In this age of “cutting edge” technologies and newly discovered treatments, the field of sexual and reproductive health has its own share of emerging issues in the areas of medicine, ethics as well as law and policy.
Yet the questions being raised by feminists at the forefront of sexual and reproductive health advocacy don’t really just focus on the types of medical care available or their touted scientific benefits but rather remain attentive to issues of social justice.
Presenting at the Banff National Health Conference, Professor Joanna Erdman Co-Director of the Reproductive and Sexual Health Law Program at the University of Toronto, posed direct challenges to existing frameworks on health law and policy. In her paper, she took on the built-in limitations of an approach she characterized as the “technological fix,” in relation to the recently approved Human Papillomavirus Vaccine (HPV) in Canada.
The HPV Vaccine, which protects against the human papillomavirus, a leading cause of cervical cancer, instantly relit a hotbed of issues related to women’s (and young girls’) sexuality.
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The vaccine’s efficacy in preventing HPV infections (which can lead to cervical cancer) is said to be most effective if introduced between the ages of 9-13 (up to 26 years), before the initiation of sexual intercourse.
Because of this, pre-teen and teen-aged girls became “the target” population of Canada’s health program. As expected, controversy erupted anew around parental consent to concerns about “promoting promiscuity” among young girls.
Yet, she warned that behind the Canadian government’s commitment to instituting “universal” programs aimed at girls in schools, a “technological myopia” is evident in coming to the conclusion that simply undertaking a universal vaccination program in schools will take care of the problem of cervical cancer.
In doing so, she pointed out how the policy seems to have made a leap in considering the innovation as the solution, much to the neglect of issues of equity.
In order to understand the social and legal issues better though, the medical aspect of cervical cancer, HPV and the vaccine, need some consideration. While over half of all sexually active women in North America aged 18-22 are said to be infected with HPV, in most women, the infection clears up on its own. In cases where it doesn’t, the infection can lead to cervical cancer.
Persistent HPV infection is further classified by doctors as low risk and high risk infections. High risk infections are not at all the same as cervical cancer and the progression rate (high risk infections leading to cancer) is at one percent. In a given year, among 1350 diagnosed cases of HPV in Canada, the number of deaths reached 390, with a notable higher rate among aboriginal and migrant women. (In fact, over 80 percent of cervical cancer cases are in the developing world.)
This alone, Prof. Erdman pointed out illustrates how the risks of developing cervical cancer are in fact systemic and barriers to access are multiple.
Gardasil, produced by Merk-Frost Ltd.in Montreal is said to be the most expensive vaccine ever developed for mass use, with costs reaching up to 404.85 Cd dollars for a three course treatment. (Pundits have written a lot about this issue including how Merk came up with its price tag)
Indeed, while Gardasil works like other vaccines, HPV isn’t like most infections. While the vaccine works by preventing a known virus which can lead to cervical cancer, the mode of transmission of HPV is sexual intercourse.
Interestingly, Professor Erdman raised how in the marketing of the vaccine, it underwent a strategic repositioning of the drug from addressing a known STD infection, to that of a “cancer prevention” vaccine.
Despite the recognized benefits of universal programs aimed at young girls, there is still a need to raise concerns about the question of more likely vulnerable and disadvantaged groups of women, simply falling through the cracks. The Canadian universal school-based federally funded program was pegged to have a hefty price tag of over 300 million.
Meanwhile, the school-based program is basically a one-time intervention and has nothing to do with the overall structures of the health system, nor is it integrated in reproductive and sexual health programs. Likewise, receiving the vaccine does not remove the necessity of regular screening later in life.
Indeed, rather than looking at the vaccine as some sort of “cure all,” that will save all women from the dangers of cervical cancer, Prof.Erdman emphasized the continuing importance of screening for cervical cancer. In the long run, an effective health system still needs to make screening procedures available (mainly the pap smear and in limited resource settings, the acid wash) which by themselves, remain inaccessible to disadvantaged groups of women.