Roosevelt Institute | Cornell University

The HPV Vaccine, Eight Years After its Approval by the FDA

By Annie BuiPublished November 9, 2014

Increasing the uptake of the HPV vaccine amongst young men and women in the United States poses a number of issues, including those of financial affordability and moral choices made by American parents on behalf of their children.

By Annie Bui, 11/9/2014

According to the Centers for Disease Control and Prevention, it is estimated that approximately 50 percent of those who are sexually active will contract human papillomavirus (HPV) at some point in their lives. While a majority of HPV infection cases will resolve on their own, more than 40 out of these 150 or so strains of HPV are linked to certain types of cancer.

The two predominant HPV vaccines on the market today — Merck's Gardasil, approved by the FDA in 2006, and GlaxoSmithKline's Cervarix, approved in 2009 — protect against cervical cancers in women, with Cervarix even being available for males.

However, eight years after the first HPV vaccine was approved by the FDA and available on the market, vaccination rates and "take-up" have been slow despite awareness of the importance of the vaccine, according to the Kaiser Family Foundation. Approximately one-third of girls aged 13-17 received all three recommended doses of the vaccine, with vaccination rates only slightly higher in 2013 than in the previous year.

Although the vaccination figure among adolescent females only stands at a little over one-third, the prevalence of HPV infection has dramatically decreased, according to a 2013 study by Markowitz, et al. From 2003 to 2010, there has been a 56 percent decline in the prevalence of HPV among females aged 14 to 19. This is an encouraging finding, but what could the United States and its lawmakers — both on the local and national scope — do to drive the vaccination rates up higher, and the prevalence rate even lower?

In a figure provided by the Kaiser Family Foundation, it is shown that Washington, D.C., along with one state — Virginia — has a law in place that mandates HPV vaccinations for school entry. According to the Virginia Department of Health, "a complete series of three doses of HPV vaccine is required for females, [with] the first dose administered before the child enters the sixth grade." This law went into effect in late 2008, just two years after the first HPV vaccine was approved by the FDA.

Additionally, a handful of states — twelve, to be exact — require public education for school children and parents on HPV vaccinations. Another six states offer funding for the vaccine, while two states, North Dakota and Colorado, offer both public education and funding.

These are the existing policies undertaken by some states in an effort to boost the prevalence of HPV vaccination among adolescents and school children, but the passage of time is required before decision makers and other public policy officials are able to see what methods are most effective. A "number of financing, public acceptance, and delivery system challenges" still need to be tackled in order to increase the uptake of this vaccine.

The Affordable Care Act may partially address the financial aspect of this issue, however, as it requires all new private insurance plans to cover the cost of HPV vaccines for the recommended male and female age groups without cost sharing. Additionally, in terms of public financing, programs such as the Vaccines for Children (VFC) Program cover children ages 18 and younger who are eligible for Medicaid, are uninsured, American Indian or Alaska Native, or underinsured, according to the National Cancer Institute.

However, the biggest hurdle that public health officials and other policymakers face when it comes to HPV vaccination are the primary decision makers of a child's health — the parents themselves. While some parents are willing to let their child receive the vaccine because of its efficacy and the health benefits it may confer down the road, other parents may delay or express hesitation toward the vaccine because of the inherent social message it may send. "Why should my 11 or 12 year old get this vaccine if he or she is not even sexually active — and who is to tell me that my child needs it at such a young age?"

The task of increasing the uptake of the HPV vaccine in the United States is a multifaceted one, as it touches not only on issues of economic and financial affordability, but also ethical and moral choices made by parents on behalf of their young children.