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Why 40% Of Girls Still Aren't Getting The HPV Vaccine

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Photographed by Jessica Nash.
A new report, out last week from the Centers for Disease Control and Prevention (CDC), reveals that a distressingly high percentage of teens still aren't getting the human papillomavirus (HPV) vaccine, which was first approved in 2006. Today, 40% of girls and 60% of boys ages 13 to 17 aren’t vaccinated — despite ample evidence that the vaccine is both safe and effective.

However, according to the same report, only about 20% of teens remain unvaccinated for bacterial meningitis — a rare disease that affects about 4,100 Americans per year and kills 500 of them. Serious adverse reactions to both the HPV and meningitis vaccines are similarly rare.

Bacterial meningitis is a gruesome disease. Although most people who get it survive, they are often left with brain damage, hearing loss, or other severe, lifelong issues. Most of the time, the bacteria that cause meningitis are not as contagious as those responsible for the cold or flu, according the CDC. But transmission is most likely between people who are living in close contact, such as in college dorms. So, like a freak car accident, a meningitis infection can be both rare and serious — why wouldn’t parents take the opportunity to protect their children from it?

In comparison, cervical cancer affects around 12,000 American women each year, and virtually all cases are caused by HPV, the most common sexually transmitted infection, which affects another 14 million people every year. This means the HPV vaccine, unlike meningitis, has “moral” underpinnings. After all, you can’t get HPV without sexual or genital contact. In 2011, the most recent year for which data is available, over 4,000 women lost their lives to the disease. But with the HPV vaccine, many future HPV infections — and the cervical cancer deaths that result from them — are highly preventable.

The principle roadblock is providers not recommending the vaccine.

Dr. Anne Schuchat
So, despite the fact that this vaccine could quite literally save their lives, why are so many teens still not getting it? It turns out that the issue goes beyond availability, cost, or even parental objections. In fact, it starts in the most basic of places: with doctors who, despite having the vaccine in stock, simply don’t offer it to their patients. The reasons for this are many, but the squeamishness even doctors feel at discussing teen and young adult sexuality — coupled with the current climate of vaccine hysteria — contributes to our country’s subpar vaccination rate.

"We think the principle roadblock is providers not recommending the vaccine," said Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases, last week in a CDC press briefing. "[They're] not providing a strong recommendation the same way they recommend the...meningitis vaccine."

In particular, providers are less likely to recommend the vaccine to younger adolescents, even though it's intended for ages 11-12, explains Shannon Stokley, MPH, one of the authors of the new CDC report. "They also talk about it differently," she says. Because the HPV vaccine isn't necessary for school entry like the meningitis and Tdap vaccines usually are, doctors may unintentionally make it seem less important. "Most providers think they’re giving a strong recommendation, but parents are hearing something different," says Stokley.

Colleges require the meningitis vaccination based upon the physical reality that many people are stuffed into dorms together, possibly hastening the spread of meningitis. But the reality of teen and young adult sexual activity — according to the Kinsey Institute, over a quarter of teens have had their first intercourse experience by age 15, and nearly two-thirds of sexually experienced teens have had at least two partners — isn’t addressed in the same way.
Indeed, previous surveys have highlighted parents' beliefs that their children are not sexually active yet as a major reason for not having those children vaccinated. But this belief — whether true or not — can actually be framed as a reason for early vaccination. "The best way for this vaccine to prevent cancer is for you to get it before you come in contact with the virus," emphasizes Eduardo Lara-Torre, MD, assistant professor at Virginia Tech-Carilion School of Medicine. "So having teen girls get the vaccine guarantees maximum protection." That makes it vital that parents begin the vaccine course (which requires three doses given within a year) when their kids are young teens or preteens.

It's encouraging that, overall, the HPV vaccine rate has increased in small increments since 2013, similar to the meningitis vaccine coverage rates. But, the coverage rate for the HPV vaccine still lags substantially behind that of the meningitis vaccine, and it's not equal in all areas of the country. Stokley explains that while Rhode Island has the highest coverage rate for the first dose among girls (76%), Kansas has the lowest (38.3%).

Programs like Vaccines For Children, a federally funded service that covers the cost of the HPV vaccine and other essential immunizations for uninsured kids, have resulted in an unusual landscape. Cost is typically a barrier to healthcare access in America, but with the HPV vaccine, we see that coverage rates are actually higher among those with lower incomes: 67% of teen girls below the poverty line have gotten their first dose by age 13, compared to about 58% of those above the poverty line — possibly because kids below the poverty level often receive a bunch of recommended vaccines all at once. When it comes to the meningitis vaccine, however, the rates for those above and below the poverty line are nearly identical, at 88% and 85%, respectively.
"The first thing that needs to happen here is we as providers need to promote universal vaccination," says Dr. Lara-Torre. "When providers recommend the vaccine, there is a better chance the parents will accept it, compared to just waiting for the parents to bring it up." Because the HPV vaccine isn’t required for entry to school in the same way that the meningitis vaccine is, it’s up to medical professionals to recommend it anyway.

So should everyone who gets vaccinated against meningitis (a disease that infects 4,100 people in the U.S. every year) also get vaccinated against HPV (which affects 14 million every year)? Almost certainly yes. "We know a provider's recommendation is very powerful," says Stokley. "Parents trust their doctors." Which means that doctors need to be the ones accepting the sexual reality of teens’ lives — including the need to protect teens from the risks that come with that reality — and encouraging parents to do the same.

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