HPV Vaccination: Key Points for Healthcare Providers

Although cervical cancer rates in Ontario have declined slightly over the past two decades—largely because of effective screening programs that detect and treat precancerous changes—the incidence of other HPV-related cancers, particularly oropharyngeal cancers, has been rising. This trend underscores the importance of HPV vaccination as a critical tool in cancer prevention.

Estimates for 2024 indicated that 669 Ontarians would be diagnosed with cervical cancer, with 159 deaths projected. Nationally, approximately 8,100 Canadians were expected to be diagnosed with head and neck cancer—many linked to HPV—with 2,100 deaths projected. The HPV-9 vaccine (Gardasil®9) provides safe and long-lasting protection against nine high-risk HPV types, significantly reducing the risk of cervical, vulvar, vaginal, anal, and oropharyngeal cancers. Vaccination is most effective when administered before HPV exposure and does not protect against HPV types not included in the vaccine. Therefore, eligible individuals should continue to follow cervical screening recommendations even if vaccinated.

Accessing Publicly Funded HPV Vaccine

Grade 7 to 12 students who are under the age of 15 are eligible for a two-dose HPV immunization series administered six months apart. Students who are initiating an HPV series at 15 years of age and older, or are immunocompromised, or live with HIV, are eligible for a publicly funded three-dose HPV vaccine series administered at 0, 2, and 6 months.

Ottawa Public Health provides the two-dose immunization series to students in grade 7 through the School-Based Immunization Program. If a student misses or does not complete their vaccine series, they remain eligible to receive vaccination until the end of their grade 12 school year.

To vaccinate students who require catch up or a third dose of vaccine, you can order publicly funded HPV vaccines through the request form for school-based vaccines for eligible grade 7-12 students. Alternatively, students can book an appointment at a community clinic via the Kids Come First: Vaccinate to Up-to-Date booking page or may drop in to one of our Neighbourhood Health & Wellness Hubs.

You can order publicly funded HPV vaccines for high-risk individuals (i.e., men up to 26 years old who have sex with men) through the request form for high risk HPV vaccine. Ottawa Public Health also offers HPV vaccination to high-risk individuals

through our Sexual Health Clinic.

HPV vaccine immunization coverage varies across Canada as do dosing schedules. Evidence is being reviewed on current dosing schedules in Ontario, and at this time, no changes to recommendations have been implemented.

Options for Individuals Not Covered by Publicly Funded HPV Vaccination

Individuals outside the eligibility criteria for publicly funded HPV vaccination may still receive the vaccine with a prescription from a health care provider but will need to pay for it through private insurance or out-of-pocket — the cost of the HPV-9 vaccine is approximately $215 per dose, plus pharmacy dispensing fees, which typically range from $10 to $15.

Ensuring Equity in HPV Vaccination

Evidence from other jurisdictions in Canada indicates that HPV vaccination rates tend to be lower in communities experiencing greater material and social deprivation, as well as among immigrant and Indigenous populations. In Ontario, while more recent data are unavailable, it is known that First Nations women have been nearly three times more likely to die from cervical cancer than other women—a disparity that reflects the legacy of harms stemming from colonization, as well as longstanding inequities in access to HPV vaccination, screening, treatment, and culturally safe care. Although incidence rates declined and disparities between First Nations and non-Indigenous women have declined significantly since 2010, trends in mortality remain unclear, underscoring the need for better data on whether prevention efforts are truly saving First Nations lives. Consider taking a moment when interacting with eligible individuals, particularly Indigenous Peoples, newcomers, and those experiencing poverty, to check whether they have received their publicly funded HPV vaccination, and follow up accordingly.

Physician Resources

• HPV vaccine immunization: dosing schedules in Ontario.
• Vaccine request form, OPH: order publicly funded HPV vaccines for school-based vaccines for eligible grade 7-12 students
• Existing evidence on HPV and health equity in Canada: Ethics, equity, feasibility and acceptability considerations, Health Canada

Patient Resources

• Information for parents: School vaccination clinics for grade 7, Parenting in Ottawa
• General information on HPV in 18 languages, HPV Global Action
• Kids Come First: book an appointment for catch-up vaccinations at a community clinic
• Neighborhood Health & Wellness Hubs: book an appointment for catch-up vaccinations

Emil Prikryl, MD, MSc, FRCPC
Associate Medical Officer of Health, Ottawa Public Health

Christine Gloade, RN (EC), BScN, MN
Public Health Nurse Practitioner
Ottawa Public Health

Jenna Bennett, RN, BScN, MPH, CCHN(C)
Nursing Project Officer
Ottawa Public Health