A Multiple Streams analysis of the decisions to fund gender-neutral HPV vaccination in Canada

Abstract

In Canada, the human papillomavirus (HPV) vaccine is licensed and recommended for females and males. Although all Canadian jurisdictions fund school-based HPV vaccine programs for girls, only six jurisdictions fund school-based HPV vaccination for boys. The research aimed to analyze the factors that underpin government decisions to fund HPV vaccine for boys using a theoretical policy model, Kingdon's Multiple Streams framework. This approach assesses policy development by examining three concurrent, but independent, streams that guide analysis: Problem Stream, Policy Stream, and Politics Stream. Analysis from the Problem Stream highlights that males are affected by HPV-related diseases and are involved in transmitting HPV infection to their sexual partners. Policy Stream analysis makes clear that while the inclusion of males in HPV vaccine programs is suitable, equitable, and acceptable; there is debate regarding cost-effectiveness. Politics Stream analysis identifies the perspectives of six different stakeholder groups and highlights the contribution of government officials at the provincial and territorial level. Kingdon's Multiple Streams framework helps clarify the opportunities and barriers for HPV vaccine policy change. This analysis identified that the interpretation of cost-effectiveness models and advocacy of stakeholders such as citizen-advocates and HPV-affected politicians have been particularly important in galvanizing policy change.

HPV vaccination in male physicians: A survey of gynecologists and otolaryngology surgeons' attitudes towards vaccination in themselves and their patients

“…Most cost effectiveness studies are focused on whether vaccinating men is cost effective in decreasing cervix cancer in women. These studies show that vaccinating men is not cost effective, especially when female coverage is moderate-high [8] . Cost effectiveness data is more favorable for vaccination of men when considering all HPV related diseases and when female vaccination rates are below 40% [9] .…”

Using an integrated conceptual framework to investigate parents' HPV vaccine decision for their daughters and sons

“…7,8 As of 2018, all jurisdictions also offer programs for boys in schools; 9 however, the roll out of these programs (since 2013) has been staggered and HPV vaccination rates in Canada remain suboptimal. 3,8,10 Because HPV vaccination targets children, 3 parental acceptance is critical to ensuring uptake. Previous research has indicated common themes associated with uptake, such as the importance of parents believing in the benefits of vaccination and perceiving few barriers.…”

Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey

“…Since HPV vaccine programmes and policies are constantly evolving, 25 it is timely to evaluate comprehensively variations in programme outcomes that target girls and boys, jurisdictions at a national and local level and HPV vaccination by sociodemographic groups. For this reason, this study will be useful to policymakers in understanding where the HPV vaccination programmes are meeting coverage targets, where disparities in vaccination exist, and which groups or jurisdictions may benefit from interventions designed to increase vaccination.…”

“…26 To date, only a handful of countries have extended their publicly funded, school-based HPV vaccination programmes to boys. 25 27 28 Investigating Canadian parents' HPV vaccine knowledge, attitudes and behaviour: a study protocol for a longitudinal national online survey Gilla K Shapiro, 1,2 Samara Perez, 1,2 Anila Naz, 2 Ovidiu Tatar, 2 Juliet R Guichon, 3 Rhonda Amsel, 1 Gregory D Zimet, 4 Zeev Rosberger 1,7,2,5,6 To cite: Shapiro Open Access Figure 1 Publicly funded school-based HPV vaccine programmes in Canada. This figure identifies the year that publicly funded school-based HPV vaccine programmes were initiated for girls and boys by Canadian jurisdiction.…”

“…Canada has been an international leader in providing gender-neutral HPV vaccination; 25 by September 2017, 10 of Canada's 13 regions will have commenced schoolbased HPV vaccination programmes that include boys (figure 1). [29][30][31][32][33][34][35][36] However, implementation of male HPV vaccination across Canada has been staggered, presenting a natural experiment to evaluate and compare the impact of the introduction of the HPV vaccine programmes on parents' attitudes, knowledge and vaccine coverage.…”