Citizen intervention in a religious ban on in-school HPV vaccine administration in Calgary, Canada Juliet R. Guichon a, ⁎, Ian Mitchell a,b , Patricia Buffler c , Art Caplan d a Faculty of Medicine, University of Calgary, 3280 Hospital Drive N.W. Calgary, AB T2N 4N1, Canada b Faculty of Medicine, University of Calgary, Alberta Children's Hospital, 2888 Shaganappi Trail N.W., Calgary, AB T3B 6A8, Canada c School of Public Health, Division of Epidemiology, University of California, Berkeley, CA 94720-7360, USA d New York University Langone Medical Center, Division of Medical Ethics, 227 E 30th St, NY, NY 10016, USA abstract article info Available online xxxx Keywords: HPV Vaccination Public health Cancer prevention Catholicism Public advocacy Discrimination In 2008, Alberta Roman Catholic Bishops' discouraged in-school HPV vaccination because: “a school-based approach to vaccination sends a message that early sexual intercourse is allowed, as long as one uses ‘protec- tion.’” The publicly funded Calgary Catholic School District Board voted against in-school HPV vaccine admin- istration. In 2009, vaccine uptake was 70% in Calgary public schools and 18.9% in Calgary Catholic schools. To physician-citizens who requested in-school vaccination, the elected school trustees repeatedly responded that they were “directed” by the bishop. When trustees refused to hear from the city's chief oncologist, a citizen's group was created and held a June 2012 media event to help overturn the ban. The Board remained intransigent until the citizen's group threatened legal action, former senior administrators pressured the Board, Pediatrics reported that the HPV vaccine had no effect on sexual behavior, and the bishop told trustees that they could consult school councils. 87% (91/104) of school councils approved in-school HPV vaccine ad- ministration. On November 28, 2012, the Board permitted the HPV vaccine, four years after first requested by public health officials. This paper outlines a successful health campaign that may serve as a model for ad- dressing unwarranted concerns about community health programs dedicated to improving public health. © 2013 Elsevier Inc. All rights reserved. Introduction Despite extensive vaccine research and testing justifying regulato- ry approval, vaccine administration can be impaired by non-health related concerns, including normative views of religious and other groups. In one Canadian city, elected school trustees succumbed to the pressure of non-elected persons to ban routine human papilloma- virus vaccine (HPV) immunization in schools. Eventually, effective citizen action helped to overturn the vaccine ban. Background In July 2006, a quadrivalent HPV vaccine (HPV4, the Merck Canada Inc. product called “Gardasil”) received Health Canada approval for use in females aged 9 to 26 (NACI, 2012). In March 2007, the Canadian Federal Government announced a $300 million allocation for the national vaccination of girls (Colucci et al., 2008). In Canada, health services and education fall within the jurisdic- tion of the provinces and territories (Constitution Act, 1867). Routine publicly funded immunization of school-age children typically occurs in schools, whether publicly or privately funded (Public Health Agency of Canada, 2012). Catholic schools are pub- licly funded in Ontario, Saskatchewan, Alberta and the Yukon and Northwest Territories. Alberta announced its HPV vaccine program in June 2008 (Lang, 2008); the six Alberta Catholic bishops discouraged participation writing, “the decision regarding the use of the Gardasil vaccine is a parental, not an Alberta government, responsibility”(Smith et al., 2008). The bishops suggested that parents should disagree with in-school vaccination because “a school-based approach to vaccina- tion sends a message that early sexual intercourse is allowed, as long as one uses ‘protection’”(Smith et al., 2008). Bishop Frederick Henry of Calgary later frankly told a journalist (Kaufmann, 2012), […] even if future data shows a rise in cervical cancer rates among the district's ex-students, he wouldn't alter his stance. “It's not about a matter of statistics or any other study,” said Henry, adding he can't be held accountable for sexual choices. “What is our teaching on sexuality? If people choose to walk away from that life there are consequences and they have to acknowledge that — it's not my job.” Preventive Medicine xxx (2013) xxx–xxx Abbreviations: AHS, Alberta Health Services; Board, Board of Trustees of the Calgary Catholic School District; CCSD, Calgary Catholic School District; HPV, human papillomavirus; NACI, Canadian National Advisory Committee on Immunization. ⁎ Corresponding author at: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Teaching Research and Wellness Building, 3280 Hospital Drive N. W. Calgary, Alberta T2N 4N1, Canada. Fax: +1 403 270 7307. E-mail address: guichon@ucalgary.ca (J.R. Guichon). YPMED-03644; No. of pages: 5; 4C: 0091-7435/$ – see front matter © 2013 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ypmed.2013.06.005 Contents lists available at SciVerse ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed Please cite this article as: Guichon, J.R., et al., Citizen intervention in a religious ban on in-school HPV vaccine administration in Calgary, Canada, Prev. Med. (2013), http://dx.doi.org/10.1016/j.ypmed.2013.06.005