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Low HPV vaccination rates in Minnesota: Intervening at entry to middle school could help

REUTERS/Jessica Rinaldi
When the human papillomavirus (HPV) vaccine was approved by the FDA, it seemed to be an issue that had a lot of positive momentum.

When it comes to vaccination rates in Minnesota, one vaccine lags behind the rest. The human papillomavirus (HPV) vaccine protects against an extremely common sexually transmitted infection. It prevents 70 percent of cervical cancers, 90 percent of genital warts, and is effective at reducing throat, penile and anal cancers as well. Despite this impressive record, and the fact that the CDC recommends the vaccine to both boys and girls at the age of 11 or 12, it’s not very popular. Only 37 percent of girls in Minnesota completed the three-part vaccination in 2013, and an even lower 8.3 percent of boys.

Manami Bhattacharya

When the human papillomavirus (HPV) vaccine was approved by the FDA, it seemed to be an issue that had a lot of positive momentum. A shot against cancer — what could be objectionable about that? Apparently, a number of things — from systemic and political issues to parental concerns.

Systemic issues have certainly contributed to the low rates of HPV vaccines. The vaccination was originally approved for only girls, and the HPV vaccine was framed to appeal to women. Even after the recommendation was expanded to boys, advertising was often still aimed at girls. Another problem is provider-centered. Although doctors approve of the vaccine, they often don’t bring it up, especially to their male patients. Based on these facts, it’s not surprising that boys’ vaccination rates are so low.

A great deal of the problem is political. Conservative groups have openly been wary of the vaccination. Minnesotans may remember then-Rep. Michele Bachmann’s unfounded and infamous claims that HPV vaccination causes mental retardation. One expert estimated that a high-profile comment like hers could cause a three-year setback in vaccination rates.

Parental concerns hampering vaccinations

Of course, middle-schoolers usually don’t make their own medical decisions, or drive themselves to the clinic. Research surrounding the vaccine found that parents have many concerns, including paying for the vaccine and inadvertently promoting sexual behavior in adolescents. Some don’t bring their children back to finish the series. Many underestimate their children’s risk of contracting the infection. Their ideas are often incorrect. For example, the Vaccines for Children program will cover low-income or uninsured children, and most health insurance will cover the vaccine. Studies have also shown that vaccination is not linked with increases in sexual behavior.

Recent Department of Health initiatives to increase vaccination rates in Minnesota include a reminder project to help with vaccine completion, a promotion campaign for teens and parents, and the creation of educational materials for providers. However, similar ongoing campaigns in the nation have seen only small gains in vaccination rates. Despite the concern that these campaigns may or may not work, they have pushed HPV and vaccination into the spotlight. Both parents and providers have been primed on the issue, even if all their concerns have not been addressed, creating an ideal stage for policy change.

Some seek mandatory vaccines

The quickest way to increase vaccination rates is to mandate the vaccine for school attendance. Making vaccination mandatory for middle school entrance has been a successful policy for other countries like the UK, where vaccination rates for girls are over 80 percent. Currently only Virginia and D.C. have implemented this program, although 24 states have tried. Even in the two places it passed, it has been met with controversy. In Virginia, policymakers have tried many times to repeal the law.

Rather than push a policy that is controversial and difficult for policymakers to endorse, a better solution may be to increase the amount of good information available for parents so they can make a better-educated choice on the behalf of their children. Parents often suffer from incomplete or incorrect information about the vaccine.

Hawaii recently passed legislation that would require public schools to provide information on the HPV vaccine to parents of entering sixth-graders. A source of good, clear information about vaccine safety and effectiveness, along with information about reducing costs and financing the vaccine may help with vaccine uptake. This information could also include different strategies for parents to talk about the subject of HPV with both their child and their child’s provider. This type of policy is low-cost and far-reaching; it may lessen some of the parental concerns surrounding the vaccine, and improve vaccination rates.

It is imperative that we raise the vaccination rates. Unlike other vaccinations, there are no public outbreaks of cancer at Disney. HPV is often a silent infection, and its escalation to cancer is a slow process. Parents have the right to complete and correct information about HPV vaccination when making far-reaching decisions for their children. Misinformation should not stand as a barrier to preventing cancer.

Manami Bhattacharya is a graduate student in the School of Public Health at the University of Minnesota.

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Comments (2)

  1. Submitted by Rachel Kahler on 04/14/2015 - 09:00 am.

    Mandatory HPV vaccination

    Fortunately, you’re right, there are no cancer outbreaks at Disney. That being said, I support mandatory vaccination for easily communicable diseases. Diseases such as chicken pox and mumps carry a risk of transmission simply by being in the vicinity of a person with the disease. HPV does not. I do not support mandatory HPV vaccination in order to allow a child in a public school–it’s out of line with the risk. HOWEVER, I do support potentially mandating doctors and other health practitioners discussing the vaccine with parents of children of the right age. It really is a public health issue and doctors should be supporting a goal of health.

    I’ve seen the effects of HPV infection. Not myself, but a loved one. She survived, but it was an expensive and scary issue at the time, and she’s not guaranteed to be free of the effects for the rest of her life. Parents are foolish to believe that their children don’t need protection from such an insidious disease. The bigger issue is that parents don’t want to get past the idea that their children will eventually have sex. Certainly, a vaccination at 11 or 12 is unlikely to increase sexual behavior–as a teenager, the risk of an STD is definitely not a deterrent to sex. Even if parents explained to their 11 or 12 year old what the vaccine was for (I don’t ever recall being told why I got lots of shots when I was a kid), I can’t imagine that it would be a REASON for having sex–the risk of pregnancy is a much more obvious risk and it still isn’t a foolproof deterrent.

    We do need to talk more about the cancers associated with HPV, though. Talk about how devastating they are. Many of the opponents of the vaccine like to talk about the hypothetically small number of people who benefit from it. It’s not so small, though. There are over 12,000 new cases each year, with over 3500 deaths per year in the US for cervical cancer alone, almost all due to HPV infection some years earlier. That doesn’t include any pre-cancerous medical issues. Penile cancer has a lower incidence (less than 2000 cases per year), but somewhat north of 60% of penile cancers are associated with earlier HPV infection. And I’m pretty sure most men live in fear of the day they discover that their penis has cancer and has a chance of killing them.

  2. Submitted by Dan Kegel on 04/14/2015 - 11:08 am.

    Best practices for increasing vaccination coverage?

    What has worked elsewhere? Let’s learn from the experience of others. A quick search finds e.g.

    http://www.sciencedirect.com/science/article/pii/S0264410X15004600

    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6329a3.htm

    http://www.sciencedirect.com/science/article/pii/S0264410X13015934

    http://link.springer.com/article/10.1007/s10198-015-0680-2

    http://www.sciencedirect.com/science/article/pii/S0264410X1401576X

    http://www.researchgate.net/profile/Maria_Ganczak/publication/272815326_Evaluation_of_Human_Papilloma_Virus_(HPV)_vaccination_strategies_and_vaccination_coverage_in_adolescent_girls_worldwide/links/54ef37290cf25f74d721c1a8.pdf

    Doctors and policymakers should be aware of these ideas and try some of them out without further ado!

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