Source: www.theglobeandmail.com
Author: Kelly Grant, Health Reporter

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Boys in Nova Scotia will begin receiving free vaccinations against the human papillomavirus next fall, a move that makes the Maritime province only the third in Canada to extend public funding of the cancer-thwarting shot to all children, regardless of gender.

In the budget unveiled on Thursday, Nova Scotia’s Liberal government announced it would make the HPV vaccine available to Grade 7 boys as part of the regular school-based immunization program. The expansion is expected to cost $492,000 a year.

Every province in Canada already covers the HPV vaccine for girls in an effort to prevent genital warts and cervical cancer, both of which can be caused by some strains of the virus, which is transmitted through sex and skin-to-skin contact.

But in recent years, oncologists and major health organizations – including the Canadian Cancer Society and the National Advisory Committee on Immunization – have begun calling for HPV vaccinations for boys, too. Until this week, only Prince Edward Island and Alberta had heeded that call with a publicly funded program.

HPV can lead to cancers of the penis, anus, oral cavity and throat in men, as well as genital and anal warts.

“We have a vaccine. It can prevent cancers in men and women, so we want Canadians to be vaccinated against it, because we can actually prevent cancers from starting in the first place,” said Robert Nuttall, the assistant director of cancer control policy at the Canadian Cancer Society.

Nova Scotia’s decision to fund the vaccine for boys was especially important to one recently retired member of the provincial legislature. Gordie Gosse, who until last week represented the riding of Sydney-Whitney Pier in Cape Breton, was diagnosed nearly a year ago with Stage 4 throat cancer caused by HPV. The 59-year-old former speaker of the legislature had more than 12 hours of surgery to remove the tumour and reconstruct parts of his face, followed by chemotherapy and radiation.

“If I’d had the vaccine, I wouldn’t have had the cancer,” he said in an interview on Friday.

Mr. Gosse, a member of the opposition NDP, made it his final mission as an elected official to extend public funding of the HPV vaccine to boys, which, according to a spokesman for the province’s department of health, the Liberal government was already studying as part of its annual vaccine review.

When his private members’ bill on the male vaccine program passed second reading on April 1, Mr. Gosse figured the measure would be in the budget. He announced his retirement the next day. “I was quite ecstatic,” Mr. Gosse said.

The HPV vaccine is most effective when administered before a child or teen starts having sex.

However, provincial governments are wrestling with whether it is cost-effective to vaccinate boys as well as girls.

“Right now it’s [about] money,” said Eduardo Franco, chair of the department of oncology at McGill University in Montreal.

Dr. Franco pointed to an evaluation done in Quebec two years ago that found vaccinating boys would not be cost-effective, in part because men who sleep with women would benefit from the protection the vaccine provided to their female partners. But that leaves gay men vulnerable, Dr. Franco said.

“The solution is truly universal HPV vaccination,” he said. “No questions asked. We [should] just take it for granted that it’s part of the adolescent vaccine calender.”

Alberta’s Grade 5 HPV immunization program costs $11-million a year – $4-million for boys, $4-million for girls, plus an extra $3-million a year for a limited-time “catch-up” program for Grade 9 boys that ends in 2017.

But the overall HPV immunization program is expected to save an estimated $13.4-million a year down the road by preventing some cases of HPV-caused cancer, according to Alberta Health.

Ontario is reviewing its HPV immunization program, said David Jensen, a spokesman for the Ministry of Health and Long-Term Care.

“Various factors are being considered such as scientific evidence (e.g., burden of disease and vaccine effectiveness), economic and societal factors, as well as cost effectiveness and impact on the health system,” he said by e-mail.