Since the vaccine for human papillomavirus was released in 2006, the main hurdle to getting more children inoculated has been clear: convincing parents to vaccinate their pre-teen children for a sexually transmitted disease.
Rates of vaccination have not been as high as doctors had hoped, despite the fact that the HPV vaccine is one of only two vaccines that can prevent cancer. That's why the Jewish Healthcare Foundation has recently launched a campaign to draw attention to the importance of the vaccine.
"We care because HPV can cause six kinds of cancer, and it's a simple vaccine," says Laurie Gottlieb, spokesperson for the JHF. "There are about 33,000 HPV-related cancers in the United States every year.
"There's a vaccine that could've prevented these cases, and kids aren't getting it."
HPV, a sexually transmitted infection, can lead to cervical, vulvar and vaginal cancer in women. In men, the virus can cause penile, anal and oropharyngeal cancer. The HPV vaccine is administered in three doses and is recommended for children ages 11 and 12; young women can get vaccinated until age 26, and young men can get vaccinated until age 21.
"When you think of it collectively, cancer is the disease that creates the most fear in people," says Dr. Alan Finkelstein, a member of the JHF's advisory committee. "So the idea that we have a vaccine that can prevent that is kind of the holy grail of medicine."
But according to a 2013 Centers for Disease Control report, fewer than 38 percent of adolescent girls have received the full HPV vaccine. The number is even lower for adolescent boys, at 14 percent.
"The goal of the campaign is to increase uptake," Gottlieb says. "HPV is one of the most common sexually transmitted infections."
A CDC study found that HPV vaccination rates are low for two main reasons: Parents don't know about the vaccine, and not enough physicians are recommending it. But the reasons parents have for not vaccinating their children vary depending on the sex of the child.
For parents of girls, the No. 1 reason was lack of knowledge. Approximately 14 percent of respondents said they were worried about the safety and possible side effects of the vaccine. And 11 percent said their daughters were not sexually active.
"There's a general level of discomfort because we know HPV is transmitted through sexual contact and we get in a position where parents are not willing to consider the sexuality of their 10- or 12-year-old," Finkelstein says. "They may think, 'Something like that couldn't happen to my child.'"
For parents of boys, the top two reasons given for not vaccinating their children were that the vaccine was not recommended and that it was not needed or necessary. Increasing the vaccination rate among boys is a main focus of the JHF campaign.
"The connection between HPV and cervical cancer has been clear for longer than connections between HPV and cancers that are associated with boys," says Finkelstein. "Once it became clear that HPV was the cause of many of those, it became more obvious it was important to immunize boys."
The JHF is also seeking to increase vaccinations among vulnerable populations like African-American women, who are less likely to be vaccinated and more likely to die from cervical cancer. In 2013, Duke Medicine's Dr. Adriana Vidal and her colleagues released the results of a study focusing on HPV rates in this population.
"The motivation was: Even though the screening for cervical cancer is similar for African-American and white women, there is a difference between incidence and mortality, so we wanted to find out why there was a disparity," Vidal says.
While the study made a number of findings regarding incidence and mortality, it also found that black women are more likely to be infected with less common strains of HPV. They are more likely to acquire strains of HPV not covered by current HPV vaccines.
"African-American women were less likely to be infected with HPV strains 16 and 18," which are covered by the vaccine, Vidal says. "We're not saying, 'No, the vaccines are not good for them,' but we're saying there should be more attention for strains beyond 16 and 18."
A new vaccine is currently undergoing a round of clinical trials. It will protect against nine strains of HPV, including two of those most common among black women.
As another part of its campaign, the JHF has formed a group of grandmothers to do community outreach in an effort to break down some of the stigma associated with talking to children about sexually transmitted infections. One participant, Sheila Fine, says she recently talked to her grandchildren about the HPV vaccine on a family vacation.
"We shouldn't be afraid to talk about this," Fine said at a recent meeting of the grandmothers group. "We're talking about saving lives."
Despite progress on the issue, there is still a segment of the American population that is against vaccines, believing they are harmful to children. Organizations like A Shot of Truth, a New Jersey-based nonprofit that questions whether there is a link between childhood vaccines and autism, say the dangers of the HPV vaccine outweigh the documented benefits.
But according to Gottlieb, an eight-year CDC study of 1 million individuals who have been vaccinated found only one major side effect: post-injection syncope, or fainting.
A Shot of Truth also questions the efficacy of the HPV vaccine in preventing cancer. "A myth reported consistently by the media is the HPV vaccine is a 'cancer-prevention vaccine,'" says the campaign. "There has never been any scientific data to qualify this statement, as the vaccine was never studied long enough to show it indeed prevents cancer."
"It's a very safe vaccine," Gottlieb says. "We're saying there's a vaccine that prevents cancer. Why wouldn't you get it for your child?"