As you may have heard, if you’ve been in my vicinity over the last couple of months, the Calgary Catholic School Board has decided that they will not allow the HPV vaccine to be provided to their students within the school. And that, my friends, makes me suspect that despite the election of Canada’s coolest mayor, Calgary still has a strong reactionary streak.
Human papillomavirus (HPV) is an extremely common virus. For example, carriage studies have shown that it can be present in approximately 25% of women (Sellers et al. 2000. Prevalence and predictors of human papillomavirus infection in women in Ontario, Canada. Survey of HPV in Ontario Women (SHOW) Group. Canadian Medical Association Journal 163:503). Despite aggressive screening and treatment, roughly 180 women in Alberta will be diagnosed with cervical cancer each year (Alberta Health Services 2009. Report on Cancer Statistics in Alberta).
In 2008 Alberta Health began offering the HPV vaccine to girls in grade five, in three doses, over a six month period. That same year, Bishop Fred Henry issued an edict stating that “Although school-based immunization delivery systems generally result in high numbers of students completing immunization, a school-based approach to vaccination sends a message that early sexual intercourse is allowed, as long as one uses ‘protection.’ ” Since then the Calgary Catholic School Board has steadfastly refused to allow Alberta Health to offer the vaccine in the schools.
There are so many disturbing overtones in this stance, but what jumps out at me is the Bishop’s admittance that this position will result in children not getting the vaccine. This callous disregard for the welfare of children is so non-Christian it’s breathtaking, especially in the light of the recent decision of the Pope to retract the Catholic ban on the use of condoms. When even the Pope says that: “In certain cases, where the intention is to reduce the risk of infection, [condoms] can … be a first step on the way to another, more humane sexuality” and is justified to protect human life, on what grounds does the Bishop encourage the Catholic School Board to prohibit the administration of a vaccine?
I have joined with bioethicist and Assistant Professor Juliet Guichon in forming a society whose aim is to advocate for the provision this immunization in schools. I don’t think that parents should ever be forced to vaccinate their kids, but I think that access to basic health care is a fundamental right. While children in the Catholic School system can go to public health clinics to get their shots for free, study after study has shown that children who come from disadvantaged families are far less likely to complete their vaccination this way. Dr. Ian Mitchell, a bioethicist and pediatrician at the University of Calgary, says it the most eloquently: “If you are an immigrant, if you are not so affluent, if you don’t have a car, if you’re very dependent on an hourly wage, it is very unlikely that you’ll get immunization. So we saw this decision by the Catholic school board as affecting all children, but really affecting the most vulnerable children.” At its heart, this is an issue about providing basic health care to the vulnerable of our society.
Here is the letter from HPV Calgary to the Calgary Catholic School Board:
Dear Trustees of the Calgary Catholic School District Board,
Thank you very much for your letter dated July 25, 2012 in reply to our letter of July 4, 2012. In our July 4 letter, we respectfully requested that the trustees please respond by “expressing what your conscience affirms to be in the best interests of the most vulnerable children in the Catholic schools in Calgary.” We are saddened that your response did not describe how, if at all, the Board’s HPV vaccine ban is in the best interests of the children enrolled in the school district.
The Alberta School Boards Association has stated that, “The school board, as a representative of the people, is a decision-maker and direction-setter.” In its publication, “What do School Boards do?” (available here), the ASBA states that a school board “integrates information from many sources” and, before deciding, “the school board considers the interests of all the students in the jurisdiction – not just the interests of students from a particular school or area.”
1. Sources of the Board’s Information Regarding the Importance of In-School Administration of HPV Vaccine
Two provincial ministers of health, public health officials, physicians and parents have formally advised the Board that in-school administration against HPV is the best method to distribute the vaccine. It is best because children of low socio-economic status, who are most at risk from the virus, are more likely to receive the vaccine in school and much less likely to receive it in the community. This fact requires the Board to exercise its fiduciary leadership role to ensure that “each student has the opportunity to achieve his/her potential” despite a student’s low socio-economic status.
