HPV is the most common sexually transmitted disease in America. With the exception of HIV, it is also the most fatal. But for almost a decade, we've had a vaccine that prevents HPV infection and, by extension, the deadly cancers it causes. So why aren't American adolescents getting access to this vaccine?
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When the HPV vaccine was introduced in 2006, the Centers for Disease Control and the American Academy of Pediatrics immediately recommended it be received by all adolescents (in the last decade, these institutions have jointly recommended just two other vaccines, namely meningococcal and Tdap). Their reasoning was simple: The human papilloma virus (HPV) is known to cause several types of cancer, including carcinomas of the cervix, anus, penis, and throat. By preventing HPV infection, the HPV vaccine can stave off several types of cancer. You might think that Americans would be signing up in droves to have their children vaccinated against cancer. You'd be wrong.
In 2013, the Centers for Disease Control reported that only one-third of girls aged 13–17 had received all three shots of the HPV vaccine, which, like the hepatitis B vaccine, is delivered by a course of three injections. Compare that to Australia and the UK, where HPV vaccinations rates approach twice those of the U.S., or Rwanda, where more than 80% of teen girls receive the entire series. At the time, CDC director Tom Frieden expressed his concern over the vaccine's miserable uptake:
Our low vaccination rates represent 50,000 preventable tragedies – 50,000 girls alive today will develop cervical cancer over their lifetime that would have been prevented if we reach 80 percent vaccination rates.
Last month, the CDC reported the most recent results of its teen immunization survey. The numbers were discouraging. Fewer than 60% of girls had started the HPV vaccination series. Only 38% had finished it. The numbers for boys, whom the CDC also recommends should receive the vaccination, are markedly worse.
"It's frustrating to report almost the same HPV vaccination coverage levels among girls for another year," said Dr. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases, in a statement. These numbers are, to quote the CDC's report, "unacceptably low." By comparison, the survey indicates that roughly 80% of adolescents receive the meningococcal and Tdap vaccines.
This disparity is mind boggling, especially in light of the relative risk posed by the diseases these vaccines target. Paul Offit illustrates this point quite powerfully in an op-ed published in last week's New York Times.
In his piece, Offit – a professor of pediatrics in the division of infectious diseases, and director of the Vaccine Education Center, at the Children's Hospital of Philadelphia – attempts to account for the HPV-vaccine's slow uptake by the American public. Part of it, he says, is "a clash between perception and reality." He proceeds to debunk several common misconceptions about the HPV vaccine's effectiveness (it is virtually 100% effective at preventing the most common cancer-causing HPV infections, for at least 30 years), safety (the vaccine has been shown to cause no serious side effects), and propensity to promote promiscuity (it doesn't).
If you believe in the safe, preventative power of vaccines, I doubt much of this comes as a surprise to you. But here's something you may not have known: You'll recall the statistic cited earlier, that 80% of U.S. adolescents receive meningococcal and Tdap vaccines to prevent meningitis, tetanus, diptheria, and whooping cough. Well, according to Offit, people are more than 20 times more likely to die of HPV than from the other four diseases combined:
People just don't understand how serious an infection HPV can be. In a typical year in the United States about 150 people die from meningococcus, four from tetanus, none from diphtheria, 20 from pertussis, and roughly 4,000 from cancers caused by HPV. People are more than 20 times more likely to die from HPV than from the other four diseases combined.
About 79 million people in the United States have been infected with HPV, and 14 million new infections occur every year. As a consequence, 18,000 women and 8,000 men suffer preventable cancers of the cervix, anus, penis and throat; it's the most common, and except for H.I.V., the most fatal sexually transmitted disease.
To recap: Roughly one-in-three Americans is carrying a sexually transmitted infection with a mortality rate second only to HIV. That infection is largely preventable by a vaccine – a vaccine that the majority of American adolescents are not receiving. That's astounding.
What can be done to improve HPV vaccination rates? One solution may be to stop talking about HPV in terms of sex. When Schuchat delivered the CDC's latest results on vaccination rates, she reported that one of the main reasons parents gave for not vaccinating their kids against HPV was that their doctors just weren't recommending it. Why not? Offit posits that, because HPV is often transmitted sexually, and because many doctors are likely uncomfortable talking about sex with 11-year-olds, physicians may be neglecting to raise the subject of HPV vaccination with their patients. This, Offit points out, is silly:
Amy B. Middleman, chief of adolescent medicine at the University of Oklahoma College of Medicine offers one solution in the coming NOVA television special "Vaccines — Calling the Shots": Don't talk about sex. "The sex part," says Dr. Middleman, "the way in which you get the target disease, is irrelevant. We don't talk about diphtheria, and how you can get diphtheria, before we give the Tdap vaccine." In other words, it's not about sex. It's about cancer.