• 2/22/2008
  • Toronto, Ontario, Canada
  • Andre Picard
  • Globe and Mail (www.theglobeandmail.com)

HPV immunization is the most highly publicized, expensive and politicized vaccination campaign in Canadian history.

It is also, from a public health perspective, a monumental flop.

Ontario launched its program to vaccinate all Grade 8 girls with much fanfare last August. Yet, to date, only half of those in the target group have received one or more of the three doses of Gardasil.

That is a pathetically low level of uptake, particularly for a vaccine that has the potential to prevent cervical cancer. (The vaccine is not mandatory, but in school-based programs 80 to 90 per cent of students usually get vaccinated.)

Why are teenaged girls and their parents rejecting the vaccine in such large numbers?

Why have the greatest medical minds in our country been unable to convince the public that preventing cervical cancer with a simple vaccine is not only possible, but a wondrous thing?

Answering those questions should be a priority for public health officials and health policy makers from coast to coast.

The failure here is not with the vaccine. Gardasil is one of the most studied vaccines ever. The results from those studies were impressive: The vaccine has an almost universal ability to prevent infection with strains of the human papillomavirus that are responsible for the bulk of cases of cervical cancer (not to mention that HPV is also responsible for most causes of throat cancer and penile cancer). Logically, this should prevent cervical cancer, though only time will tell.

Still, it is a leap of faith worth taking and one we have made before – for example, in vaccinating children against hepatitis B (another sexually transmitted disease) to prevent liver disease.

No, HPV vaccination is a flop, without question, because of a failure to communicate.

The hallmark of public health communications has, for far too long, been proselytizing: “If we say everyone should have the vaccine, everyone should have the vaccine. Trust us.”

Sorry, but that way of communicating – preaching rather than educating – just doesn’t cut it any more. Not in the age of 24-hour news channels, the Internet and instant messaging.

It is not enough to be on the side of the angels: You have to make your case and make it well.

That is particularly true when you are tackling sensitive topics such as sexual mores and gynecological health – which will necessarily arise in a discussion of HPV – and when you are dealing with a volatile, headstrong population such as teenaged girls.

At some schools, girls at the front of the HPV vaccine line were texting their friends farther down the queue that the shot really hurt. And it does hurt more than most vaccines, for reasons not entirely clear. But the speed at which information – both true and false – now moves is precisely why public health officials have to be much more candid.

The concerns with the HPV vaccine are many and varied: Will vaccinating young girls somehow encourage them to become sexually active sooner? Can you get cancer from the vaccine? Are there side effects? Does the vaccine prevent cervical cancer? If you have received the vaccine do you no longer need to get a Pap test?

Public health officials and medical professionals have, in far too many instances, been dismissive of these concerns instead of patient in their explanations.

Worse yet, they have at times been downright hostile toward those who dared question the wisdom of the HPV vaccination campaign.

The day before Ontario launched its campaign, a group of researchers published an article in the Canadian Medical Association Journal that argued it was premature to have a universal HPV vaccination campaign.

The lead author, McGill University epidemiologist Abby Lippman, was vilified in Salem-witch-trial manner for failing to toe the party line. Whether you agree with the point of view or not, she did what scientists should do: ask tough questions.

Public health officials should answer them, not tuck their tails between their legs and whine.

There are those who essentially blame Dr. Lippman for the failure of the HPV vaccination campaign. There are those, too, who blame the media, in particular a cover story in Maclean’s magazine titled “Our girls are not guinea pigs” and articles in The Globe and Mail that were critical of the political machinations that led to the rapid adoption of a $300-million funding program to support HPV vaccination in Canada.

Surely we can do a little better than shooting the messenger. Beginning with getting a message.

The decision to launch a universal HPV vaccine campaign is probably justified – or at least justifiable – but the way in which it was done stinks to high heaven.

The HPV campaign was a cynical bid by politicians to woo the votes of soccer moms, and public health officials naively (at best) went along for the ride.

The lesson here is that politics and public health don’t mix. Complex public health campaigns should never be undertaken without first doing the necessary groundwork, including education and developing a 21st-century communications plan.

Haste makes waste, the old aphorism says. Haste also makes for poor public health policy.