Courtesy / CDC Public Image Gallery.
While Texas has one of the better vaccination rates nationwide for children 19-35 months old, the U.S. Centers for Disease Control and Prevention (CDC) report that more parents are seeking non-medical exemptions from school immunization requirements and that preventative vaccination rates for adolescents remain stagnant.
A case in point is the vaccination rate for human papillomavirus (HPV), the most common sexually transmitted infection and a cause of genital warts and cancer. Despite evidence that HPV vaccinations are safe and effective, vaccination rates across the United States remain low – particularly among adolescents ages 13 to 17. In Bexar County, 32.8% of females and 19.9% of males are reported as having completed the vaccine series. The national average is 41.9% completion for females and 28.1% for males.
In an effort to help increase HPV vaccination rates throughout San Antonio and Bexar County, Methodist Healthcare Ministries of South Texas is supporting a new American Cancer Society campaign, called "Cancer Prevention: It's worth a shot,” by donating $500,000 toward the group's comprehensive, two-year cancer prevention initiative.
The program focuses on increasing HPV vaccinations among children in South Texas who are served by community health clinics in Bexar and surrounding counties and supporting a community-based HPV vaccination education campaign for parents and families. The health centers participating in the program include Amistad Community Health Center, Atascosa Health Center, and CentroMed.
Kevin Moriarty, president and CEO of Methodist Healthcare Ministries, explained that the intention of the donation was to fund something tangible for low-income and medically underserved communities in Bexar County.
“We made the decision not to give the money to research,” Moriarty told the Rivard Report. “A lot of money [for disease prevention] typically goes into the research bucket, and you don’t know what goes into your local community.”
The grant funding will work toward improving consumer experiences by building a customized immunization program that will include education for healthcare providers, patient outreach, education, and follow-up.
Each community health center will receive funding to support its comprehensive program. The project aims to encourage more providers to recommend getting the HPV vaccine to parents of preteens, something that doesn't always occur.
Even when a healthcare provider recommends getting the vaccine, educating parents about what HPV is and what the vaccine can prevent is key. Results of the CDC's National Immunization Survey found that Texas parents did not vaccinate their children against HPV for several reasons, including a belief that the vaccine is not necessary, failure of a healthcare provider to recommend the vaccine, and a lack of knowledge about the vaccine and HPV.
Martha Alaniz, 49, emigrated from Mexico and is now a legal citizen. She chose to vaccinate her daughter Evelyn, now 26, for HPV in 2007 upon recommendation from her healthcare provider. Alaniz said she was unsure about having her daughter vaccinated, but the doctor explained that the vaccine would soon become mandatory. Alaniz gave her okay despite having little understanding of HPV.
“I was given maybe less than five minutes to read a flyer about the vaccine," Alaniz said. "I was told it would help prevent certain infections but wasn’t sure exactly what it prevented.”
When asked how she felt about her decision to vaccinate knowing now that it is not mandatory, she said that she initially felt “fooled, like maybe there was something wrong with [the vaccine] and they were trying to do an experiment to see what happened.”
Alaniz’s other children are two boys, ages 18 and 23. When her daughter was vaccinated, she wasn’t aware that the HPV vaccine was for both males and females. The vaccine was never offered or recommended for the boys, she said. Now that she is fully aware of the vaccine's benefits, Alaniz plans to vaccinate both of her sons.
The CDC's Advisory Committee on Immunization Practices (ACIP) has recommended HPV vaccination at age 11 or 12 since 2006 for females and since 2011 for males. Until recently, a completed HPV vaccine consisted of a three-dose series.
In 2016, ACIP updated its recommendations to a two-dose schedule for individuals who begin the vaccination series at ages 9 through 14 – a decision that was based on clinical trial research indicating the vaccine, when received within the recommended timeframe, maintained effectiveness at this level. Three doses are still recommended for those who start the vaccination series at ages 15 through 26.
The vaccine is preventative, which means it provides strong protection against new HPV infections but is not effective at treating established HPV infections or disease caused by HPV. It is highly recommended for preteen boys and girls so they are protected before ever being exposed to the virus, because the vaccine is more effective when given before age 13 than in the later teen years.
Low rates of vaccination against HPV, which is transmitted through intimate skin-to-skin contact, represent a serious public health threat. Several types of HPV are responsible for the vast majority of cervical, anal, oropharyngeal (middle throat), and other genital cancers that affect men and women.
HPV infection is associated with nearly 22,000 cancer cases diagnosed in the U.S. each year. Approximately 79 million people in the U.S. are currently infected with a strain of HPV, with about 14 million new infections occurring annually.
In Texas, there are about 4,000 HPV-associated cancer diagnoses per year. HPV-related treatment costs for men and women in the state approach $170 million annually.
Suncerria Tillis, senior director for Primary Care Systems with the American Cancer Society, said the vaccination initiative is taking its national HPV education strategy and localizing it to Bexar County. Seventy-five percent of Methodist Healthcare Ministries' funding will go toward in-depth education about HPV and the importance of vaccinating for both medical providers and consumers.
The education efforts will focus on combating the stigma surrounding the HPV vaccine and improving education for healthcare providers and consumers.
“It’s not an issue of coverage of the vaccine,” Tillis said. “It's more of an issue that providers aren’t routinely recommending it. It’s a relatively new vaccine, and there has been some controversy around it as well.”
Because HPV is sexually transmitted, some parents worried that the vaccine would encourage promiscuity among adolescents, as it is specifically directed toward people who are engaging in sexual behavior. However, research by the American Academy of Pediatrics has found that HPV vaccination of young women did not increase their levels of sexual activity.
Most insurance companies are now required to cover the cost of immunizations and preventative care, which includes the HPV vaccination. It also is covered under Medicaid. And for underinsured children, the Vaccines for Children Program works with community health centers to cover the cost for program-eligible individuals. For those who are unable to qualify for program funding, the vaccine's out-of-pocket cost is $300-$400.
Twenty-five percent of the American Cancer Society's funding is reserved for coverage to vaccinate underinsured, program-ineligible individuals, namely those who do not qualify for Medicaid, Vaccines for Children, or for other reasons such as citizenship or residency issues.
The Cancer Society is hoping its local program can achieve the kind of success El Paso County has achieved in raising HPV vaccination rates. El Paso County has the highest HPV vaccine rates in the state of Texas. According to its 2015 Health Report, its immunization program focused on hiring 26 full-time employees to educate the private and public sectors on the importance of vaccinations.
“Its one thing to have a new guideline, or a new treatment, or a new medical intervention," Tillis said."Its another thing to have it really put into practice.”