The success of the COVID-19 vaccine, an almost unimaginable scientific achievement just a year ago, has brought the debate over the required immunization back to the attention of our state.
As states and districts decide whether children should receive the COVID-19 vaccine before returning to class, it’s a good time to think about another life-saving vaccine that is grossly underused and should also be required by schools in Pennsylvania: the HPV vaccine.
HPV, or human papillomavirus, causes a variety of conditions, ranging from benign to fatal. Some strains cause genital warts, while others cause cancers of the cervix and other organs. It is spread through any form of genital contact and is so common that the vast majority of Americans will be infected with some type of infection during their lifetime.
The HPV vaccine, first approved for girls in the United States in 2006, is one of two available vaccines that prevent cancer-causing viruses. Since its debut, it has proven to be so safe and effective that the American Academy of Pediatrics now recommends the two-shot series for all children ages 9 and above.
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Despite this recommendation, the HPV vaccine is administered at drastically lower rates than other childhood immunizations. According to the Centers for Disease Control and Prevention, in 2019, only 51% of teens were aware of their HPV series, compared to 91% for the measles-mumps-rubella series.
When the vaccine was first introduced, vaccination was hampered by the belief that getting the shot would encourage teens to have sex. There is plenty of evidence to disprove this theory, and thankfully this is now relatively low on the list of reasons why parents choose not to vaccinate their children.
But based on the yawning gap in vaccination rates, there’s no question that parents still view the HPV vaccine as different from other childhood vaccines.
Allowing parents to continue to refuse or delay vaccination based on these views has deadly consequences. The need for mandatory HPV vaccination isn’t about sex at all – it’s about cancer.
Cervical cancer is one of the leading causes of cancer deaths in women worldwide. Treatment of advanced cervical cancer often requires disfiguring pelvic surgery, chemotherapy, and radiation. Despite this aggressive treatment, advanced cervical cancer has a dismal five-year survival rate of 17 percent.
And while cancer is the most feared outcome of HPV infection, it’s certainly not the only unpleasant one. HPV-infected people with positive Pap tests must undergo colposcopy and biopsy, an inconvenient procedure in which a piece of the cervix is removed for microscopic examination. If that biopsy shows cancer or precancer, that patient is now subject to further removal of parts of the cervix (or even all of it), which can cause complications, including bleeding, damage to other organs, infection, and preterm birth.
These outcomes – not to mention those of the other cancers that cause HPV – will be the fate of thousands of children whose parents refuse to vaccinate them. According to the CDC, using the vaccine as recommended could prevent more than 32,000 HPV-related cancers each year.
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As a pediatrician, I and my colleagues have developed strategies to encourage HPV vaccination. These include focusing on the cancer-causing aspect of HPV rather than the sexually transmitted aspect, highlighting the robust data supporting its safety, and grouping it with the other recommended vaccines rather than discussing it separately.
While educational campaigns and one-on-one discussions are critical to building community buy-in, they are modestly effective at best. The best way we have to increase HPV vaccination and prevent cancer is to make it compulsory to go to school. This will be an education campaign in itself: it will point out that the HPV vaccine is just as important for children’s health as it is for meningitis and chickenpox.
Some parents refuse to vaccinate on time because they want to wait until their children are older. Unfortunately, delayed vaccination carries risks. The injection is most effective when given before beginning any form of sexual activity. Since more than half of American teens are sexually active by the time they turn 18, and we don’t test for HPV until age 21, not only is it unnecessary for parents to wait until they decide their children are old enough. to talk about sex. it wastes critical time.
In addition, there is another vaccine against a sexually transmitted cancer-causing virus that public schools in Pennsylvania need: the hepatitis B vaccine given to infants.
Three states have already mandated HPV vaccination for schools, and the results are encouraging. Rhode Island began requiring HPV vaccination for seventh grade enrollment in 2015 and has since made significant strides in closing the gap between HPV and other required vaccinations.
By allowing half of our nation’s children to go unvaccinated against HPV, we are dooming tens of thousands of them to grow up to be cancer patients. They will undergo painful treatments and psychological trauma, and many will die. We have a safe and effective way to save them from this fate. We owe it to them to make sure they receive it.
Leigh Finnegan is a pediatrician in Philadelphia.