13 Years After the HPV Vaccine Was Introduced, US Uptake Remains Low

Samantha DiGrande

Parth Shah, PharmD, PhD, of the Fred Hutchinson Cancer Research Center, led a session to discuss the uptake challenges of the human papilloma virus (HPV) vaccine at the American Society of Clinical Oncology’s Annual Meeting by first explaining the known percentages of cancers attributable to the virus in the United States: cervical cancer 91%, vagina cancer 75%, and vulva cancer 69%, among others. The meeting took place May 31-June 4, 2019, in Chicago, Illinois.

Although multiple cancers are attributable to the virus, explained Shah, of the population ages 13-17 in the United States that should be vaccinated, both boys and girls, only 49% actually receive the vaccine.

The challenges around facilitating larger uptake of a vaccine that prevents cancer can be frustrating for providers. Parents' hesitancy about vaccinating their children with the HPV vaccine has been around since it was approved in 2006, although it has garnered more attention as the anti-vaxxer movement has taken hold in the United States, as seen by the 940 confirmed cases of measles this year. (This is the greatest number of cases reported in the United States since 1994, and since the disease was declared eradicated in 2000.)

In terms of the low uptake of the HPV vaccine, Shah believes reasons are multifactorial. Namely, low uptake can be attributed to societal and cultural norms, community, and relational and individual reasons.

“As far as societal reasons, a few states currently have or tried to initiate school mandates for the vaccination. Not only were they controversial, but they were largely ineffective. When the vaccine came out and school mandates were being discussed, it was largely pushed by the manufacturers which generated distrust. In terms of community challenges, we’re vaccinating in some schools but schools are governed by local jurisdictions, and sometimes providing preventive services is not a priority. And finally, for relational and individual reasons, you need to consider the parents' perspective,” he said.

Shah explained that over the past few years, the CDC has collected data on why parents chose to not vaccinate their child for HPV. Among the top reported reasons were safety concerns and side effects, lack of knowledge about the vaccine, not believing it was necessary, no provider recommendation, and parents reported that their child was not sexually active, so they did not need it.

Based on prior data and studies, Shah recommended that in having conversations with patients who are due for the vaccine and their parents, the physician should make a statement that notes the child’s age, announce that they are due for vaccines that prevent several diseases, place the HPV vaccine in the middle of the list, and say that you’re available to vaccinate today.

Deanna Teoh, MD, MS, FACOG, FACS, of the University of Minnesota, also emphasized the impact social media has had on vaccination trends. The younger population is more likely to receive their news from social media, while Facebook is the site where adults get most of their news. Multiple social media sites– Facebook, YouTube, Twitter, and more– have been in hot water recently for providing a space for the anti-vaxxer movement to gain strength. Oversight of site governance policies that was not consistent has been attempted since the rise of the measles outbreak. 

To offer a different perspective, Ian Frazer, MBBS, MD, DSc, of the University of Queensland in Australia, explained that uptake of the vaccination is not a problem in Australia, due in part because “we bribe them to get vaccinated. There is a substantial social security handout if your child is fully vaccinated by 5 years old, so we find that almost country wide vaccination rates are high.”

Frazer and his late colleague, Jian Zhou, PhD, developed and patented the basic technology behind the vaccine.

Because most Australians saw the vaccine as a local invention, Frazer explained that uptake was quite good. In fact, the question being asked now in Australia is should they continue with screening for the disease since the vaccination rates are so high.

However, the question is not as straightforward as it seems, because to date, the only screening tool available for HPV is a Papanicolaou (Pap) smear. This presents a problem, as only only females, or roughly half the population, is able to be screened.

An audience member also brought the room’s attention to another problem in regard to lack knowledge about the importance of the vaccine not previously mentioned: “Some patients truly don’t even know that they have an HPV-related cancer. We need to first educate patients about their own disease, and then address the fact that there’s a vaccine to prevent it,” she said. This way, they’ll share that information with their loved ones, and maybe a greater uptake will start to occur.
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