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Second Opinion

Risky Business

Keeping kids healthy includes giving the HPV vaccine. So what’s stopping us?

umbrella illustration

Illustration by Sherrill Cooper

As a pediatrician and adolescent medicine specialist, I feel strongly that providing immunizations, because of their dependable effectiveness at preventing disease, is the most important part of my job. Most pediatricians feel the same way, which is why it is puzzling to me that the pediatric community is blamed for the relatively low uptake of the HPV vaccine. 

According to the Centers for Disease Control and Prevention (CDC), four out of every 10 adolescent girls and six of 10 boys haven’t started the recommended HPV vaccine series. This is abysmal when compared to the less than one in 10 U.S. children who has not received earlier childhood vaccines, such as measles, mumps and rubella, or polio. 

What makes the HPV vaccine so different? It can’t be the disease prevalence: The CDC estimates that 14 million people are infected with HPV annually in the United States, and that nearly all will be infected at some point in their lives. It can’t be the disease severity: HPV is known to cause a variety of cancers, including cervical, oropharyngeal and penile. It can’t be the efficacy, since vaccine trials have shown that 99 percent of vaccinated individuals develop immunity to the virus, and epidemiologic data following introduction of the vaccine demonstrated a 56 percent reduction in HPV infection among teens. In fact, the HPV vaccine is the first cancer-preventing vaccine available.

No, what seems to make the HPV vaccine different is that the virus itself—and many of the diseases the vaccine targets—is related to sex, and when it comes to sex and teenagers, too many adults, including parents and pediatricians, want to avoid the subject. 

If we want to protect our youth, however, both parents and pediatricians need to step up to the plate and use all tools at our disposal to keep them healthy, including the HPV vaccine. Parents and pediatricians have to acknowledge that vaccinating kids doesn’t increase the risk that they will engage in earlier or more risky sexual activity. In fact, one of the benefits of giving the vaccine at the recommended age of 11 is that this is much earlier than the age when most adolescents will begin having sex, and it should allow parents and providers to focus on the cancer-preventing properties without having to also relate it to current sexual activity. 

That being said, it is also critical for clinicians caring for adolescents and their families to help prepare them for the fact that nearly all youth will eventually engage in sexual activity, and that a majority will initiate sex by the time they reach 19. Epidemiologic data tell us that this has been true for many decades in the United States, well before the HPV vaccine was developed. In my own research and clinical work, I have found that youth are seeking more opportunities to learn about and discuss their reproductive health with doctors and other trusted adults. So as clinicians working with adolescents, we have an important obligation to give them a safe space to do that.

I have spent the past 10 years working as an adolescent medicine physician, and during that time, I have recommended the HPV vaccine to countless adolescents and parents for all of the reasons outlined above. This fall, I will sit on the other side of that conversation for the first time when I take my own child for her 11-year-old well-child visit. Like any other parent preparing for the joys and challenges of the adolescent years ahead, I am apprehensive. I know I will need advice from friends and colleagues about the best way to handle many situations, but this HPV decision isn’t one of them. To me, a vaccine that reduces my daughter’s chance of cervical cancer is a no-brainer. n

Krishna Upadhya is an assistant professor of pediatrics and an adolescent medicine specialist at Johns Hopkins.

What seems to make the HPV vaccine different is that the virus itself—and many of the diseases the vaccine targets—is related to sex, and when it comes to sex and teenagers, too many adults, including parents and pediatricians, want to avoid the subject.