Much of the process of SGBA involves gathering and analyzing information, as we saw in the modules on issues, populations, evidence and implications. The task of formulating recommendations serves a different function: it aims to translate knowledge and analysis into action in order to solve a problem or address the needs of a population. Every recommendation will identify a specific goal, such as control of an epidemic or reduced death rates. It is critical to be clear about what this ultimate goal is because it will shape the design as well as the evaluation of recommendations.
Consider the case of Human Papilloma Virus (HPV), a sexually-transmitted infection that has been linked to cervical cancer. In 2007, Canada’s National Advisory Committee on Immunization (NACI) issued recommendations for the use of Gardasil™, a vaccine designed to reduce the risks of contracting HPV. The NACI recommended that the vaccine be given to:
- Females between nine and 13 years of age, before the onset of sexual intercourse;
- Females between the ages of 14 and 26 years of age, even if they are already sexually active, have had previous pap abnormalities, or have had a previous HPV infection
At the same time, the NACI recommended that Gardasil™ not be given to:
- females under nine years of age
- pregnant women
These recommendations are clearly designed to reduce the incidence of cervical cancer rather than to eliminate HPV. While only females can develop cervical cancer, both males and females can contract HPV and pass it to each other as well as to others of the same sex. Vaccinating only half of the population might help to reduce the incidence of cervical cancer, but it is not an effective solution for the spread of HPV, which has been associated with health conditions other than cervical cancer that affect both males and females.