Fewer in-school HPV vaccinations could cause rise in preventable cancers, doctors warn

Clinicians are warning that the cancellation of Ontario's in-school HPV vaccination programs in the spring of 2020 could lead to thousands of preventable cancers in the future if children aren't tracked to make sure they eventually get immunized. 

All Ontario children normally receive two doses of the vaccine, in the fall and spring of Grade 7, but this spring's vaccinations were cancelled due to the COVID-19 pandemic. That means last year's Grade 7 cohort missed its second dose, while parts of this fall's new batch of Grade 7 students could miss their first.  

The plan to administer the vaccine going forward varies across the province. The Ontario government has given local health units guidance to offer the vaccination at special catch-up clinics or make the vaccination available at doctor's offices.

Human papillomavirus, or HPV, can cause cancer in men and women and will infect three in four Canadians during their lifetime, according to the Canadian Cancer Society.

Research suggests the vaccine has had a dramatic impact on reducing the rate of cervical, anal, penile, vaginal, head and neck cancers. 

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"This is really important," said Dr. Vivian Brown, past-president of the Federation of Medical Women in Canada and chair of HPV week in Canada. 

"We don't want people to slip through the cracks and find out they were supposed to get a shot and never got it. They're entitled to it, it's paid for by public health, and we want to protect boys and girls against the cancers that HPV causes."

In-school vaccinations cancelled

Other physicians' organizations, including the Society of Obstetricians and Gynaecologists, are urging public health administrators not to lose track of this cohort of children.

Public health units in Ottawa and Toronto have been trying to offer "catch-up" clinics where parents can bring in their children, but they attract significantly fewer people, Brown said.

"We know statistically that school-based programs have the best uptake," she said. 

According to Ottawa Public Health (OPH), some 10,000 boys and girls in Grade 7 usually take part in the in-school vaccination program.

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While OPH offered catch-up clinics in the summer, they're now suspended as its focus turns to delivering the flu vaccine. The health agency is, however, offering the vaccine to physicians who can then administer the shot in their offices.

"OPH will be assessing the timing of student catch-up immunizations after the influenza vaccine season, if feasible," said a health unit spokesperson in a statement.

Students affected by the cancellation will also have their HPV immunizations updated before the end of summer 2021, OPH said.

Toronto Public Health has cancelled in-school immunizations until the spring of 2021, and is taking appointments later this month for parents able to bring their kids to a community clinic. 

Timing critical

The HPV vaccine is recommended for children younger than 15 because they seem to be better at building immunity against the virus, requiring only two doses for life-long immunity rather than three doses after the age of 15, according to public health officials.

Because HPV is a sexually transmitted virus, it's also critical the vaccine is taken before children become sexually active.

A study published last month in the New England Journal of Medicine found that girls vaccinated before turning 17 were 88 per cent less likely to get cervical cancer. Those vaccinated after 17 cut their chances in half.

That research suggests the vaccine's timing is critical, Brown said, and affected families should be contacted to make sure they know they have opportunities to vaccinate their child outside of the school setting.

Brown said the idea of having to diagnose someone from this cohort with cancer years later would be "heartbreaking."

"What you would have to tell someone is that this was a preventable cancer [and they got it] because they were overlooked."