A doctor prepares a dose of the HPV vaccine in Caracas, Venezuela. HPV vaccine completion in Canada has dropped drastically.YURI CORTEZ/AFP/Getty Images
Imagine if there were a vaccine that could prevent lung cancer. Health officials and doctors across this country would make every effort to give it to anyone and everyone.
Canadians, especially smokers, would line up around the block or sign their children’s school permission slips with barely a second thought. The scourge of cancer is painfully felt and sadly well known by virtually everyone. Doing one simple thing to avoid such suffocating hurt and suffering would be a no-brainer.
Just such a vaccine exists – to prevent cervical cancer. It is a miraculous medical advance. And yet, Canada is losing ground against a killer disease that should no longer exist.
After decades of decline driven by advances in testing and vaccines, overall cervical cancer mortality rates have plateaued, and are actually increasing for women ages 33 to 54. The disease, which killed about 400 people in 2023, is the fastest-growing cancer in Canada and the leading cause of cancer deaths for women between 25 and 35.
Cancer mortality rates fall across Canada, but progress stalls on cervical cancer
This is the first major increase in cervical cancer rates in more than 40 years, despite Canada’s vow to eliminate the disease by 2040.
It is a public-health tragedy because cervical cancer is entirely preventable. But our neglect of the incredible tool at our disposal is what makes it shameful.
Virtually all cervical cancer is caused by long-lasting infection with high-risk strains of human papillomavirus, a common sexually transmitted infection that, without vaccination, an estimated three-quarters of Canadians will have at least once. HPV can also cause anal, penile and throat cancers, and is considered a “significant public health problem” by Health Canada.
The HPV vaccine is safe and remarkably effective. More than 18 years since it was first made available in Canada, there have been no cases of cervical cancer in women who were vaccinated before they became sexually active. Not one. It is less effective for women vaccinated later, but recommended for everyone age 9 to 26, and for women up to age 45.
With just six weeks to go in 2025, Canada is still a far cry from reaching its target of 90 per cent of 17-year-olds fully vaccinated by this year, and has allowed the pandemic to steal precious ground. Prepandemic uptake rates for the final dose ranged between 57 to 91 per cent, and nationally about 84 per cent of 14-year olds had received at least one dose of the two- or three-shot course, mostly through the school-based immunization programs in every province and territory. After COVID-19 disruptions, HPV vaccine completion has dropped drastically to rates ranging from 15 to 81 per cent. In Ontario, a paltry 61 per cent of students were up to date on their HPV vaccines in the 2021-22 school year.
Anti-vaccine sentiments, driven by misinformation and stoked during the pandemic, are certainly to blame, but only in part. Provincial and territorial health systems are displaying a shocking lack of urgency – and willingness to pay – to close the vaccination gap.
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Why must patients in Ontario and most other provinces pay around $600 out of pocket to catch up on missed HPV shots? Only Quebec, Manitoba and Newfoundland and Labrador have “once eligible, always eligible” policies, and Alberta and B.C. cut off public coverage for the shots at age 26. While the high short-term cost is surely a concern for strapped health care systems, it seems obvious this approach would prevent more costly illnesses down the road. This would also help address the low-income and vulnerable populations disproportionately affected by cervical cancer. But, like with the slow adoption of at-home HPV testing kits – another essential prong of cervical cancer prevention – provinces and territories act as if they are allergic to common-sense, evidence-based solutions.
It’s clear this vaccination push must extend beyond public health and into every touchpoint Canadians have with our stretched medical system. The power of a trusted health care provider to build bridges and encourage vaccination in hesitant patients and parents is well documented, and more important now than ever. It should the responsibility of every health care worker, every doctor, nurse, dentist and pharmacist, to initiate these conversations whenever possible.
A vaccine to prevent cervical cancer is nothing short of miraculous, but Canadians cannot let the technology dazzle us into a complacency that is costing women’s lives.