In-school vaccine administration is best also because it is most effective in making it easy for parents to facilitate receipt of the three doses necessary for the vaccine. Moreover, in-school vaccine administration protects the public purse. The Board’s ban has placed financial burdens on our health care system not just in increasing the cost of vaccination but also in the future costs to treat those who will become infected who might have been protected by easy access to the vaccine.
The ASBA specifically states that the Board’s generative leadership role is grounded in the notion that “it takes a whole village to raise a child” and recognizes that the Board should “reach out to involve the community in a dialogue about the needs of the community, its youth and the future.” As sources of information about the need for in-school administration of the HPV vaccine, has the Board consulted:
(1) The nurses who visit the schools, particularly St. Mary’s, St. Francis, Bishop Carroll, Bishop Grandin, Bishop McNally and Bishop O’Bryne High Schools to learn what the nurses are seeing generally in the student population and how the Board might assist the nurses to help prevent disease?
(2) A representative group of Catholic School District teachers who might offer the Board a sense of the complexity of the family situations in which some of their students live?
(3) Calgary child protection officials regarding the incidence of sexual abuse in Calgary which, among other harms, can lead to HPV transmission?
(4) Specialists in Aboriginal health given that the incidence of HPV is disproportionately high in the Aboriginal population? or
(5) The school boards of other publicly funded Catholic School Systems in Ontario, Saskatchewan and Alberta? The overwhelming majority of these Catholic boards believe that in-school HPV vaccine administration promotes Catholic social justice teaching by helping to protect vulnerable children, and thus helps permeate the Catholic schools with the Catholic faith.
In addition to asking the Board who it has consulted as sources before making its decision to ban the HPV vaccine, we respectfully ask this question: Has the Board refused to hear anyone on the subject of in-school HPV vaccination and, if so, who did the Board turn down, why, and what office did he, she or they hold?
2. The Best Interests of Children Enrolled in the School District
As the ASBA makes clear, the Board has the duty to consider the interests of all children, not just those from a particular area. A report on the work of University of Toronto sociologist, John Myles, states that In Calgary, from 1980 to 2005, the gap between rich and poor neighbourhoods deepened dramatically. While the region roared into a period of unprecedented prosperity, Census data show that the income differential between have and have-not communities […] grew by 81 per cent – far more than any other urban centre. The increase was enough to [give] Calgary […] the dubious distinction of leading the country in neighbourhood income inequality. The article titled, “Income Inequality And Cities: Calgary’s Two Faces […]” describes a typical Calgary parent of low socio-economic status: “the single mother of two lives in Forest Lawn, an east side neighbourhood considered among the city’s most challenged. Carless and often without bus fare, the 43-year-old, who depends on social assistance, gets around mainly by foot.”
How is the Board’s response, given that this mother may struggle to vaccinate her children three times in the community, a compassionate response to her lack of economic and other resources? How does the Board reconcile the low uptake of the vaccine among poor children in the Calgary Catholic School District with Catholicism’s beliefs, values and goals that require the faithful to attend to issues of social justice?
In sum, we respectfully request the Board please to answer the following questions:
1. What sources of information has the Board seriously considered, who has it consulted and from whom has it refused to hear?
2. What attention, if any, has the Board given to the interests of children regarding in-school vaccination administration, especially those who are the most vulnerable?
3. How does the Board’s vaccine ban conform to Catholic social justice teaching?
We look forward to receiving the Board’s response before September 12, 2012.
We also respectfully ask the Board please:
4. To place the matter of in-school HPV vaccination on the Board’s agenda for its meeting on September 12, 2012; and
5. To vote to open the publicly funded school doors to the federally-funded HPV vaccine program so that parents who so choose can easily enable their children to be vaccinated against HPV.
Thank you very much.
