The disruption of childhood vaccines during the pandemic could lead to a rise in cervical and other cancers without an aggressive effort to get HPV (human papillomavirus) vaccines into the arms of children and teens who have missed them, say Canadian medical experts.
HPV is the most common sexually transmitted viral infection. It is usually harmless and goes away by itself, but in some cases it can lead to cervical or head and neck cancers.
Studies have shown that widespread use of the HPV vaccine dramatically reduces cases of cervical cancer, particularly among girls vaccinated before they reach the age of 17. The vaccine is also believed to prevent some head and neck cancers in men and women caused by HPV.
Which is why the disruption of vaccinations as a result of school closures during the pandemic is raising alarm.
Ottawa’s Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynaecologists of Canada, said Canada was on track to meet its target of eliminating cervical cancer by 2040 — until the pandemic hit. Now that goal cannot be met without a “huge catch-up.”
Some of that catch-up is already beginning in Ottawa, where Ottawa Public Health is starting to visit all schools to offer the two-dose HPV and other vaccines to students in grades 7 and 8. OPH is also offering to catch up at community clinics and offering the vaccine to physicians to give to eligible patients.
Ottawa Public Health said it doesn’t have accurate up-to-date numbers to indicate how many students missed the HPV vaccine, but is compiling information to better understand the gaps.
Data from elsewhere suggests the pandemic has dramatically reduced the number of school-aged children being vaccinated against HPV.
In Hamilton, according to Blake, the school-based vaccination rate for HPV was down to seven per cent in 2020, compared to 62 per cent in 2019. In Alberta, rates are around 10 per cent. Prior to the pandemic, Ontario had a vaccination rate of around 66 per cent by age 16. Newfoundland’s was close to 90 per cent.
“We have an amazing, safe vaccine to prevent cancer and we offer this to every student in every province and territory through public health,” said Dr. Vivien Brown, past president of the Federation of Medical Women of Canada and chair and co-founder of HPV prevention week in Canada. Because of the pandemic “there has been a huge decrease in immunization. We have to catch up and protect people from the risk of HPV, the risk of cancer.”
Blake, who works as an obstetrician and gynecologist at the Riverside campus of The Ottawa Hospital, said she deeply understands the value of preventing cervical cancer as a clinician who treats young patients with the cancer. It is the second most common cancer in women between the ages of 20 and 44 and it can be lethal or life-altering.
In 2019, 1,350 Canadian women developed cervical cancer and 410 women died from it.
“One woman in three who get cervical cancer will die from it. People don’t seem to understand how lethal this cancer can be,” Blake said. Those who survive it can become unable to bear children because of treatment.
“It is not a nice cancer to get.”
Like many illnesses, its impact is unequally spread.
Indigenous women in Canada, for example, are more likely to get cervical cancer and more likely to die from it than non-Indigenous Canadians.
Blake said a new HPV test that can detect the virus before it causes pre-cancerous changes is also necessary, replacing the long-used Pap test. The provincial government has indicated it is committed to switching to the more sensitive test, she said.
While Ontario chose one school year in which to make the vaccine available — Grade 7 — Australia made it available to everyone and is now close to eliminating cervical cancer.
Blake suggested HPV catch-up vaccines could be given at the same time COVID-19 vaccines are given to younger school-aged children.
Ontario’s decision to offer the vaccine in Grade 7 when it was first introduced more than a decade ago might make that catch up more complicated, she said.
By the end of middle school and heading into high school, students who missed the vaccine are at higher risk of exposure to HPV.
Quebec, in contrast, offers the vaccine to children in Grade 5.
“(Ontario) has left it to the very last minute to administer the vaccines, which gives us no wiggle room.”
The first HPV Prevention Week (which was from Oct. 3-8 this year), was organized five years ago in Canada by the Federation of Medical Women of Canada and the Society of Obstetricians and Gynaecologists of Canada.
This year’s campaign had a new sense of urgency with organizers calling on provincial and territorial governments and public health units to prioritize HPV prevention following the disruptions of the pandemic.