17 October 2018

From The University of Toronto Obstetrics and Gynaecology Residency Program: A letter of action regarding HPV vaccination in Ontario
Authors: Dr. Emma Skolnik MD, Dr. Sara Porisky MD, Dr. Jessica Smith MD, Dr. Emily Delpero MD and Dr. Alisha Olsthoorn MD, Chelsie Warshafsky MD.

Hon. Christine Elliott
80 Grosvenor Street, 10th Floor, Hepburn Block
Ministry of Health and Long-Term Care
Toronto
ON
M7A 1E9
Fax   416-326-1571  

Dear Minister Elliott:

On October 1, 2018 the Society of Obstetricians and Gynaecologists of Canada (SOGC) issued a challenge to Canadians to become the first country in the world to eradicate cervical cancer through vaccination, screening, and early treatment.  We write to you as resident physicians and as the future leaders of women’s health in Canada, to stand alongside our mentors and teachers currently practicing in Obstetrics and Gynaecology in support of this objective.

Human Papilloma Virus (HPV) causes cervical, vulvar, anal, penile, and head and neck cancer. Cervical cancer is almost exclusively caused by HPV.  In Canada, approximately 1500 women are diagnosed with cervical cancer each year, and 400 women die annually from it. The incidence of HPV-related head and neck cancers are also rapidly rising in Canada, especially in males.

Over 85% of people will acquire at least one HPV infection in their lifetime. The virus is spread through any form of sexual contact and the rate of transmission per sexual encounter is approximately 40%, putting any Canadian who is sexually active at risk.  

Despite its prevalence, the formula to fight HPV transmission and eradicate cervical cancer is now within our grasp.  The nonavalent HPV vaccine protects against the nine strains of HPV known to cause approximately 90% of cervical cancers, 80% of cervical pre-cancers, 75% of HPV-related vulvar, vaginal and anal cancers and pre-cancers, and over 90% of genital warts.  Thus, current best-practice guidelines recommend that all men ages 9 to 26 and all women ages 9 to 45 to receive the nonavalent vaccine.

As of 2016, grade 7 students in the province of Ontario can receive the nonavalent HPV vaccine through public health vaccination programs offered in schools.  However, between 2007 and 2016, only female youth were eligible for government-funded vaccination, and only the quadrivalent vaccine was provided.  Thus, any females who completed grade 8 before 2007 and any males who completed grade 7 before 2016 were not funded to receive the vaccine, and are at high risk of developing HPV-related cancers. Furthermore, any females who were vaccinated before 2016 have suboptimal protection, having only received the quadrivalent vaccine. This list of citizens at risk includes men and women who fall within the recommended targets for vaccination by the SOGC, as described above.

While some may have private insurance coverage, most people who fall within the at-risk demographics do not, including those who only have basic coverage through post-graduate education. These limitations render the 600$ vaccine prohibitively expensive, and thus inaccessible for most of the target population.

The HPV vaccine has the potential to eradicate fatal cervical and other types of cancer and is an integral part of best-practice Canadian medical guidelines, yet there remains a significant proportion of the population for whom this resource remains inaccessible. As physicians devoted to the service of our patients, we feel compelled to advocate for - and to protect the health of - these citizens.

We are thus calling on the Ontario government to take the following actions:
1. Include the nonavalent HPV vaccine in OHIP+ coverage, allowing all males under the age of 24 who were not provided the funded vaccine in schools before 2016 to get vaccinated
2. Offer the nonavalent HPV vaccine free of charge to all males under age 26 and all females under age 45, through public health sponsored vaccination programs

If you agree with us, please complete the petition below.


ADDENDUM JANUARY 21, 2019:
We have since received a response from the office of Minister Elliott. They have informed us that OHIP+ does not in fact cover any vaccines. We are therefore proceeding with our second request only. We are attempting to secure a meeting with their office in the very near future.