Winnipeg Free Press - PRINT EDITION

Free-vaccine project to end

Province won't pay for shots after March 31

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Manitoba is phasing out free HPV vaccinations for young women, a move that has irked several Winnipeg doctors.

Until March 31, women ages 17 to 26 will still be able to get free shots that guard against the human papilloma virus, which is linked to cervical and other cancers. After March, the vaccine will no longer be covered and will cost women roughly $450 out of pocket.

There are no changes to the five-year-old program that seeks to inoculate nearly every Grade 6 girl as part of the school-based vaccination schedule.

The move, made quietly late last month, shocked many local doctors, especially those who work in women's health.

"I think it's unfortunate," said Carrie Corbett, a Winnipeg obstetrician-gynecologist. "It's a very safe vaccine, and HPV is super-prevalent."

For the last 18 months, women between 17 and 26 have had access to a free course of the HPV vaccine through their doctor's office or neighbourhood clinic. In that period, about 6,000 young women got the shot, a decent rate of uptake, said Michael Routledge, the chief provincial public health officer.

The program, which especially targets women at high risk of contracting HPV, was intended as a trial. Few other provinces offered similar free shots to the same age group. Routledge said Manitoba's vaccine advisory committee recently reviewed all the up-to-date research, looked at what a similar national committee was recommending and decided the benefits of the program were far smaller than those of the in-school effort.

"I wouldn't say it's zero, but our best scientific estimate is the benefit is pretty minimal," Routledge said.

He said the decision was based only on medical evidence, not cost.

Even if the province bought the vaccine at a third of the retail price, the 18-month trial would likely cost close to $1 million.

Denise Black, another Winnipeg ob-gyn, said few doctors and even fewer young women realized the vaccine was available for free during the last 18 months, so ending a program before it could have a broad impact is doubly frustrating. Doctors at Black's clinic in St. Vital make a point of offering the vaccine to most young women they treat, and uptake was strong.

"Overall, though, province-wide, it's been abysmal," Black said. She said the optimal time to administer the vaccine is before the start of sexual activity, but it's never too late to get it.

New research shows the vaccine can help reduce the number of abnormal cells even after a woman has had an abnormal pap smear.

After March 31, women older than 17 will need to get a prescription for the three shots that make up the full HPV vaccine. That typically costs $450.

If a woman gets the first shot before March 31, the province will cover the cost to complete the six-month process.

Throughout the month, Black and Corbett say they hope to do as many HPV vaccines for young women as possible.

maryagnes.welch@freepress.mb.ca

Shot in the arm

What is HPV?

That's the human papilloma virus, which is very common and comes in many forms. Anyone can get HPV easily from sexual contact or intimate touching. Three out of four people will have at least one HPV infection in their lifetime and most won't even know it.

Low-risk HPV can cause genital warts. High-risk HPV can linger and lead to cancer, especially of the cervix. In Manitoba, roughly 45 women are diagnosed with cervical cancer each year, and about 15 women die annually from the disease.

What's the vaccine?

Usually Gardasil, which has come into widespread use in the last five years as provinces, including Manitoba, added it to the suite of immunizations available to children and adults. It's a three-step process -- an initial needle and then a booster shot at two months and six months.

Who can get the shot?

It works best if the vaccine is administered before a women is sexually active, but it's never too late.

For the last five years, Grade 6 girls have received the shot as part of the province's school-based vaccination program. And any teenager who might want the shot or any girl who missed getting it through school can get it from a doctor for free.

Any woman 17-26 can get the shot for free through their doctor, though that isn't widely known.

Doctors must decide a young woman is "at risk" of getting HPV before administering the free shot, but the "at risk" criteria are fairly broad and include women who have had more than one sexual partner.

What's changed?

Late last month, the province decided women between the ages of 17 and 26 would no longer be covered for the HPV vaccine.

After March 31, any woman older than 17 will have to get a prescription for the vaccine, which costs about $450.

What should you do?

If you want the free shot, see your doctor before March 31.

As long as you get the first shot before month's end, the province will pay for the whole three-shot course.

Source: CancerCare Manitoba, Manitoba Health

Republished from the Winnipeg Free Press print edition March 5, 2014 A4

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