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Why Are HPV Vaccination Rates So Low? Misconceptions Among Patients and Providers May Play Equal Parts

Barley half the nation’s adolescents complete the recommended two doses of the human papillomavirus vaccine, even though the immunization has demonstrably reduced cases of HPV infections and pre-cervical cancers since it was first introduced in 2006.

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Two new studies published in September shed light on why patients and their parents don’t consider it a standard part of the vaccine schedule in the same way as the MMPR or Tdap. One, published in Pediatrics, suggests that providers working in pediatrics and family medicine don’t adequately emphasize the importance of the shot; another, published in JAMA Pediatrics, found that most U.S. adults don’t understand the breadth of diseases HPV can cause.

What Did the Studies Find?

The Pediatrics research surveyed 588 providers, primarily physicians, who work with children, and found that many parents refuse the HPV vaccine for their adolescents. (The Centers for Disease Control and Prevention recommends all boys and girls between 11 and 12 years old receive both doses.)

Providers don’t emphasize the importance of the HPV vaccine

What often plays a determining role in their decision is how the provider talks about it. For example, if providers use a “presumptive-style” approach — where they say something like, “We’ve got three vaccines today: Tdap, HPV and Meningitis,” and don’t single out HPV — parents are more likely to agree. 

Researchers also found that providers’ acceptance of the vaccine has improved drastically since 2006, but they’re still not in full agreement. Six years ago, only 60 percent of pediatricians “strongly recommended” the vaccine for girls, compared to 85 percent in 2018. For boys, that stat rose from 52 percent in 2013 to 83 percent in 2018.

Patients don’t understand the full impact of HPV infections

The second JAMA study examined misperceptions among the public about the severity of HPV — which, according to its authors, contribute to low-vaccination rates. Looking at 2,564 men and 3,697 who took the National Health Survey, it concluded that two-thirds of men and one-third of women between 18 and 26 did not know that HPV causes cervical cancer.

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In addition, more than 80 percent of men and 75 percent of women in the same age group did not know that HPV can cause oral, anal and penile cancers. What’s more, it only 19 percent of men and 31.5 percent of women who were either eligible or had an eligible family member for the vaccine received recommendations from a provider.

“Low levels of HPV knowledge in these older age groups is particularly concerning, given that these individuals are (or will likely be) parents responsible for making HPV vaccination decisions for their children,” said Kalyani Sonawane, PhD, assistant professor at UTHealth School of Public Health, the study’s lead author, in a statement.

What Should Providers Tell Patients About the HPV Vaccine?

First, providers should take time to remind parents and patients of the HPV vaccine schedule:

  • Children between 11 and 12 years old should receive the first dose and then the second 6 to 12 months later.
  • Patients who start the vaccine series at 15 years old or later should receive three doses over a six month period.
  • The CDC recommends the vaccine for adults up to age 26. Unvaccinated adults between 27 and 45 years old should talk to their providers about the risks and benefits.

Important facts about HPV for providers

Then, you can share the following facts about the vaccine, per the American Cancer Society:

HPV vaccines are safe. More than 270 million doses of the vaccine have been distributed worldwide, with more than 100 million doses in the U.S. The most common side effects are very mild, as is the case with most immunizations.

HPV vaccination does not cause fertility issues. In fact, it can actually protect fertility by preventing gynecological problems related to the treatment of cervical cancer.

HPV vaccines do not contain harmful ingredients. Yes, it does contain aluminum, but people are exposed to aluminum every day through food and cooking utensils. Aluminum-containing vaccines have been used for decades and have been given to more than 1 billion people without problems.

HPV vaccination is necessary regardless of sexual activity. For parents concerned about giving a vaccine protecting against an STI to a child, explain that research shows the later it’s administered, the less protection it offers.

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Boys and girls should receive the HPV vaccine. HPV is most commonly associated with cervical cancer, but it can lead to numerous cancers in men, such as oral, penile and anal cancers.

The HPV vaccine is highly effective at preventing cancer. Studies have shown it prevents almost 100 percent of persistent cervical infections with HPV types 16 and 18, plus the pre-cancers that those persistent infections can cause.

The HPV vaccine does not lose effectiveness over time. Current research shows those who received the HPV vaccine continue to have antibodies to the virus, which provides long-term protection. There is no indication that they decrease over time.


HPV Vaccine Delivery Practices by Primary Care Physicians, Pediatrics.

Public Knowledge of Human Papillomavirus and Receipt of Vaccination Recommendations, JAMA Pediatrics.

Human Papillomavirus (HPV): Vaccinating Boys and Girls, Centers for Disease Control and Prevention.

HPV Vacs: Just the Facts for Providers, American Cancer Society.

Last updated: 9/17/2019

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