Why Are HPV Vaccination Rates So Low?

Apr 25, 2017

HPV infections are leading to an increasing number of cancers in both men and women. There’s a vaccine that can address that, but most people in Virginia aren’t getting it. In fact, compliance rates for HPV vaccination are so low here and throughout the U.S., that the National Cancer Institute-designated Cancer Centers call it “a serious public health threat.” WMRA’s Emily Richardson-Lorente has the story.

HPV — the Human Papilloma Virus — is a wickedly common sexually transmitted virus; more than four out of five of us will be infected with it at some point, most without ever knowing it or showing any symptoms. But for an increasing number of Americans — about 31,500 each year — a lingering HPV infection will eventually lead to cancer. And not just any cancer — the cringe-inducing cancers: cervical, vaginal, penile, anal. Plus, increasingly, cancers in the throat, transmitted through oral sex. The good news is that there is a childhood vaccine that’s remarkably effective in preventing these cancers in adulthood. The bad news is that lots of kids aren’t getting it.

JESSICA KEIM-MALPASS, PhD, RN: It’s incredibly easy to opt out.

That’s Jessica Keim-Malpass, an Oncology Nurse and Assistant Professor of Nursing at the University of Virginia. She’s been studying HPV vaccination compliance in the state for a few years now.

KEIM-MALPASS: I became really interested in this vaccine and this issue in particular because we have been doing just a very poor job of getting our kids vaccinated.

Virginia was actually ahead of the curve when the HPV vaccine was released in 2006. We were, in fact, the FIRST state to make the three-shot vaccine mandatory for 6th-grade girls. But in the decade since then, our vaccination rate has fallen behind 31 other states. As of 2015, only about one-third of Virginia kids were getting fully vaccinated by age 18.

KEIM-MALPASS: Many people say, “What good is having a mandate when it's essentially so easy to get out of it? It doesn't even really do its job.”

In fact, state law says parents can opt out at their 'sole discretion' … no paperwork required.  But WHY do so many parents opt out? Keim-Malpass says some parents are just uncomfortable with the idea of vaccinating their little girl or boy against HPV.

KEIM-MALPASS: Parents assumed that because this vaccine is targeted to HPV, which is in fact, a sexually transmitted infection, it may promote sexual debut.

'Sexual debut' may not be a term you or I have ever used, but you get what she’s saying, right? It’s oogy to think about this stuff with your 11-year old. But research has shown that vaccination does not lead to sexual debut.

KEIM-MALPASS: The whole reason that the vaccine works is that we are targeting boys and girls before they have sexual encounters and we know that it works better when we get them at that young age.

In fact, children ages 11 to 14 react so well to the vaccine, that the CDC recently reduced the number of shots required at those ages from three to just two. Of course, for some parents, the number of shots is a moot point, because they just don’t trust vaccines. To which Keim-Malpass says:

KEIM-MALPASS: Now that the vaccine has been out for ten years, we know that it's really effective at preventing devastating cancers and we know that it's safe.

Vaccine skepticism and parental squeamishness may not be easy obstacles to overcome, but Keim-Malpass identified one change that could make a BIG difference: the doctor’s delivery.

KEIM-MALPASS: If the provider has hesitation about the recommendation, then we know that that leads to hesitation on the parent end as well.


DR. WONG: Hi Madeline, how are you?

MADELINE: I’m fine.

That’s Charlottesville pediatrician Emily Wong.

EMILY WONG, MD: We have found in our own office that when we gave a better recommendation, there was a lot better uptake of the vaccine than we had expected.

A year ago, Dr. Wong and her colleagues realized they were presenting the TDAp and meningococcal vaccines as mandatory to parents of 6th graders, and the HPV vaccine as effectively optional — because, after all, skipping the vaccine wouldn’t bar their kids from school. 

WONG: And when we presented it like that, well no one would choose the optional vaccine, and when we think about what we’re trying to prevent, I think that’s the most important thing that we recognize that we’re trying to prevent cancer, and there are very few things that we have to prevent cancer.

Initially, the CDC recommended the HPV vaccine only for girls — primarily to prevent cervical cancer, which kills about 4,200 women a year in the U.S.; boys weren’t added to the CDC’s recommendation until 5 years later. 

WONG: In the beginning, they thought, 'Oh, we're just vaccinating the boys because we're trying to protect the girls,' but now that we realize there is a growing number of oropharyngeal cancer in males …

Those are cancers in the throat, at the base of the tongue or the tonsil.

WONG: … parents of boys have become more receptive as well.

EMILY: And you trust the HPV vaccine?

WONG: Yes, I've had it administered to my own child.


DR. WONG: Alright, Madeline, well, t’s been 15 minutes since your shot. How are you feeling?

MADELINE: I feel alright.

DR. WONG: Okay, great, well you’re free to go then. And just remember that you need to have a 2nd shot after six months, alright?

MADELINE: Alright.

If every child received their HPV vaccination on schedule, that could prevent up to 90% of HPV-related cancers down the road, according to the American Cancer Society. That’s an awful lot of adults who won’t get cancer, and won’t have to wonder if a childhood vaccine could have prevented it.