Ontario, Canada, this fall is scheduled to launch a program that would provide Merck's human papillomavirus vaccine Gardasil at no cost to all eighth-grade girls in the province, government officials announced on Thursday, the Toronto Star reports (Ferguson, Toronto Star, 8/3).

Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases, and about 99% effective in preventing HPV strains 6 and 11, which together with HPV strains 16 and 18 cause about 90% of genital wart cases, among women not already infected with these strains (Kaiser Daily Women's Health Policy Report, 7/18). Canada's health ministry, Health Canada, last year approved Gardasil for girls and women ages nine to 26 (Gillespie, Toronto Star, 8/2).

The Canadian government in March announced that it is including about $258 million in the 2007-2008 budget to help pay for provincial HPV programs (Kaiser Daily Women's Health Policy Report, 3/21). The national government plans to provide 117 million Canadian dollars, or about $111 million, over three years for Ontario's program, which aims to vaccinate 85,000 eighth-grade girls this fall, Toronto's Globe and Mail reports. Provincial officials plan to call on the national government for permanent funding (Campbell, Globe and Mail, 8/2).

According to the Star, provinces individually are deciding the details of the programs, including what age group to vaccinate. Ontario is the first province to develop an HPV vaccine program. Nova Scotia officials in June said they would vaccinate seventh-grade girls, and Prince Edward Island officials have said that sixth-grade girls will receive the vaccine.

About 400 women die of cervical cancer each year in Canada, according to the Star. In Ontario, about 550 women are diagnosed with cervical cancer and 150 die of the disease annually, the Star reports (Toronto Star, 8/2).

Related Commentary
In a related commentary published online in the Canadian Medical Association Journal on Wednesday, Abby Lippman, an epidemiologist at McGill University in Montreal, and colleagues wrote that there is no urgent need for wide-scale cervical cancer vaccinations in Canada because deaths from the disease have been declining, Reuters reports.

"A careful review of the literature ... reveals a sufficient number of unanswered questions to lead us to conclude that a universal immunization program aimed at girls and women in Canada is ... premature and could possibly have unintended negative consequences for individuals and for society as a whole," the researchers wrote.

More needs to be known about Gardasil, including whether factors such as smoking or poor health influence its effectiveness and the duration of immunological protection, they said, adding that without a public education campaign, misunderstanding about the vaccine could lead teenagers to practice unsafe sex (Egan, Reuters, 8/2).

The commentary is available online. Note: You will need Adobe Acrobat to view the commentary.