Op-ed published in the Student Working Group for Vaccines Ethics & Policy
Stigma, misinformation, and access inequities — an unfortunate trifecta of reasons — explain why millions of American teens and young adults are still vulnerable to the cancer-causing human papillomavirus (HPV), despite the fact a safe and effective vaccine has been available since 2006, nearly two decades ago.
HPV is a common virus whose dangers transcend demographic boundaries: it affects us all, regardless of gender, age, race, ethnicity, or party lines. Nearly 13 million people get infected with HPV each year, with most exposed in their teens and early twenties. The debilitating infections can cause genital warts and cancers of the cervix, vagina, vulva, anus, and back of the throat, topics that are traditionally stigmatized and not discussed openly.
The American Cancer Society advocates for parents to have their children get the HPV vaccine between ages 9 and 12, when the body produces the most antibodies to the vaccine. Teens and young adults, aged 13 through 26, who are unvaccinated (or partially but not fully vaccinated) are encouraged to get the vaccine as soon as possible.
Per the CDC, over 135 million doses of the HPV vaccine have been safely administered in the U.S. since 2006. The vaccine is nearly 100 percent effective against precancers and provides long-lasting protection. A notable study conducted over 11 years demonstrated the vaccine’s efficacy in preventing 90% reduction in cervical cancer incidence.
However, despite demonstrated scientific success and various efforts by nonprofits and public health educators to debunk misinformation, parents are still hesitant. For example, some parents still erroneously believe that the HPV vaccine makes pre-pubescents sexually promiscuous or affects their fertility later in life or is only for girls. Polarization around vaccines during the COVID-19 pandemic has exacerbated parental hesitancy about vaccines in the last three years.
HPV vaccination rates for teens ages 13-17, a measure of parental confidence, are much lower than the 80% target, laid out in the Healthy People 2030 national health objectives. Per the 2022 CDC NIS-Teen national survey, only 52.3% of girls and 47.6% of boys are fully vaccinated. Similarly, HPV vaccination rate among young adults ages 18-26 is also low, at 39.9%, indicating less-than-effective outreach efforts to inform young people about the high-risk HPV poses.
Data indicate severe disparities in vaccinations in low-income and rural communities. Recent data from 2022 show that in low-income families, only 39% of uninsured 13-year-olds were vaccinated, despite the federal program Vaccines For Children (VFC) making free HPV vaccines available to families. Evidently, we are not doing enough to promote awareness of such programs. HPV vaccination rates in rural areas are 10% points lower than in urban areas, and parents of teens and young adults in rural areas are less likely to initiate and complete the series.
Studies also show disparities in racial minorities and the LGBTQIA+ communities. Studies show that Black, Hispanic, and Native American women are disproportionately more likely to get cervical cancer which is preventable by the HPV vaccine. National HPV vaccination data for adults is not widely examined by gender identity. CDC NIS-Teen data, the nation’s gold standard for teen vaccine rates, also does not report data for LGBTQIA+ teens. However, Fenway Health, an organization dedicated to LGBTQIA+ and BIPOC health care, reports that trans-masculine men who retain female reproductive organs had much lower rates for Pap test for cervical cancer screening, 27% compared to 43% in cis-women.
The causes of low HPV vaccine rates among various demographics, despite proven success, are complex and nuanced. These range from parental beliefs in moral purity, myriad myths in social media about the vaccine’s safety, unawareness of the benefits of early HPV vaccination, lack of awareness of the VFC program, and inconsistent provider recommendations. There are also logistical challenges, such as HPV vaccines not being available in accessible locations such as pharmacies and consent laws making administration in mobile clinics challenging. Unlike other vaccines, the social stigma around sexually transmitted diseases makes it harder for outreach programs to include HPV vaccines as part of routine preventive immunizations.
Given all the above, we must invest in a dedicated national awareness campaign for preventing HPV-causing cancers and invest more in cervical cancer screening. Early detection has been proven to be highly effective in reducing cancer-related deaths; rates of cervical cancer-related deaths among women have halved since the 1970s.
The PREVENT HPV Cancers Act of 2023 increases awareness and prevention with a multifaceted approach. The bill will invest $5M a year from 2024 to 2028 for a national HPV awareness campaign, “culturally and linguistically” tailored to specifically reach vulnerable populations. Recognizing that provider recommendations for early-age prevention have the highest impact, the campaign aims to reach primary care physicians, sexual and reproductive health care practitioners, and dentists, with grassroots participation from local community health centers, public health educators, schools, and colleges.
Furthermore, the bill will expand funding for the National Breast and Cervical Cancer Early Detection Program, a critical free and low-cost service for those who are uninsured or can’t afford such services. Since 1991, the program has administered 16.1 million screenings. In 2022, the program helped detect 242,261 pre-malignant and 5,220 invasive cervical cancers. The bill will invest $300M per fiscal year from 2024 through 2028, a much-needed step towards the eradication of preventable cervical cancer, especially for those vulnerable among us.
This life-saving bill is a bipartisan effort and has been in the making since 2021. On May 24, 2023, Democrat Rep. Kathy Castor (Florida) re-introduced the bill with Republican Rep. Julia Letlow (Louisiana), Democrat Rep. Kim Schrier (Washington), and Democrat Rep. Debbie Wasserman Schultz (Florida). It is time for a concerted national outreach effort with grassroots involvement at state and local efforts to remove the stigma, engage families and providers, and address inequities to promote HPV vaccination initiation and completion and cervical cancer screenings.
H.R. 3633, PREVENT HPV Cancers Act, caters to the diverse needs of many and is an invaluable opportunity for legislators across party lines to come together to prevent millions of infections that can cause cancer and save lives. I urge everyone to call or write to their House and Senate legislators and the Chairman and Ranking Members of the Ways and Means and Energy and Commerce Committees to support and pass the bill as soon as possible.
Original publication here.