HPV vaccines save lives, data shows. So why are so many Iowa children not getting shots?

Nearly two decades since the vaccine against HPV first arrived in Iowa, local public health officials in parts of the state say they still struggle to persuade residents to vaccinate their children.

In 2023, about 56% of the state's 13- to 15-year-olds were fully vaccinated against the human papillomavirus, a sexually transmitted infection that is linked to deadly cancers. That includes certain types of cancers that are prevalent in Iowa.

The new data from the Iowa Department of Health and Human Services shows last year's immunization rates are in line with recent years. The HPV vaccination rate among adolescent Iowans had fallen slightly from 57% in 2022 and from nearly 58% in 2021 and nearly 59% in 2020.

However, the state's public health data paints a starker picture in portions of southeast and eastern Iowa, where the HPV immunization rate falls below 30%. Local public health officials in those areas say they have long struggled to make progress on the vaccination rate, pointing to stigma and misinformation about the vaccine as significant factors.

Health experts warn HPV can spread easily in areas with low immunization rates, which in turn increases the risk for nearby counties, even those with higher vaccine uptake.

That's an alarming possibility for health experts, who say a lack of protection against HPV increases the risk that more Iowans could be exposed to deadly, cancer-causing viral strains.

"Down the road, those cancers lead to a lot of deaths, and they’re going to lead to a lot of deaths of Iowans. Anything we can do to increase those vaccination rates is important," said Dr. Nathan Boonstra, a Des Moines-based pediatrician and chair of the Iowa Immunizes Coalition.

Why do some Iowa counties have lower vaccination rates?

Van Buren County had the lowest HPV immunization rate in Iowa last year, with just 23% of its 13- to 15-year-olds fully vaccinated. That's a drop from 37.5% in 2020.

“In our county, it has not been well-accepted," said Lindee Thomas, public health administrator for Van Buren County.

Thomas said the county has a large Amish and Mennonite population who have universally turned down the shots for their children. But even outside that population, parents typically decline the two-series vaccine, saying they believe their children aren't old enough for a vaccine that protects against a sexually transmitted virus.

“It’s been a conversation for years," Thomas said. "We’ve always had issues with that one. When it first came out, I think it was promoted as more of a sexual vaccine instead of a cancer-preventing vaccine, and I think that has stuck with that vaccine.”

The vaccine is recommended to girls and boys at 11 and 12 years to prevent serious health problems caused by HPV, which is the most common sexually transmitted infection in the United States.

While most infections clear up on their own, HPV infections in some cases can cause certain types of cancer, including cervical, vulvar, vaginal, anal, penile and oropharyngeal (throat).

“It inherently gets stigmatized," Boonstra said. "That’s really too bad, because most people who are sexually active in their lives will contract at least one type of HPV. That’s pretty universal.”

Boonstra said the vaccine is recommended to adolescents because the shots have been found to be more effective against HPV infection if the vaccine is administered before that individual is exposed to the virus.

The 2024 Cancer in Iowa report by the University of Iowa states Iowa ranks second in the nation for the highest rate of new cases of oral cavity and pharyngeal cancer. Researchers at UI pointed to alcohol consumption as a leading contributing factor, but other studies have shown HPV is one of the leading causes of cancer in the throat, particularly among men.

"In fact, HPV-related cancers kill more people every year than polio, measles, tetanus, and chickenpox (varicella) combined before vaccines for these diseases were developed," state public health officials say.

Michele Cullen, public health manager for Jackson and Clinton counties, said Jackson County lacks many primary health care providers that can offer the immunization. She believes that is a major contributing factor in other rural counties, too.

To encourage residents to seek out the shots, Cullen said her public health staff have tried multiple ways to raise awareness about the importance of these shots.

They send students home with packets of information for their parents. Their nurses adjust hours at the county immunization clinic to expand appointment hours.

Despite this, Jackson County 's immunization rate among its 13- to 15-year-olds was just 26% in 2023, one of the lowest rates in the state. That compares to 31% in 2020.

Clinton County's immunization rate was nearly 37% in 2023.

“We’ve done outreach, we’ve done awareness and education, but we have not seemed to move the needle very much," Cullen said.

HPV shots are a frequent target of anti-vaccine legislation

Since the HPV vaccine was first recommended by federal health officials in 2006, infections of HPV strains that cause cancers and genital warts have fallen "88% among teen girls and 81% among young adult women," according to the U.S. Centers for Disease Control and Prevention.

“HPV vaccine is one of the most life-saving vaccines that we have," Boonstra said. "It is demonstrated to drastically reduce certain kinds of cancer, especially cervical cancer, but also head and neck cancers."

But because of the stigma and because it is a relatively new vaccine, Boonstra said HPV has been an "easy target" for anti-vaccine movements that have eroded confidence in the shots.

In recent years, several bills have been introduced to the Iowa Legislature that raise concerns to public health advocates like those at the Iowa Immunizes Coalition.

That includes a bill being considered by lawmakers this session that would revoke a minor's right to consent to the HPV vaccine. Senate File 2064 passed a committee vote last week, making it eligible for Senate debate.

Boonstra said if the bill did go into effect, that provision likely wouldn't affect immunization rates in Iowa. Still, he said such legislation could "chip away at the margins.”

"I really do think that our legislators know that vaccines are important," Boonstra said. "I think they know that HPV vaccine is important. Some may need to learn more about the importance of adolescents being able to make some of their health care decisions as they reach a certain age."

The Iowa Immunizes Coalition continues to watch this type of legislation closely, and other factors that could impact Iowa's immunization rate.

“We want kids to grow up healthy," Boonstra said. "We want to reduce the risk of cancer as much as possible, and an adolescent who doesn't have that vaccine is going to be at a higher risk of a number of cancers.”

Michaela Ramm covers health care for the Des Moines Register. She can be reached at mramm@registermedia.com, at (319) 339-7354 or on Twitter at @Michaela_Ramm

This article originally appeared on Des Moines Register: Low Iowa HPV vaccine rates fueled by misinformation, stigma, experts say