HPV goes up, HPV goes down, and America struggles with the vaccine’s image problem

It’s the “your teenage girl will have sex” vaccine. Not that it will cause her to have sex; studies show it won’t, and according to the surveys that’s not even what parents fear. But I have a good guess why so many check “Not needed” as their reason for not giving the vaccine: it makes them think about their daughter, or their son, having sex.

UNMIT Medical Doctor Holds Surgical Syringe

Photo by United Nations Photo

It’s probably similar to why I hurried away from the lady who approached me, as I was shopping a church sale with my two young kids, with a fingerprinting kit. For a small fee, her company would keep my sons’ prints on hand in case they were ever, you know, kidnapped or murdered.

I didn’t want to think about it.

The cemetery down the street from me has sales on gravesites from time to time. I know that I will die, that someday a gravesite will need to be purchased for me, and that I certainly will not die as a result of purchasing a gravesite.

I’m not going to buy a gravesite any time soon.

So I can understand that if a parent is terrified of their child having sex, a vaccine against a sexually transmitted infection would sound like something they don’t want to talk about. Even though it could save a girl’s life years from now, if immunity holds (the vaccine is young, but so far so good). Even though the immune response is strongest in young children. Even though it could prevent cancers in boys, too.

As one parent told NPR:

“I realize it’s probably more about my squeamishness with the thought of her becoming sexually active than the vaccination itself,” she says. “It’s not the science. I think it’s my own issues around her developing sexually.”

Sociologist Sinikka Elliott did one of those squishy, qualitative, humanities studies and wrote that in interview after interview, she heard parents think of their own teens as young, naive, and not ready for sex, and it’s everybody else’s kids that are sex-crazed, even predatory. This includes parents of boys as well as girls. One mom said she wouldn’t be ready to talk to her son about contraception until he leaves for college, even though he had already had a pregnancy scare with his girlfriend.

HPV is down, which is a good thing…

The CDC announced last month that HPV infections are down 56% in teen girls, even though only a third of that demographic is fully vaccinated. The shot works to prevent some transmission, it seems, even at that low rate. It’s good news for those girls and their current and future partners (boys’ HPV rates weren’t included in the report, although it was published alongside a study in men that concluded condoms prevent transmission. More good news!). Since then, the analyses have trickled out, centering mainly on the Big Question: Why oh why aren’t more people getting this vaccine?

You’ve already heard what I think about the “not needed” answer, and others have commented on safety concerns. I’d like to point out a few statistics about another commonly given answer, that the parent refuses the vaccine because they believe their child isn’t sexually active. First, the vaccine is timed specifically to occur before sexual activity. Second, especially for parents of older teens, are you really so sure?

According to the CDC, almost half of high schoolers have had sex. The Guttmacher Institute reports that young people have sex for the first time, on average, at 17; but that includes six percent who had had sex by age 15, two percent at age 12. Are you ready to feel really uncomfortable? For 11% of teens, their first sexual experience was “unwanted.” If you don’t want to plan for your kid having sex, you probably really don’t want to plan for them getting raped. But it happens.

HPV is up in throat cancers, which is sort of a good thing too.

It may be time to shift the conversation on this vaccine away from the focus on teen girls. Gardasil is also approved for boys, and they can suffer HPV-linked cancers too, including those of the penis, anus, and oropharynx (think throat).


Role of HPV in various cancers. Graph from Wikipedia, data from here.

The vaccine may turn out to be more important than expected: although cancer rates are falling across the board (and nobody knows why), oropharyngeal cancers – think throat cancer – are increasing. HPV types 16 and 18, which are included in both HPV vaccines, cause 90 percent of HPV-associated throat cancers. Remember Michael Douglas’s announcement that he had HPV-associated throat cancer, possibly contracted through oral sex? That’s the type that’s on the increase. In the 1980s, 16.3% of oropharyngeal cancers were caused by HPV; twenty years later, the percentage had jumped to 71.7%. (The good news? Oropharyngeal cancers have a better prognosis when they are the HPV kind.) The decline in tobacco use is partly responsible, but researchers conclude delicately that “changing sexual practices” mean that more people are being exposed to the virus via their throats.

Bingo numbers (red)

HPV types 16 and 18 are responsible for 70% of cervical cancers and 70% of oropharyngeal cancers. Both HPV vaccines protect against these types. Gardasil also protects against types 6 and 11, which cause 90% of genital warts. Photo by Abbey Hendrickson.

KJ Dell’antonia describes the awkwardness of following the HPV vaccine schedule for her son. It requires three shots given within six months, so that means two extra visits outside of the annual checkup he’d be expecting. A curious child, she writes, could ask too many questions about the extra visits, and force a conversation on sex before the parent is ready for it. She writes that the vaccine’s cause could by helped by making the shot fit into annual visits, and providing support for parents on how to have that awkward conversation.


The HPV virus

Still, the vaccine has an image problem.

It doesn’t help that many people first heard of the vaccine via marketing campaigns from Merck, rather than from their doctor.

It doesn’t help that a vocal minority of Americans are distrustful of any vaccine and will spread negative information both factual and fictional. (It doesn’t help that vaccines hit all of our risk-perception blind spots.)

It doesn’t help that the vaccine and Pap screening can be seen as competing with each other, and that the reasoning for recent changes in the Pap screening schedule (most women clear the virus within a few years, young women fastest of all) also leads parents to question the necessity of the vaccine: why vaccinate when screening can catch abnormalities before they turn into cancer?

In fact, 30% of cervical cancers can’t be prevented by the vaccine, and many women who should be getting Pap screens aren’t. Older women, less-educated women, and Asian women are the least likely to have been screened recently, and screening rates are dropping.

Screening doesn’t take the place of prevention, of course. Being aware of changes in your moles doesn’t mean you forgo sunscreen.

What’s the story outside America? Worldwide, half a million women get cervical cancer each year and half of those die from it. Eighty-five percent of those deaths are in low and middle income countries. A review published in March details successes and failures of HPV vaccine campaigns. Spain, Scotland, England, Portugal and Australia all have over 70% coverage. In Rwanda, an aggressive public health campaign combined with donations of the vaccine from Merck resulted in 99% coverage. Vaccination campaigns aren’t all roses in other countries, though. India is dealing with a serious HPV vaccine image crisis itself, after deaths were blamed on the vaccine.

What do you think? Could the HPV vaccine change its image? Do we need a cervical cancer awareness campaign? Teal and white are the colors, if anybody wants to get on that.


How would this look on a 5K?

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