Item - 2013.HL22.2

Human Papillomaviruses (HPV) are the cause of almost all cervical cancers, are a leading cause of other genital cancers and warts, and contribute to cancers of the head and neck.  Three out of every four Canadians will have at least one HPV infection in their lifetime.  Each year the diagnosis and treatment of HPV-related infections cost the Canadian health care system more than $300 million.

In 2007, the National Advisory Committee on Immunization (NACI) issued a statement recommending the use of the HPV vaccine for females between nine and 26 years of age to prevent cervical cancer, as well as other infections such as genital warts.  That year, the Ontario Ministry of Health and Long-Term Care (MOHLTC) made the HPV vaccine publicly available, free of charge, to all grade 8 girls (13-14 years of age).  In September 2012 the MOHLTC also funded a “catch-up” program to vaccinate females born between 1993 and 1998 who had not received all three HPV shots while in grade 8. 

Toronto Public Health (TPH) provides HPV vaccine to over 13,000 grade 8 females each year and since September 2012 has also provided over 9,000 vaccinations to females born between 1993 and 1998 in over 60 catch-up community vaccination clinics.  As TPH already provides school-based vaccines to grade 7 students (hepatitis B and meningitis vaccines), providing the HPV vaccine to grade 7 females instead of grade 8 females would create efficiencies in the program.  Girls could receive any catch-up doses at school-based clinics in grade 8 instead of having to attend a TPH community clinic while in secondary school.

In January 2012, NACI added a recommendation for all males aged nine to 26 to receive HPV vaccine to prevent anal and genital cancers and genital warts.  It also recommended HPV vaccine for all males who have sex with males since they have a disproportionately higher burden of HPV infections.  Vaccinating males with HPV vaccine will also reduce the spread of HPV infection to females.  Ontario's MOHLTC has not to date acted on this recommendation, and the HPV publicly funded vaccination program remains available only to females in grades 8-12.  

In April 2013, Prince Edward Island announced it will be the first province to publicly-fund an HPV vaccination program for boys, though other provinces are considering the decision.  In February 2013 Australia became the first country to provide publicly funded HPV vaccine to males aged 12-13 years as part of a school-based vaccination program. 

Currently males in Ontario can be vaccinated through their health care provider at a cost of approximately $400 to $500 for all three shots.  This is a significant cost to access a potentially lifesaving vaccine.

Providing the HPV vaccine free of charge to males through TPH's vaccination program supports the principles of health equity.  In addition, expanding the HPV vaccination program to males will provide important health benefits not only to the male population, but to society as a whole by:  limiting/reducing the spread of infection (genital warts), and reducing morbidity and mortality (due to cancer) and costs to the health care system related to the diagnosis and treatment of genital warts and HPV-associated cancers. 

This report outlines the importance of maintaining the publicly funded HPV vaccination program for females (including the catch up program), and recommends the expansion of the school-based publicly funded program to adolescent males and males who have sex with males.