HPV immunization policies

Policies and programs for underserved populations

One of the tragedies of cervical cancer is the disproportionate impact it has on some underserved populations. Any effort to reduce cervical cancer must take into account inequities that currently exist.

To this end, the 2019–2029 Canadian Strategy for Cancer Control and the current Action Plan for the Elimination of Cervical Cancer in Canada explicitly address the inequities and barriers in accessing prevention and care that are experienced by rural and remote communities, people with low income, recent immigrants, First Nations, Inuit and Métis and other populations, such as LGBTQ2S+ individuals.

First Nations, Inuit and Métis

First Nations, Inuit and Métis continue to experience poorer cancer outcomes than non-Indigenous people in Canada due to inequities and barriers in accessing care, especially culturally appropriate care. Contributing to these inequities are historical trauma and abuse, colonization and ongoing systemic racism.

• These factors contribute to higher HPV infection rates and higher rates of invasive cervical cancer among First Nations, Inuit and Métis compared to non-Indigenous people in Canada.
• Reports indicate that rates of cervical cancer among First Nations and Inuit in Alberta are 2.3 times higher than the non-Indigenous population.
• Immunization programs should build on the strengths of communities and should eliminate the specific barriers experienced by First Nations, Inuit and Métis which include geographic access challenges and fear and mistrust of health systems.

Immigrant and refugee populations

There are two primary opportunities to ensure adequate protection of immigrant and refugee populations against cervical cancer: ensuring they have access to vaccination and addressing misinformation related to HPV vaccination.

• Children and adolescents who are new to Canada may already be vaccinated according to the recommendations of their home country, which may not be the same as Canadian recommendations.
• A major barrier for immigrants and refugees to receiving vaccination is a lack of knowledge.

Low income and minority populations

• Low income individuals as well as individuals identified as members of a visible minority population are disproportionately affected by HPV and cervical cancer.
• High HPV vaccination rates in school-based programs does not necessarily mean there is equitable coverage among various socio-demographic populations.
• To ensure that there is equitable uptake of HPV vaccinations, there must be ongoing monitoring of inequities even in jurisdictions with high vaccine uptake rates.

Rural and remote populations

• Rural and remote populations experience higher rates of cervical cancer and lower rates of HPV vaccination.
• It is important to understand the specific challenges facing rural and remote populations if the mandate to eliminate cervical cancer is to be met.
• Conveniently located clinics are a key factor for ensuring the completed dose series of the HPV vaccine. This suggests that it might also be important to expand the range of healthcare professionals that are permitted to administer a vaccine.

Implemention of population-specific strategies is imperative to increasing HPV vaccination rates. A mixed approach of improving parental/guardian HPV education, communication between healthcare providers and parents, and school-based approaches could be effective at reducing the vaccine disparities among remote, rural, suburban and urban areas.