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Data Doctor: Human Papillomavirus Vaccine: Why the Delay?

September 2, 2019 by Mountain Family

By Dr. Chris Tonozzi, MD, Director of Data Quality

The human papillomavirus infection was recognized many decades ago as the cause of cervical and other cancers. It was an important breakthrough in 2009 to have a vaccine developed that would prevent infection. The human papillomavirus (HPV) vaccine was approved by the U.S. Food and Drug Administration that year and we started vaccinating at that time. Vaccination began with girls, but shortly thereafter the vaccine was approved for boys and we began vaccinating them as well. The infection is transmitted during sex, and it is one of the most common genitourinary infections today. There are an estimated 6.2 million cases of HPV per year in the United States.

The National Cancer Institute states: “Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures.”(Source.) This is a compelling argument for the vaccine!

To the dismay of many medical providers, the acceptance of the HPV vaccine has been difficult. The Centers for Disease Control and Prevention infographic below shows how the vaccine, even for girls (line 1) has been adopted much more slowly than a vaccine like Tdap (Tetanus, Diphtheria, Pertussis), the top line in the graph (source).

“National and State Vaccination Coverage Among Adolescents Aged 13 – 17 years — United States, 2012.” Morbidity and Morbidity Weekly Report, Centers for Disease Control and Prevention (CDC), 8-30 2013, retrieved 8-27-2019.

Let’s consider what the cause—or causes—might be.

Has vaccine safety contributed to that slow uptake?
The vaccines are very safe and generally have no serious risk of adverse events. More than 100 million doses have been given worldwide (source).

Is the vaccine effective?
The vaccines have demonstrated effectiveness of over 90 percent in protecting against infections due to HPV subtypes 16 and 18, which cause most cervical cancers (source).

Are politics playing a role?
The reason for slow HPV vaccination rates is likely that the vaccine became politicized, related to the increasing polarized political climate in the US. Conservative groups have asserted that making HPV vaccination mandatory is a violation of parental rights. They have also promoted the idea that it will give adolescents a false sense of immunity to sexually transmitted disease (source) and that HPV vaccination leads to promiscuous sexual activity—an argument that research has firmly debunked (source).

Health care providers also share some of the burden of responsibility. A 2015 study of health care provider communication revealed that we were recommending the vaccine less strongly than other vaccines being given at similar ages (source).

At Mountain Family Health Centers, we recently studied our HPV vaccination rates. As part of our Peer Review program, we evaluate whether our providers may be able to improve their practice of medicine. We found that when an adolescent is seen for a preventive visit at Mountain Family, the teen receives the HPV vaccine 79 percent of the time. (Mountain Family does not have the HPV vaccination rate for all of our adolescent patients, just those seen for preventive visits). National data from 2017 show that 49 percent of adolescents were up to date with the HPV vaccine (source).

Our providers are also practicing the latest CDC guidance, which emphasizes communicating the vaccine as a usual adolescent vaccine and emphasizing that it is a cancer prevention vaccine (source).

There has been frustration over the last decade about the slow adoption of the HPV vaccine, but we’re making progress. And we have reason to believe that Mountain Family Health Centers providers are doing exceptional work on this front.


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