Progress on HPV Vaccines Is Too Important to Lose

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HPV vaccination among US teenagers plummeted during the early pandemic, a disappointing reversal for shots that can prevent more than 33,000 cases of cancer each year. Worse, efforts to get vaccinations back on track could be thwarted by legal trouble.

We cannot let a decade of slow and steady progress on the HPV vaccine be lost.

It took a decade to get the American public to accept the HPV vaccine as a safe and effective part of routine health care. These efforts included mitigating the (unsubstantiated) belief that these injections could promote sexual activity among adolescents by preventing HPV. That’s because the virus excels at spreading through skin-to-skin contact—so much so that almost everyone is exposed, perhaps multiple times, during their lifetime. And while the immune system can clear the infection most of the time, certain strains can linger for years, starting a process that turns otherwise healthy cells into cancerous ones.

There’s no doubting the benefits of these shots: The HPV vaccine can nearly eliminate cases of cervical cancer and has a profound effect on many others, including rectal, penile, vaginal, vulva, and some types of head and neck cancer.

These vaccines also save the health care system money. A recent study commissioned by the Children’s Research Hospital of St. Jude, found that preventing cancer by increasing the number of completed HPV vaccinations could reduce direct national health care spending by more than $26 million.

This is one of the reasons why HPV vaccination is now the norm for adolescents in many parts of the US. From 2016 to 2021, the percentage of teenagers who received their first shot in the vaccine series jumped from roughly 60% to nearly 77%. And the gap in vaccination coverage between girls, the original targets of these shots in 2006, and boys, who were recommended by the Centers for Disease Control and Prevention in 2011, is finally starting to close.

The pandemic threatened to reverse this progress. Disruptions to routine doctor visits and changes in priorities during appointments meant that about 1 million doses were missed in 2020. Data from the CDC’s annual survey of adolescent vaccinations suggests at least a partial recovery in 2021, but we won’t have full data until next year.

The missed doses also coincide with an increasingly hostile climate for preventive health services that fall under the broad umbrella of reproductive or sexual health. This politicization of routine health care could undermine access to and acceptance of HPV vaccines.

After the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, which led to the overturning of the landmark abortion decision Roe v. Wade, access to many other therapies and preventive services, including HPV vaccination, may be at risk. Reproductive health experts worry that states with the most draconian abortion laws could next try to restrict access to FDA-approved drugs or vaccines that conservative groups have long considered controversial. For example, Texas lawmakers tried to ban gender-affirming care for teens earlier this year, and other states are trying to make access to hormone therapies more difficult.

And even if individual states do not take over such cases, private insurance companies do. This risk to the HPV vaccine was made clear earlier this month by a ruling in a lawsuit filed against the US government by Christian employer Braidwood Management. The company said the Affordable Care Act required it to include certain types of preventive care that violated its religious beliefs, and a Texas judge agreed — at least in part. The ruling said Braidwood was not required to offer health insurance that would have covered PrEP, a drug to prevent the transmission of HIV.

But the original suit wasn’t just about PrEP. She also called for coverage of contraceptives, HPV vaccination, and screening and counseling for sexually transmitted infections. And while the lawsuit ultimately didn’t affect HPV vaccine coverage, the decision doesn’t insulate them from future problems, says Andrew Twinamatsiko, associate director of the Health Policy and the Law Initiative at Georgetown University’s O’Neill Institute. Legal Center. The Texas ruling “exposes additional preventive services to those vulnerable to religious appeals, however spurious.”

These kinds of legal challenges to preventive care are occurring in states where HPV vaccination rates are already among the lowest in the country. In Texas, for example, only 51% of teenagers were vaccinated against HPV in 2021.

Mississippi, which brought Dobbs’ case to the Supreme Court, ranks last in the nation for HPV vaccination among teenagers — only 33% of teens there have been fully vaccinated against the virus. A recent survey of providers there revealed many reasons for this lack, from anti-vaccination views, to HPV’s connotation of sexual activity, to the way providers talked to parents about the vaccine—offering it as an option rather than recommending it as routine care, e.g.

Reproductive and sexual health workers are bracing for more legal challenges that, if sustained, could make HPV vaccines less affordable for some families. Just as important, they could change the perception that these shots are a routine part of health care.

“We should feel positive and optimistic about the progress we’ve made and not let this reframing of the HPV vaccine be this weird fringe thing,” says Melissa Gilkey, a professor at the Gillings School of Global Public Health at the University of North Carolina.

Fortunately, there are some states that are showing how to do it right. Rhode Island stands out as having the highest HPV vaccination rate in the country in 2021. This is not surprising since the state is one of the few to mandate vaccination. As of 2015, children there are required to begin the series before entering seventh grade. Mandates will probably not be the solution for every state, but they should be considered in places where it is politically feasible (and where it will not draw negative attention to these shots).

And the message of St. Jude’s also proposed a secondary path to improving HPV vaccination: improving the meningococcal vaccine, which is usually also offered when a child turns 11. This vaccine is mandatory in many but not all states, and the report found that people who get one often get the other. Healthcare professionals should be trained to strongly recommend both, the researchers said.

But unless the courts continue to recognize these cancer preventions as essential health care, it will be difficult—if not impossible—to help the HPV vaccine regain its momentum. It would simply be a shame to go back with a vaccine that could save so many people from cancer.

More from Bloomberg:

• Who is still dying from Covid? CDC can’t answer that: Faye Flam

• Groundbreaking malaria shot needs more funding to succeed: Lisa Jarvis

• Don’t want late abortions? Facilitate early access: Sarah Green Carmichael

This column does not necessarily reflect the opinion of the editors or Bloomberg LP and its owners.

Lisa Jarvis is a columnist for Bloomberg Opinion covering the biotechnology, healthcare and pharmaceutical industries. Previously, she was executive editor of Chemical & Engineering News.

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