Advances in HPV vaccines are too important to lose

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HPV vaccinations among US teenagers fell precipitously during the early pandemic, a disappointing reversal for vaccines, which can prevent more than 33,000 cancer cases each year. Worse, efforts to get immunization back on track could be hampered by legal challenges.

We must not let a decade of slow and steady progress in HPV vaccination go to waste.

Getting the US public to accept the HPV vaccine as a safe and effective part of routine healthcare has been a decades-long struggle. These efforts consisted of dispelling (unfounded) beliefs that by preventing HPV, these shots might encourage sexual activity in teenagers. That’s because the virus excels at skin-to-skin contact — so much so that nearly everyone may be exposed more than once in their lifetime. And while the immune system can get rid of the infection most of the time, certain strains can persist for years, setting in motion a process that turns otherwise healthy cells into cancerous ones.

So there is no doubt about the usefulness of these vaccinations: the HPV vaccine can almost eliminate cases of cervical cancer and have a profound impact on many others, including anal, penile, vaginal, vulva and certain head and neck cancers.

These vaccines also save the healthcare system money. A recent study commissioned by St. Jude’s Children’s Research Hospital found that preventing cancer by increasing the rate of HPV vaccination completions could reduce national direct health care expenditures by more than $26 million.

This is one of the reasons HPV vaccination is now the norm for adolescents in many parts of the United States. From 2016 to 2021, the percentage of teenagers who received their first vaccine in the vaccine series increased from about 60% to nearly 77%. And the gap between immunization rates in girls, which were the original targets for those shots in 2006, and boys, for which the Centers for Disease Control and Prevention recommended it in 2011, is finally beginning to close.

The pandemic has threatened to undo that progress. Disruptions in routine doctor visits and shifts in appointment priorities resulted in approximately 1 million doses being missed in 2020. Data from the annual CDC survey of teenage immunizations points to 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, which fall under the broad umbrella of reproductive or sexual health. This politicization of routine healthcare could undermine access to — and uptake of — HPV vaccines.

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

And even if individual states do not take up such concerns, private insurers could do so. That risk to the HPV vaccine was highlighted earlier this month by a ruling in a lawsuit filed against the US government by a Christian employer, Braidwood Management. The company said the Affordable Care Act requires it to cover certain types of care that go against its religious beliefs, and a Texas judge agreed — at least in part. The ruling said Braidwood was not required to offer health insurance that covered PrEP, a drug used to prevent transmission of HIV.

But the original suit wasn’t just focused on PrEP. It also called for coverage for 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 protect it from future challenges, says Andrew Twinamatsiko, associate director of public health policy and legislative initiative at Georgetown University’s O’Neill Institute Legal Center. The Texas ruling “makes other prevention services vulnerable to religious challenges, no matter how wrong they may be.”

These types of legal preparedness challenges arise in states where HPV vaccination rates are already among the lowest in the country. In Texas, for example, only 51% of teens were up to date on their HPV vaccination as of 2021.

Mississippi, which brought the Dobbs case to the Supreme Court, ranks last in the nation for HPV vaccinations in teens – only 33% of teens there have been fully vaccinated against the virus. A recent survey of providers there revealed many reasons for the shortage, from vaccine opponents to HPV’s association with sexual activity to the way providers talked to parents about the vaccine – offering it as an option rather than giving it as such recommend normal care for example.

People working in reproductive and sexual health are preparing for more legal challenges that, if confirmed, could make HPV vaccines less affordable for some families. Equally important, they could turn the notion on its head that these shots are a routine part of healthcare.

“We should be positive and optimistic about the progress that’s been made and not allow the HPV vaccine to be reframed as this odd fringe phenomenon,” said Melissa Gilkey, a professor at the University of North Carolina’s Gillings School of Global Public Health.

Luckily, there are some states showing how to do it right. Rhode Island stands out for having the highest HPV vaccination rate in the country in 2021. This is not surprising as the state is one of the few that mandates vaccinations. Since 2015, children there have had to start watching the series before entering seventh grade. Mandates probably won’t be the answer for every state, but places where it’s politically feasible (and where it doesn’t draw negative attention to those shots) should consider it.

And the St. Jude report also suggested a sideline for improving HPV vaccination: improving meningococcal vaccination, which is also usually offered when a child turns 11 years old. This vaccine is mandatory in many states, but not all, and the report found that people who do often get the other. Health workers should be trained to strongly recommend both, the researchers said.

However, it will be difficult — if not impossible — to help the HPV vaccine regain momentum unless the courts continue to recognize this cancer prevention as essential health care. It would just be shameful to go backwards with a vaccine that could save so many people from cancer.

More from the Bloomberg Opinion:

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

• Breakthrough malaria vaccine needs more funding to succeed: Lisa Jarvis

• You don’t want later abortions? Make the early more approachable: Sarah Green Carmichael

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

Lisa Jarvis is a columnist for Bloomberg Opinion, covering biotechnology, healthcare and the pharmaceutical industry. Previously, she was Editor-in-Chief of Chemical & Engineering News.

For more stories like this, visit bloomberg.com/opinion

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