In this week's issue of Maclean's, reporter Cathy Gulli looks at the many unanswered questions concerning Gardasil, the controversial HPV vaccine. Canada's Chief Public Health Officer has written to us to explain why his agency is going forward with the vaccine and his letter is reprinted below. Gulli's response to can be viewed here.

Dear Editors,

It was with concern that I read your cover story on the HPV vaccine.

The kinds of questions raised in the article have been debated at the introduction of virtually every public health measure in our history, from the treatment of water supplies to the introduction of life-saving vaccines. Having a healthy debate is essential; however, the way Maclean's approaches the issue of the HPV vaccine is inappropriate and one-sided.

The suggestion that as public health officials we would support a vaccine that would put the health, or worse, the lives, of girls and women at risk, is irresponsible. The health and safety of Canadians is of paramount importance to me and to public health officials across the country.

Unfortunately, we tend to only have this debate when we are considering the introduction of prevention measures, despite the fact history has repeatedly demonstrated that public health efforts designed to prevent illness and death are consistently safer, more effective and less costly than treatment.

It is easy to forget that, in science, it is impossible to eliminate all doubt. The key policy question is how much evidence is needed in order to make a positive decision. In the case of a vaccine for HPV we have relied on not just a small number of opinions. Rather, decisions have been made on the advice of many experts. While each of the concerns raised in the article could be addressed and rebutted in detail in a statement that would be longer than the original article, suffice it to say that the decision to support HPV vaccination was based on advice from the National Advisory Committee on Immunization, a body of experts in fields including pediatrics, infectious disease, immunology, and public health, and which thoroughly reviews the science on vaccines, considers the issues, and offers advice on their safe and appropriate use.

In turn, the National Advisory Committee based its recommendation on the scientific evidence, and on Health Canada’s review and approval of the vaccine. Looking beyond our own borders, we see that the vaccine has also been approved for use in the U.S., Australia, New Zealand, Mexico, Brazil, the whole of the European Union, and others.

It is also worth noting that those who are charged with the protection of public health in our country(our provinces’ Chief Medical Officers), those who care for women with cervical cancer(the Society of Obstetricians and Gynecologists)and many others have endorsed the use of this vaccine.

Canadians in the thousands have already had their daughters vaccinated. We will continue to review the evidence and adjust guidelines accordingly as needed. We also look forward to newer, better and less expensive vaccines as they come on the market.

In the meantime, the willingness of governments to support and fund vaccine programs like this is welcomed, and their leadership in moving quickly should be congratulated rather than criticized. Coupled with a continued emphasis on screening and other preventive measures,  immunization will bring us ever closer to the promise that cervical cancer, and the deaths and illness related to it, will someday become a scourge of the past.

Dr. David Butler-Jones, MD MHSc CCFP FRCPC FACPM
Chief Public Health Officer of Canada

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