A 'no-brainer': N.B. medical community welcomes HPV vaccine for boys

The New Brunswick medical community is applauding the Gallant government's plan to expand the "life-saving" vaccination program against the human papilloma virus to include boys during the next school year.

HPV, the most commonly sexually transmitted infection, is spread through skin-to-skin contact during sex and can lead to several types of cancers, including cervical, oral pharyngeal, anal, and penile.

The HPV vaccine has been available to Grade 7 girls in New Brunswick since 2008. Starting this fall, it will also be offered through the school system to Grade 7 boys — about 7,000 students in total.

"We've been advocating for it for [several years], so obviously we were thrilled to see it finally come through," said Anne McTiernan, executive director of the Canadian Cancer Society for New Brunswick.

"It's huge in terms of prevention of HPV-related cancers."

• Male HPV-related oral cancer rates on the rise: Canadian Cancer Society

The program expansion was announced earlier this month as part of the 2017-18 provincial budget. About $486,000 has been allocated.

New Brunswick is the eighth province to extend the program to cover boys since the vaccine was approved by the National Advisory Committee on Immunization in 2012 for use in males aged nine to 26.

P.E.I. was the first to introduce it for boys in 2013. Saskatchewan and Newfoundland and Labrador are the only provinces that have not.

New Brunswick's decision to include boys comes after switching girls from a three-dose regimen to two in the fall of 2015, saving about $210,000 annually.

The World Health Organization recommended the switch after studies "demonstrated that a two-dose HPV immunization schedule is expected to provide similar protective efficacy compared to a three-dose schedule," public health officials said.

For McTiernan, the vaccine "seems like a no-brainer."

About 75 per cent of Canadians will get an HPV infection at some point in their lives, she said, most within the first two to five years of becoming sexually active.

"Not everybody's going to get cancer obviously," said McTiernan, but an estimated 4,400 Canadians were diagnosed with HPV-linked cancers last year and about 1,200 die from them annually.

In New Brunswick, there were almost 400 HPV-related cancers between 2010 and 2014, the latest figures available.

McTiernan suspects recent national studies showing one in three HPV-related cancers are in males, and that mouth and throat cancers in males are increasing, may have prompted the provincial government to act.

"Clearly it's not an issue that's just related to girls and women, so it's important to see an inclusive, gender neutral school-based prevention program," she said.

Dr. Lynn Murphy-Kaulbeck, president of the New Brunswick Medical Society, agrees. The association, which represents the province's physicians, has also been lobbying to extend the vaccine to boys "for quite a while."

"I think it all comes down to priorities, but obviously our current government has heard very clearly that this should be a priority and they've taken that advice moving forward," said Murphy-Kaulbeck.

She contends expanding the program will save the health-care system money in the long run, not to mention saving lives.

"If you look at the evidence that's out, this is clearly a cost-effective program in the fact that you're going to prevent some fairly significant cancers down the road — and prevention here is key."

I think there would be a small subset that would think that by their children having this vaccine that it would somehow lead to more sexual activity and that is a complete falsehood.- Lynn Murphy-Kaulbeck, N.B. Medical Society

It's also a "very low-risk" vaccine, said Murphy-Kaulbeck, who had her own son, now 15 years old, vaccinated.

She hopes many parents will choose to take advantage of the program and have their sons immunized.

About 73 per cent of eligible girls in the province currently get the vaccine. Across Canada, the uptake ranges between 40 and 90 per cent.

"I'd like to see 100 per cent uptake," said Murphy-Kaulbeck, who is an obstetrician. "I think that's what we should strive for with all our vaccinations."

'Misconceptions'

But she acknowledged that's unlikely, given the fact some parents are against vaccinations in general, and the "misconceptions" about the HPV vaccine in particular.

"I think there would be a small subset that would think that by their children having this vaccine that it would somehow lead to more sexual activity and that is a complete falsehood," she said. "Public education is imperative."

Health Minister Victor Boudreau said there will be a public awareness campaign, but could not say whether the cost is included in the allocated funds, or whether it will be covered by his department.

"We'll be working over the next few months with the two [regional health authorities], as well as with the Department of Education and Early Childhood Education and the [school] districts to make sure that everything is in place for this fall … making sure everybody knows how the program will unfold, who's responsible for what," he said.

Campaign will urge participation

The campaign will urge participation, said Boudreau, who would also like to see 100 per cent uptake by both boys and girls for the "important program."

"Obviously it's being done across the country and in jurisdictions around the world and it's felt to be a step in making these children more immune to these viruses and illnesses, and the more we can do, I think, to equip our children to be stronger, I guess, against these viruses, the better it is," he said.

New Brunswick's acting chief medical officer of health, Dr. Jennifer Russell, recommended the move to include boys this year, following a comprehensive review of the entire immunization program, and based on scientific research, recommendations from expert groups, local burden of disease data, and cost-effectiveness studies.

The department managed to secure the additional funding to be able to offer it for free.

Up to the parents

But ultimately, it's up to the parents to sign the consent forms, stressed Boudreau.

"They may have medical reasons, they may have personal beliefs, religious beliefs as to why they don't want to participate and that's totally up to them. This is not something that's forced on the parents or on the children," he said.

"We make the program available, we talk of the benefits of the program, we encourage it, but at the end of the day it's the parents' decisions."

Russell said she's "ecstatic" to be able to offer the "life-saving" vaccine to boys, and called it a "huge win" for New Brunswickers.

"My fellow physicians in the province are very, very happy about this, as well as patients and family members of people who have suffered from these cancers. We are all really grateful that this is coming to fruition."

Russell said she had regularly received phone calls and emails from physicians who found it "distressing" seeing young patients with preventable and devastating cancers, asserting it was a much-needed vaccine and questioning why it was taking so long to implement.

Introducing rotavirus vaccine

"As you know, the wheels of progress turn slowly sometimes," she said. "But at the end of the day, when you have a success like this, it's really important to celebrate that success."

Public health will also be introducing the rotavirus vaccine to the routine childhood immunization schedule, as a result of Russell's program review.

Rotavirus is a common cause of gastroenteritis in children under the age of five, leading to physician and emergency room visits and hospitalizations, she said.

The vaccine will be administered by mouth in two doses at two and four months of age.