Why Are HPV Vaccine Rates So Low?

Health officials say another issue is that the vaccine protects against a virus associated with sexual activity. That makes it tough for some parents to support early immunization. "This is a country that promotes abstinence-only sex ed," says Yale University gynecologist Dr. Mary Jane Minkin.

Even studies of physicians' attitudes toward the vaccine have found that doctors are more likely to recommend the HPV shots for older teens, not tweens, because they're "worried about parental response," says Dr. Jessica Kahn of Cincinnati Children's Hospital Medical Center. "[Yet] to try to predict when your child is going to initiate sex and vaccinate right before then is a very risky proposition."

Ironically, one solution might be to make Gardasil available for even younger kids. Doctors say parents would then be less likely to think of it as a sex-related vaccine. That's what happened with the hepatitis B vaccine, which is now given in three doses before babies are 18 months old. Earlier vaccinations also tend to have a higher compliance rate, since babies and young children typically visit their doctors more regularly than tweens and teens. The 2006 National Immunization Survey showed that 81.3 percent of 13-to-17-year-olds had received three doses of hep B.

For now, health officials are trying to target tweens with the concept of an "adolescent platform" of vaccinations that includes Gardasil. Ideally, preteens would get immunizations like the meningococcal conjugate vaccine (or MCV4), the tetanus, diphtheria, pertussis vaccine (or Tdap) and the HPV vaccine. The federal government's Advisory Committee on Immunization Practices actually recommends that girls be immunized with all three at 11 or 12, and those aged 13 to 26 be given a "catch-up" vaccine.

Young women and girls may not be the only ones to get the vaccine in the future. Merck is also studying the vaccine in men, who in rare cases can get penile cancers, anal cancers and cancers of the head and neck from HPV. The drug company expects to submit data to the FDA on men later this year. And last month it submitted data to the FDA on trials conducted in women up to the age of 45.

Still, the most pressing goal is to increase the vaccination rates among tweens, so they're immunized before they may be exposed to the virus. As awareness of the vaccine and its benefits spreads, there are encouraging signs that a growing number of parents are on board. "Cancer has touched my family," says Diane Simpson-Bundy, a suburban Chicago mom who plans to vaccinate her eight-year-old daughter in a couple of years. "If there's an opportunity to prevent a particular kind of [cancer], I'm all for that."

That's precisely the message health officials hope more parents will hear.

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