutions that will get us there.
Visit canadavshpv.ca to access the recently released HPV Immunization Task Force White Paper with short- and long-term recommendations for addressing the Ontario immunization crisis and advancing the goal of eliminating HPV-related cancers. The task force, assembled by the Federation of Medical Women of Canada (FMWC), is comprised of physicians, pharmacists, researchers, public health nurses and dentists from across Canada.
Dr. Vivien Brown is chair of the Federation of Medical Women of Canada (FMWC) HPV Immunization Task Force, chair and co-founder of HPV Prevention Week in Canada and a past president of FMWC. HPV Prevention Week runs from Oct. 1 to 7.
