Despite initial excitement about the nation’s first explicit anti-cancer vaccination, America’s cultural taboo on teen sexual activity is leaving too many unprotected, especially in rural areas.
The Gardasil vaccine manufactured by Merck was approved by the U.S. Food and Drug Administration in summer 2006. It was the first to protect against several cancers associated with the human papilloma virus, or HPV — cervical, vulvar, vaginal penile and anal. It also later was found to guard against upper throat cancer.
But, a decade later, only about half the nation’s girls and less than 40 percent of boys have been given required doses of the vaccine for full protection, according to data released by the U.S. Centers for Disease Control and Prevention. A separate study shows a persistent knowledge and accessibility gap between rural and urban areas, resulting in less protection for children and teens living in rural areas.
In Iowa, for instance, only about 45 percent of teens are up-to-date with HPV vaccinations, and most of those with the benefit of protection live in population centers. The numbers place Iowa in the middle nationally — above the three lowest states that have roughly 25 percent coverage, and below a dozen that boast coverage rates above 50 percent. (Rhode Island has the highest coverage rate at more than 87 percent for both genders.) Even as vaccination rates are rising overall, people living in rural areas are not only less likely to have been vaccinated, but less likely to know a vaccine exists.
According to researchers, rural adults are less likely than urban adults to believe HPV can cause cervical cancer, that HPV can be transmitted through sexual contact, or that HPV is linked to oral, anal and penile cancers. This despite the fact that rural residents in the U.S. have higher HPV-associated cancer incidence and mortality — a statistic expected to grow if vaccination disparity persists.
This urban-rural vaccination disparity has prompted the Rural Health Information Hub to hold a webinar Sept. 18 featuring speakers from the CDC, academic and public health communities. In addition to addressing HPV vaccination barriers, the group will discuss low opt-in in rural areas of the meningococcal conjugate and Tdap vaccines and provide strategies aim at reducing disparity.
No doubt overall health care access barriers play some role in rural areas, as does a national conversation surrounding vaccines that has erroneously provided credence to conspiracy theories surrounding childhood vaccinations. But the HPV vaccine, because it targets a virus passed through sexual activity, has been specifically highlighted by groups falsely claiming its use will increase or otherwise signal approval of teen promiscuity.
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Such charges have fueled controversy surrounding the vaccine, making some primary care physicians less likely to strongly recommend the series of shots. Instead, parents need to be reminded that clinical trials showed the vaccine provides nearly 100 percent protection against infections caused by common strains of HPV — infections that can lead to cancer and, too often, death.
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