Pediatricians spend a good deal of time discussing routine childhood vaccines with our patients and families. Our south-of-Pittsburgh suburban practice has always had a very high rate (higher than the national average) of families who understand and accept the scientific, medical, and public health reasons for immunizing children completely, and on time, according to best practice, evidence-based guidelines. People here in this neck of the woods realize that vaccines they are the most effective, safest, and relatively inexpensive tools we modern humans have to save lives and improve our standard of living. (There is no rational argument against that last statement — Internet trolls on this blog’s comment section will not be given a voice here; all others with opinions to the contrary should submit their full names.)

So why is it we pediatricians get frustrated when parents either refuse or want to delay giving their children the human papillomavirus (HPV) vaccine? There are a few reasons why parents say “no” and they usually revolve around the perception that the efficacy and safety of these HPV vaccines have not yet been established. In fact, after more than 10 years of use, tens of millions of doses given in the United States, and multiple evidence-based, peer-reviewed scientific inquiries, the effectiveness and safety of HPV vaccines has been clearly demonstrated. I’ve also read in the pediatric literature that some parents refuse HPV shots because they are afraid the vaccine will somehow give their preteens and teenagers the “green-light” to become sexually active. I have never actually had a parent tell me this. What some parents have told me is that, based on the religious values they are teaching to them, their children won’t be exposed to HPV infections. Some parents accept the importance of the vaccine but prefer to wait until their children are older and can be part of the conversation about the purpose of preventing sexually-transmitted cancer before administering the three-dose series. I happen to be sympathetic to this line of thought, though, as a pediatrician, I don’t trust that preteens and teenagers will refrain from consensual (and, unfortunately for some, non-consensual) sexual activity. My knowledge and experience tells me to immunize before any possible exposure exists.

A study that was published in Pediatrics earlier this year hints that the difficulties pediatricians have in promoting this important vaccine doesn’t lie with parents. Instead, the problem is with pediatricians and family doctors, one-third of whom do not strongly recommend HPV vaccines for the 11-12 year-old age group:

Results demonstrated that 60% of pediatricians and 59% of family practitioners reported strongly recommending HPV vaccine for girls aged 11 to 12 years. For boys aged 11 to 12 years, 52% of pediatricians and 41% of family practitioners strongly recommended the HPV vaccination. Eighty-four percent of pediatricians and 75% of family practitioners reported frequently or always discussing HPV vaccination at patients’ 11-12 year well visit, according to the researchers.


Pediatrician Jason V. Terk reveals another reason for this “epic fail” of providing potentially life-saving HPV vaccines to our patients — “pediatricians’ lack of experience and familiarity with the diseases that the HPV vaccine prevents”:

It is human nature to consider those things we have a direct experience with to be more important. That is why the public’s acceptance of vaccines in general has waxed and waned as the public’s experiences with the diseases they prevent has waxed and waned. So it is with the HPV vaccine: It is the first routinely recommended vaccine that is given in the pediatric patient to prevent diseases that appear later in adulthood. Since HPV-associated cervical dysplasia/cancers, genital cancers and oropharyngeal cancers are not diseases that pediatricians treat or have a professional experience with, we unconsciously feel less of an imperative to perform with the vaccine that prevents these diseases. We will not likely be witnesses to our personal failures in our patients who do not get the HPV vaccine.

In fact, we are at risk for being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. The cohort of patients that we have cared for who should have received the HPV vaccine and did not are left vulnerable to cancers that cause incredible suffering and disfigurement. Only we can fix what it wrong with us. Only we can turn around this epic failure.


This explains why the adult specialists I know — obstetrician/gynecologists, ENT surgeons, dermatologists — beg us to give HPV vaccines to our young patients. They beg us because they will be the ones left, along with their patients, to pick up the pieces caused by our “epic failure” to communicate.


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