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Letters
Open Access

Vaccinations against human papillomavirus missed because of COVID-19 may lead to a rise in preventable cervical cancer

Laura M. Diamond, Lauren E. Clarfield and Milena Forte
CMAJ September 20, 2021 193 (37) E1467; DOI: https://doi.org/10.1503/cmaj.80082
Laura M. Diamond
Medical student, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Lauren E. Clarfield
Medical student, Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Milena Forte
Family physician and assistant professor in the Department of Family and Community Medicine at the University of Toronto, Sinai Health System, Toronto, Ont.
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As a result of the COVID-19 pandemic and the subsequent disruptions to in-person classes, school-based vaccination programs against human papillomavirus (HPV), hepatitis B and meningococcal meningitis were cancelled across the country. Although there have been catch-up vaccination clinics in Canada, uptake is low. These clinics rely on personal initiative and knowledge of their existence; thus, they perpetuate vaccination disparities that the school-based programs initially set out to break down.1 There is currently no plan in place in most jurisdictions for a widespread vaccination program of students who were in grade 7 in 2019/2020 and 2020/2021.

In country-wide, registry-based studies of > 1 million participants, the HPV vaccine has been shown to be extremely effective in reducing the prevalence of cervical cancer. 2,3 An increased incidence of cervical cancer in future years as a consequence of the COVID-19 pandemic would be devastating. Canadian provinces urgently need to arrange catch-up HPV vaccination programs for cohorts of students who have missed receiving their vaccines in school.

Adequate catch-up vaccination is unlikely to happen without a coordinated, school-based approach. School-based, publicly funded vaccination programs have been associated with a substantial increase in uptake of HPV vaccines in Canada, with individuals who have access to school-based programs 3.73 times more likely to get vaccinated.4 In addition, school-based vaccination programs allow for more equitable vaccine uptake among those living in low-income neighbourhoods. 5 This is especially important given the well-established increased burden of cervical cancer and reduced cervical cancer screening in low-income communities. 5,6 Furthermore, students lose eligibility for free HPV vaccination once they graduate from high school. This can mean up to $500 in out-of-pocket costs for unvaccinated high school graduates seeking a 3-dose vaccine series, serving as an additional barrier to vaccination.4,7

Ideally, a catch-up vaccination plan should be formalized and should include a clear communication strategy to families, explaining that key vaccinations have been missed, and the implications of this. The plan should include outreach to the parents and health care providers of students who were in grade 7 in 2019/2020 and 2020/2021 to ensure they are aware of the child’s current HPV vaccination status.

Footnotes

  • Competing interests: None declared.

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/licenses/by-nc-nd/4.0/

References

  1. ↵
    Toronto Public Health expands programs to support a safe return to school [news release]. Toronto: City of Toronto; 2021 Aug. 30. Available: https://www.toronto.ca/news/toronto-public-health-expands-programs-to-support-a-safe-return-to-school/ (accessed 2021 Sept. 2).
  2. ↵
    Large study confirms that HPV vaccine prevents cervical cancer [blog]. Bethesda (MD): National Cancer Institute; 2020 Oct. 14. Available: https://www.cancer.gov/news-events/cancer-currents-blog/2020/hpv-vaccine-prevents-cervical-cancer-sweden-study (accessed 2021 July 20).
  3. ↵
    1. Machalek DA,
    2. Gardland DM,
    3. Brotherton JML,
    4. et al
    . Very low prevalence of vaccine human papillomavirus types among 18- to 35-year old Australian women 9 years following implementation of vaccination. J Infect Dis 2018;217:1590–1600.
    OpenUrlPubMed
  4. ↵
    1. Bird Y,
    2. Obidiya O,
    3. Mahmood R,
    4. et al
    . Human papillomavirus vaccination uptake in Canada: a systematic review and meta-analysis. Int J Prev Med 2017;8:71.
    OpenUrl
  5. ↵
    1. Blakely T,
    2. Kvizhinadze F,
    3. Karvonen T,
    4. et al
    . Cost-effectiveness and equity impacts of three HPV vaccination programmes for school-aged girls in New Zealand. Vaccine 2014;32:2645–56.
    OpenUrl
  6. ↵
    Cervical cancer screening rates below provincial target, vary with neighbourhood income. Toronto: Cancer Care Ontario; 2014. Available: https://www.cancercareontario.ca/en/cancer-facts/cervical-cancer-screening (accessed 2021 July 20).
  7. ↵
    Human papillomavirus (HPV) vaccine fact sheet. Toronto: City of Toronto; revised June 2019. Available: https://www.toronto.ca/community-people/health-wellness-care/diseases-medications-vaccines/human-papillomavirus-hpv-vaccine/ (accessed 2021 July 20).
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Canadian Medical Association Journal: 193 (37)
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20 Sep 2021
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Vaccinations against human papillomavirus missed because of COVID-19 may lead to a rise in preventable cervical cancer
Laura M. Diamond, Lauren E. Clarfield, Milena Forte
CMAJ Sep 2021, 193 (37) E1467; DOI: 10.1503/cmaj.80082

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Vaccinations against human papillomavirus missed because of COVID-19 may lead to a rise in preventable cervical cancer
Laura M. Diamond, Lauren E. Clarfield, Milena Forte
CMAJ Sep 2021, 193 (37) E1467; DOI: 10.1503/cmaj.80082
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