Why Aren't More Parents Vaccinating Their Kids Against Cancer?

A chronicle of the medical community’s mistakes getting the HPV vaccine out.
The human papillomavirus vaccine is most effective when administered to pre-teens. So why do so many parents delay vaccinating their kids?
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The human papillomavirus vaccine is most effective when administered to pre-teens. So why do so many parents delay vaccinating their kids?

If there were a vaccine that could protect your 11-year-old son from getting cancer as an adult, you’d make sure he got it, right?

As it turns out, this immunization exists, but a majority of young boys are not adequately protected, as journalist Jane Brody noted in The New York Times on Tuesday.

The human papillomavirus vaccine ― which protects against HPV-associated cancers including throat and tongue, cervical, vaginal, vulvar, anal, and penile cancers ― is strongly recommended as cancer prevention for 11- and 12-year-old boys and girls by the U.S. Centers for Disease Control and Prevention.

The bad news: In 2015, just 28 percent of boys ages 13-17 had undergone the recommended three-dose HPV vaccine course for maximum cancer protection, and only 50 percent of boys had received at least one dose. In comparison, 81 percent of boys and girls ages 13 to 17 received a meningococcal conjugate vaccination and 86 percent received a Tdap vaccination ― two other common vaccines recommended for that age group.

Why is the HPV vaccine so unpopular? A series of blunders provide a lesson in how a cancer vaccine rollout went so wrong ― and how it’s still affecting children a decade later:

Mistake #1: The vaccine was initially introduced for girls only

The HPV vaccine got off to a rough start. For starters, the vaccine was originally only tested on and approved for girls and women. The vaccine wasn’t approved for boys until 2009, three years after it was introduced, and wasn’t recommended for boys until 2011, according to NPR.

“That was a terrible mistake,” Dr. Gregory Poland, who heads up Mayo Clinic’s Vaccine Research Group and serves as editor-in-chief of the journal Vaccine, told The Huffington Post. “It pretends that only women get or acquire the disease and that simply isn’t true.

Today, both CDC and American Academy of Pediatrics recommend that pediatricians emphasize the HPV vaccine’s cancer-preventing benefits and stress that children receive all three doses at a young age.

“If they had waited until it was recommended for both boys and girls, that would have made a big difference,” Sarah Gollust, an assistant professor of health policy and management at the University of Minnesota School of Public Health, told NPR.

Mistake #2: No one explained to parents that the vaccine was most effective in children

The FDA’s original 2006 press release notes that the HPV vaccine is only effective prior to being infected with the HPV virus. But it doesn’t stress that the vaccine is less effective for 20-somethings than for preteens, a key ommission that could have led parents to delay vaccinating their daughters.

While the release may have been based on the research available to the agency at the time, this didn’t help vaccination rates, nor did it dispel the misconception that 20-something women are the ideal candidates for HPV vaccination.

I commonly hear parents thinking that it’s better to wait until their children are sexually active before immunizing,” said Dr. Dean Blumberg, associate professor and chief of pediatric infectious diseases at UC Davis Children’s Hospital.

Unfortunately, that thinking isn’t only incorrect, it’s downright harmful.

“Younger children have a more robust immune response to HPV vaccine compared to older children and young adults,” Blumberg explained. “Specifically, children 9 to 15 years of age develop higher antibody levels after the vaccine series compared to 16- to 26-year-olds.”

Indeed, in 2013, when vaccination rates for the three-doses series hovered around 33 percent, the CDC issued a warning to Americans. Each year of low vaccination rates (numbers far shy of the agency’s 80 percent vaccination goal) would translate into an additional 4,400 future cervical cancer diagnoses and 1,400 attributed deaths. And the the statistics for HPV-related cancer are dire enough already. Every year, approximately 17,600 women and 9,300 men are diagnosed with cancer caused by the virus.

“This is a tragedy in the making,” Blumberg concluded.

Mistake #3: Poor sex ed and parental squeamishness didn’t help

Although HPV is the most common sexually transmitted infection in the United States, parental focus on the virus’ sexual transmission, rather than its cancer-causing properties, is a big frustration for doctors and health experts.

The issue is especially important because it’s not just penetrative vaginal sex that spreads HPV, and “kids are very, very naive about what constitutes sexual risk and exposure,” Poland said.

The virus can be transmitted by anal and oral sex, as well as close skin to skin touching during sexual activity, according to the CDC. Parents may be hesitant to think about their 11-year-olds having sex or even close sexual contact at some point in the future, but ultimately, that prudishness leaves their kids more vulnerable to the virus. Fourteen million new infections happen each year.

“As much as I wish it were the other way around, we as parents don’t have any control over when sexual debut would occur,” Poland said. In other words, you can’t schedule when your kid loses his virginity, and might not even know when it happens at all.

“I’m not suggesting that we hide the fact that HPV is sexually transmitted. ... But first let’s get your child protected against cancer.”

- Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital

Mistake #4: Some parents still believe this HPV vaccine myth

Some politicians, primarily conservatives, latched onto the idea that a vaccine to protect young women from sexually transmitted disease would promote sexual promiscuity, and consequently the HPV vaccine quickly developed a controversial reputation.

But that’s patently false, researchers say. A 2014 Canadian Medical Association Journal study of 260,000 girls found no difference in pregnancies or sexually transmitted diseases between vaccinated and unvaccinated participants over four years.

“I remember a very similar concern that somehow giving hepatitis B vaccine was going to increase sexual promiscuity,” Poland said. “There was absolutely no evidence for that, much as there’s been no evidence in attitudes with HPV vaccine.”

Blumberg says the main focus should be on the anti-cancer properties of the vaccine, and protecting children from disease, rather than sex.

“I’m not suggesting that we hide the fact that HPV is sexually transmitted,” he said. “If you want to talk about sex, we can do so, but first let’s get your child protected against cancer.”

UPDATE: This article has been updated to include 2015 vaccination rates.

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