Why Some Parents Are Refusing HPV Vaccine For Their Children
Aug 20, 2013

Some of the data contained in this post has been updated.  For a more recent review of the prevalence of HPV infection and more current data on the safety and efficacy of the HPV vaccine, click here to read “Questioning Whether to Get Your Child The HPV Vaccine?  Read this“, published in January, 2016.  
This post is not the result of an official survey. Rather, it’s a collection of the most common explanations I’ve heard parents make when refusing HPV vaccine for their children, followed by points to consider.

REASON #1: My child is not/ will not/ should not be having sexual relations. So why would they need an HPV vaccine?

As a mother to five daughters I get it. Every parent wants to believe that their son or daughter will remain abstinent until marriage. And some may. But the reality is that some children, even as young as 12 and 13, are already involved in sexual relations and this reality is what has influenced the age at which the HPV vaccine is recommended.  Here is what the studies suggest:

The HPV vaccine is most effective when the complete three shot series is given long before any sexual activity begins, which is one reason the vaccine is recommended for boys and girls between the ages of 11 and 12. Additionally, the vaccine illicits a greater immune response and produces higher antibody to fight infection when given at this age, compared to receiving the vaccine at a later age.
Regardless of the when a child becomes sexually active, the HPV vaccine is important because the prevalence of HPV infection is staggering:

Some parents may be surprised to learn that sexual intercourse is not necessary for infection.  Oral-genital and hand-genital transmission of some genital HPV types is possible and has been reported.  Studies show that HPV was detected in 46% of females prior to first vaginal sex.  Based on this information, it’s possible that a person can become infected during their first sexual encounter. Even if someone remains abstinent until marriage, there’s no guarantee that the person they are marrying isn’t already infected.
Yet, some parents remain concerned that vaccinating a child for a sexually transmitted disease is like giving them permission to have sex. However, research indicates that HPV vaccination has had no notable difference in the markers of sexual activity, to include pregnancies, counseling on contraceptives, and testing and diagnosis of sexually transmitted infections. In other words, the vaccine does not appear to be changing sexual behaviors, only protecting those when they eventually engage in them.
The way I see it, most children by the age of 11 can understand that the HPV vaccine can protect them from various types of cancers, but not from pregnancy and STDs. It’s a simple matter of communication by which the parents can explain that the vaccine doesn’t equate to a free pass to have sex.  If a child chooses to refrain from sexual relations, I would venture to guess that it has more to do with their upbringing and strong moral character, than whether or not their parents choose to protect them with the HPV vaccine.

REASON #2: Won’t regular PAP smears detect any abnormalities and identify cervical cancer without the need for the vaccine?

Let’s be clear. Getting the HPV vaccine is not a substitute for regular PAP smears. However, even regular PAPs depend on many variables to detect cancer, to include women being diligent about getting them, the test accurately detecting an abnormality, and the fact that an abnormal PAP (if accurate) means that an infection has already occurred. At that point, we’re not able to prevent infection but must then rely on medical science to treat it. Of course, treatment procedures can be frightening, painful, and even result in complications, hysterectomies and infertility. And since people who are infected with HPV rarely exhibit any symptoms, they could spend years unknowingly exposing others to the virus.
IncidenceOfCancerAttributedToHPVPicture1But PAP smears are only helping to identify cervical cancer at this point in time. In addition to the 10,300 women who get cervical cancer from HPV infections in the U.S. each year, there are thousands of others in the U.S. diagnosed with other HPV related cancer each year: 2,100 vulvar cancers, 500 vaginal cancers, 600 penile cancers, a combined total of 4,300 anal cancers in both men and women, and 8,400 oropharyngeal cancers in the head, mouth and neck among both men and women.   Since there is no test to check one’s overall HPV status, and no standard screening to detect HPV in the mouth or throat, getting an HPV vaccine is a critical way to reduce the number of people who suffer and die from these types of cancer, and offering a means to prevent illness rather than wait for the need for treatment.

REASON #3: HPV has been known to clear up on its own, so why get vaccinated?

It’s true that many people will be infected with HPV for years and never know it. Some may even develop an HPV infection that clears up on its own in about two years. But how many people will they have shared their HPV infection with along the way? And what will their outcomes be? There is no way to determine which cases will clear up and which will lead to cancer, so our best defense is to simply reduce the spread of the infection with vaccination.

REASON #4: The vaccine only offers protection from some of the strains of HPV. Why bother if it’s doesn’t protect from all HPV strains?

While this is true, the important thing to know is that both the quadrivalent and bivalent HPV vaccines cover the most popular HPV strains (16 and 18).  These two strains are responsible for about 70% of cervical cancers and 90% of genital warts.

