Quebec's new HPV vaccine program is cost-cutting measure that could put public health at risk, warn experts

Quebec's decision to change the mix of vaccines in its program to protect children from the human papillomavirus (HPV) is putting cost savings before public health, warns a national advocacy group that aims to educate Canadians about HPV and its complications.

"Quebec children deserve the same cancer protection as the rest of Canada," HPV Awareness says in a banner on the front page of its website.

HPV is sexually transmitted, and the virus causes genital warts and other infections, as well as cervical cancer and several other cancers.

Quebec has offered a free vaccination program to girls since 2008, expanding the program to include boys in 2016.

As of this month, the Quebec Immunization Committee (CIQ) will no longer give elementary school-aged children two doses of Gardasil9, instead offering for free a single dose of Gardasil9 and one dose of Cervarix.

If parents want their child to receive a second Gardasil9 dose, they can pay for it out of pocket for roughly $175.

'No evidence' of new program's effectiveness, group says

The two doses of Gardasil9 "provided children with complete protection against HPV-related diseases, including cancers of the head and neck, tongue, throat, anus, cervix, vulva, vagina and penis," says HPV Awareness in a news release.

It says Gardasil9 protects against nine HPV types, whereas Cervarix protects against only two. It's "worrisome," it says, that boys will now receive Cervarix, a vaccine that has not been approved for males by Health Canada and has not been proven to protect them against infections."

Furthermore, it said, in the long term for both girls and boys, "there is no evidence this new program is as effective as the current two doses of Gardasil9."

"Beginning this month, Quebec children will be the only ones in Canada, and even the world, to be given an HPV vaccination program for which there is currently no adequate scientific evidence to support whether it will work at least as effectively as the one offered everywhere else."

'Millions' will be vaccinated with new schedule

The criticism is coming from within the ranks of the very organization that oversees the Quebec Immunization Committee, the Institut national du santé publique du Québec (INSPQ).

Dr. Marc Steben, a family doctor and a sexually transmitted infections specialist at the INSPQ, also chairs the Canadian network on HPV prevention and is on the board of directors of HPV Awareness.

"We knew that our program was very good," Steben says of the decade-old vaccination schedule.

"The ministry is now proposing a schedule of vaccine that was never shown to be effective — not in Quebec, not in Canada, not in the world."

It will be eight to 10 years before it is known how effective, if at all, the new vaccine mix is, he said.

"There will be millions of Quebec kids that will have been immunized without proof that it would work," said Steben, who criticized the program for not informing parents of the change.

"We'll find out when these people become sexually active if it works or not. If it does not work, it means for 10 years we would have immunized people with something that was not effective."

Extensive research, CIQ contends

Dr. Chantal Sauvageau, who is responsible for the CIQ's public immunization program, says cost did play a role in the decision, but it doesn't mean the new vaccine mix Quebec has chosen is any less effecive.

In fact, she said, the lower cost allows the program to be expanded to boys up to Grade 9 — making it farther reaching than ever before.

When the CIQ first began its HPV vaccination program in 2008, it chose one vaccine over another based on vaccine immune response studies, she said.

At the time, there weren't any long-term studies of efficacy on which to base its decision, she said, and yet the choice proved effective.

Once again, immune response data is serving as the decision-making guide, and the data shows the combination of Gardasil9 and Cervarix generates the needed immune response, Sauvageau said. ​

"We are seeing a 100 per cent response after one dose of Gardasil9 and one dose of Cervarix," she said.

Sauvageau said while the company behind Cervarix hasn't sought approval from Health Canada, she said the data still shows it is effective for both girls and boys.

The CIQ has been looking at all the available vaccines for many years in search of the best combination. This month's new schedule was first considered in 2014. Now it was approved after careful study by experts across the province, she said.

"I think the main message is, whatever the schedule, HPV vaccines are working," she said.

"I am really concerned about the impact that these questions could raise. It would be really sad if the population thinks, maybe, the HPV program is not a good one and 'I should not get immunized.'"

With files from Sudha Krishnan