Why Don't More American Teens Get the HPV Vaccine?

Doctor giving teen HPV shot
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Human papillomavirus, or HPV, infection is incredibly common. Scientists think that more than half of sexually active adults are infected with HPV at any given time. Not all of those infections are the same. There are more than 100 types of HPV, many of which are spread sexually. Some types of HPV are considered to be high-risk. These strains are associated with an increased risk of a variety of cancers in both men and women.

Other types are considered to be low-risk. These strains are associated with genital warts.

Because HPV is spread from skin-to-skin, condoms aren't completely protective against infection. That's why it was so exciting for many people when the first HPV vaccine was developed. That vaccine, Gardasil, protected against the two most common high-risk and the two most common low-risk varieties of HPV. A few years later, another vaccine, Cervarix, was released that focused on the high-risk strain. These days, there are three HPV vaccines. The third vaccine is a new version of Gardasil called Gardasil-9 that protects against 9 strains of HPV.

The vaccines aren't perfect. However, countries that have had good vaccine uptake have seen their cervical cancer numbers drop. So why don't more American teens get an HPV vaccine?

The Benefits of the HPV Vaccine By The Numbers

In countries, such as Australia, where many young women are given the 4-strain HPV vaccine (Gardasil) before they can be exposed to the virus, the effects have been extraordinary.

A 2016 study review of the literature found that there were:

  • 90 percent fewer infections with HPV 6, 11, 16, and 18. These are the four strains protected against by Gardasil.
  • 90 percent fewer cases of genital warts.
  • 45 percent fewer diagnoses of low-grade cervical changes.
  • 85 percent fewer diagnoses of high-grade cervical changes. These are the types of changes associated with the development of cancer.

    However, for these benefits to be seen, young people have to get the HPV vaccine. More importantly, they have to get the vaccine before they start having sex.

    Some countries are doing incredibly well at getting people vaccinated. In 2014, almost three quarters of all Australian girls had been vaccinated. Denmark, Hungary, Ireland, Norway, Portugal, Sweden, and the United Kingdom all have vaccination coverage in the range of 80-90 percent. In contrast, by 2014, only 40 percent of American girls and 22 percent of American boys had been vaccinated.

    Why Is America Behind in HPV Vaccination Rates?

    The HPV vaccine came to the United States very early. However, in its early years there were a lot of debates about whether it should be part of regular vaccination recommendations. People were initially concerned about safety. It has since been shown to be a very safe vaccine. They were also concerned that the HPV vaccine might encourage young people to have more sex. That's another thing that has been shown not to be true.

    Today, the American Academy of Pediatrics recommends routine HPV vaccination for females and males ages 11 and 12. So why do vaccine rates still fall behind those of many other developed nations?

    There are a number of reasons. In no particular order:

    • Doctors don't do a good job of consistently recommending the vaccine to adolescent patients and their parents.
    • Parents aren't aware that the vaccine is needed for young men and women. Therefore, they don't know to ask for it or about it.
    • When parents are aware of it, many don't believe HPV vaccination is as important as other childhood and adolescent vaccinations. This is particularly concerning alongside the overall decline in childhood vaccination that is being seen all over the United States. Decreasing use of vaccines is largely attributable to parents' fears about vaccination. These fears are not based in science. They also fail to recognize that vaccines are many orders of magnitude safer than the diseases they are designed to prevent.
    • Parents are concerned about the cost of the vaccine. They're also worried the cost of the visits required to get the vaccine. There is some evidence that Medicaid recipients get the vaccine more often than those on private insurance. This could be for several reasons. One of those reasons is lower cost of seeking care when you don't need to pay visit co-pays.
    • HPV vaccines aren't always available in all areas of the United States. Availability varies a lot depending on where people get care.

    There are ways to fix these problems. Educational programs can help teach doctors about the importance of routine vaccination. That way, doctors could learn more about both the vaccine and how to talk about it in culturally appropriate ways. HPV vaccines can be made part of standard prevention programs. This could make discussing them easier for parents and physicians alike. Electronic medical records can be improved and access to the vaccine can be expanded. That would help doctors identify people who need the vaccine. It could also mean that parents and teens would have more options for where to get their shots.

    Finally, parents and teens need to have access to better information about the HPV vaccine. If more people understood the benefits to both boys and girls, they'd probably be more interested in getting it. Most importantly, they need to learn that getting the HPV vaccine isn't about having sex. It's about protecting health.

    Sources:

    Garland SM, Kjaer SK, Muñoz N, et al. Impact and Effectiveness of the Quadrivalent Human Papillomavirus Vaccine: A Systematic Review of 10 Years of Real-world Experience. Clin Infect Dis. 2016 Aug 15;63(4):519-27. doi: 10.1093/cid/ciw354.

    Holman DM, Benard V, Roland KB, Watson M, Liddon N, Stokley S. Barriers to human papillomavirus vaccination among US adolescents: a systematic review of the literature. JAMA Pediatr. 2014 Jan;168(1):76-82. doi: 10.1001/jamapediatrics.2013.2752.

    Krakow M, Beavis A, Cosides O, Rositch AF. Characteristics of Adolescents Lacking Provider-Recommended Human Papillomavirus Vaccination. J Adolesc Health.  2017 Jan 7. pii: S1054-139X(16)30881-3. doi: 10.1016/j.jadohealth.2016.11.028.

    Peterson CE, Dykens JA, Brewer NT, Buscemi J, Watson K, Comer-Hagans D, Ramamonjiarivelo Z, Fitzgibbon M. Society of behavioral medicine supports increasing HPV vaccination uptake: an urgent opportunity for cancer prevention. Transl Behav Med. 2016 Dec;6(4):672-675.

    Townsend JS, Steele CB, Hayes N, Bhatt A, Moore AR. Human Papillomavirus Vaccine as an Anticancer Vaccine: Collaborative Efforts to Promote Human Papillomavirus Vaccine in the National Comprehensive Cancer Control Program. J Womens Health (Larchmt). 2017 Mar;26(3):200-206. doi: 10.1089/jwh.2017.6351.

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