HPV shot could prevent 6 types of cancer, but controversy keeps NY vaccination rates low
Two doses of one vaccine protect against a group of viruses that can cause six kinds of cancer.
The shots are recommended for 11- and 12-year-old children. As of 2020, not quite one in four 13-year-olds — 24.5% — had gotten both shots in New York outside of New York City, according to a recent report by the New York State Health Foundation.
The virus in question, HPV, or the human papillomavirus, is transmitted through sexual activity and causes the majority of cervical, vaginal, vulvar, anal, penile and oropharyngeal (i.e. back of the throat, base of the tongue, tonsils) cancers in the United States, according to the Centers for Disease Control and Prevention.
HPV vaccination is available until age 26, but it’s most effective if given before a person becomes sexually active.
Yet the shots — available for girls since 2006 and for boys since 2009 — have been hindered by controversy, at first over the idea of vaccinating children against a sexually transmitted infection and later in the general anti-vaccine sentiment of the COVID-19 pandemic.
The percentage of 13-year-olds who have been vaccinated is good news, said David Sandman, the health foundation’s CEO, because it’s going up. In 2018, just one in five, or 20.1 percent, of 13-year-olds had gotten the shots.
“This was encouraging news,” he said. “We are seeing HPV vaccination rates improve overall in this state. They’re improving in both boys and girls. So definitely good news to celebrate here.”
More: Could HPV vaccine be added to state’s list of mandatory shots for students?
More: HPV vaccine still causing angst
HPV vaccination by the numbers
Many kids get the shots after they turn 13. The vaccination rate for 17-year-olds is 68.7 percent in New York, compared to 58.6 percent nationally, Sandman said.
The bad news about the numbers is that only two counties, Cortland and Niagara, of those outside New York City have met the state’s Prevention Agenda goal of 37.4 percent coverage for 13-year-olds by 2024. Rates varied from Cortland at 40.8 percent to Jefferson County at 9.9 percent.
In Oneida County, 26.4% of 13-year-olds were vaccinated in 2020; in Herkimer County, 26.4%; and in Madison County, 28%.
The stakes are high for the HPV vaccine. “HPV is the single most common sexually transmitted infection in the United States, very common and very prevalent,” Sandman said. “The majority of Americans are infected by HPV at some point in their lives. And it can have serious health consequences, especially for women. And it is one of only two vaccines (along with hepatitis B) that can help prevent cancer.”
Why some parents do not approve of the vaccine
But when the HPV vaccine first came out, it faced pushback from parents who argued that getting kids vaccinated was like giving them permission to have sex.
Those kinds of arguments seem to have died down, though, and vaccination rates started going up nicely, said pediatrician Dr. Chris Both Kjolhede, co-director of Bassett Healthcare Network’s school-based health centers.
“Then I think HPV got wrapped up in all the COVID controversy,” he said. “So we haven’t been doing as well recently in getting parents to listen to our pitch.”
Some parents will approve any shots that their family doctor recommends, Kjolhede said. And some won’t agree to certain shots no matter what the doctors says, he said.
Others are interested, but worried.
“And those are the people we spend time with,” he said. “Those people often can be persuaded, perhaps not the first time that you meet them, but in time.”
He explains the vaccine to parents by comparing HPV to cancer-causing cigarettes, Kjolhede said.
“What if you could give a vaccine and if they were so stupid as to pick up that habit, at least they’d be protected against cancer?” he said he asks. “That’s what I’m promoting here. You don’t want your kid to go out and have sex at age 11. On the other hand, at some point in their future, they may go out and have sex.”
Report: Explore making HPV vaccine a school requirement
Strong recommendations by doctors like Kjolhede likely are one of the factors that have pushed up HPV vaccination rates over time, the health foundation report noted.
It also gave credit to electronic health records and to the availability of HPV shots in school-based health centers, such as those in which Kjolhede works.
To drive the numbers up further, it suggested that New York explore two more strategies: allowing pharmacists to administer HPV vaccines, as they already do for flu and COVID-19 shots; and making them mandatory for school attendance.
Although most of the required shots are for diseases like measles and pertussis that could be spread in a classroom setting, hepatitis B, for which the vaccine is required, could not spread in a classroom, providing a precedent, Sandman said.
Rhode Island, Virginia, Hawaii and the District of Columbia already require HPV shots for school attendance, he said, adding that the evidence on the benefits is mixed.
“Our position was not necessarily to recommend a mandate,” Sandman explained. “It was something that should be explored.”
Variations between groups
Parents’ willingness to let their kids get the HPV vaccine does vary from area to area, Kjolhede noted. In Cooperstown, where many health care workers live, more parents say "Yes," for example, than in a town just 17 miles away where vaccine hesitancy is much more prevalent, he noted.
That backs the foundation study which found substantial county-to-county variations in immunizations rates as well as variations between different groups. Here are some of its findings:
The regions with the lowest vaccination rates were Long Island and the lower Hudson Valley. Sandman said vaccination rates generally vary from place to place, but the reason is not clear.
Girls had a slightly higher vaccination rate — 25.9% versus 23.4% — which could be because the vaccine was approved first for girls or because people associate it more with cervical cancer than male cancers, Sandman said.
Black and Latino kids had higher vaccination rates than white and Asian kids in contrast to most vaccines and many other health statistics. Sandman said it could be that higher cervical cancer rates among Black and Latina women have sparked more awareness or because Medicaid patients, who are disproportionately Black and Latino, are more likely to get the HPV vaccine.
Amy Roth covers issues that affect families for the Observer-Dispatch. Email Amy Roth at aroth@gannett.com.
This article originally appeared on Observer-Dispatch: HPV vaccine: COVID, controversy keep New York's vaccination rates low