REASON #5: I’m not confident in the safety of the vaccine. Aren’t there girls who’ve fainted or even died after getting vaccinated?

It’s understandable that parents are hesitant. After all, inaccurate information about the safety of the HPV vaccine is continuously circulating on the internet. However, to be an informed and educated parent, one must learn that “research” involves more than just believing everything you read on the internet. It involves checking sources and looking at the scientific evidence.
The HPV vaccine is not new. From June 2006 through March 2013, approximately 57 million doses of HPV vaccine have been administered. In that time, there has been an enormous amount of research that demonstrates that the HPV vaccine is not only well-tested, but extremely safe.
The first step in evaluating the safety of any vaccine is to understand the process of vaccine licensing and follow-on safety surveillance.  The CDC infographic entitled “The Journey of Your Child’s Vaccine” helps explain this process in detail.  After a vaccine is licensed, the CDC and FDA use three primary systems to monitor and evaluate the safety of vaccines. The three systems are:

  1. The Vaccine Adverse Event Reporting System (VAERS) which allows people to self-report adverse health events following vaccination to help detect possible new, unexpected, or increased trends in reported adverse events.
  2.  Vaccine Safety Datalink (VSD), which uses de-identified health records to monitor and evaluate adverse events following vaccination.
  3. The Clinical Immunization Safety Assessment (CISA) Project which conducts research to understand how adverse events might be caused by vaccines.

In a study published August 2009 in the Journal of the American Medical Association (JAMA), VAERS data from June 2006 through December 2008 was thoroughly analyzed.  At the time, more than 23 million doses of HPV vaccine had been administered with 12,424 reports of adverse events. Of those reports, 94% of them were “not serious” and 6% were described as “serious”, with the most frequently reported symptoms being headache, nausea, vomiting, fatigue, dizziness, syncope, and generalized weakness.  This study also investigated 32 reports of death.  However, medical investigation into these cases revealed that there was no common pattern that might suggest these deaths were caused by the vaccine. In cases where there was an autopsy, death certificate, or medical records, the cause of death could be explained by factors other than the vaccine. Some causes of death determined to date include diabetes, viral illness, illicit drug use, and heart failure.   While the deaths may have occurred after vaccination, it is important to understand that they were not a result of vaccination – a point that vaccine critics fail to clarify in their discussions about HPV vaccine safety.  In conclusion, the study found that the safety of the HPV vaccine was consistent with that of other vaccines recommended for this age group.
An additional report conducted in 2011 of the VSD studied the occurrence of specific adverse events following more than 600,000 doses of HPV vaccination. None of the adverse events found were any more common after HPV vaccination than among the comparison groups.
Since there’s concern that many U.S. children are not getting the HPV vaccine as recommended, it’s important to highlight a recent study that analyzed five years of data from the Australian HPV vaccination program, where over 70% of girls have been vaccinated as recommended.  The study revealed a sharp decline in the number of young women diagnosed with genital warts.  By 2011, no genital warts were diagnosed in women under 21 who had been vaccinated, and a significant decline in genital wart diagnoses also occurred in 21-30 year old women, a trend not observed in older women.  But what was even more impressive was that less than 1% of the female population under 21 years of age had genital warts in 2011 (to include those vaccinated and unvaccinated).  This is compared to 10.5% of women in 2006 before the vaccination program started. This data, combined with a 44% reduction in the diagnosis of genital warts among young heterosexual men (who were not among those recommended to be vaccinated) suggests that HPV infections are declining as a direct result of vaccination and the profound impact of herd immunity.
The significance of these studies, as well as more than 30 other PubMed studies linked at the end of this post, should help illustrate how safe and well researched the HPV vaccine has been.  If only U.S. parents could recognize the value of this vaccine and increase it’s uptake, than maybe one day we may expect a similarly impressive reduction in HPV infections for the youth of our nation. Perhaps by reviewing the safety data, along with this comprehensive risk/benefit analysis displayed within the Information is Beautiful infographic below, parents will begin to recognize the importance of the HPV vaccine.  

To parents who are still hesitant in regards to the HPV vaccine, I ask you this…

If your doctor recommended a vaccine that could prevent breast cancer in your daughter or prostate cancer for your son, would you refuse? By getting your child the complete three dose series of HPV vaccine at a young age, without focusing on the questions as to when they may become sexually active, you can ensure that you help reduce your child’s risk of cancer.  Who wouldn’t want to do that?


Links to various PubMed articles regarding HPV vaccination:

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