Despite strong endorsements from public health officials, teenage vaccination rates for the HPV vaccine are trailing the other two vaccines recommended for teens and pre-teens, according to the Centers for Disease Control and Prevention. The two vaccines approved to combat the human papillomavirus are Gardasil, which is sold by Merck, and Cervarix, which is sold by GlaxoSmithKline.
To be specific, coverage was 49 percent for one dose of HPV vaccine; 63 percent for MenACWY, which protects against meningococcal meningitis; and 69 percent for the TDP vaccine, which guards against tetanus, diptheria and pertussis. Meanwhile, coverage increases for Tdap and MenACWY vaccines grew 13.3 percent and 9.1 percent, respectively. For girls who received the recommended three doses of HPV vaccine, coverage increased 5.3 percent, to 32 percent over the previous year.
This represents a change from a year ago, when the CDC reported that HPV vaccination rates were creeping up among teen and pre-teen girls (see this). And so the meager increases in vaccination rate reported this week worry CDC officials who have consistently touted vaccination against HPV, which can lead to cervical cancer.
"The HPV results are very concerning," Anne Schuchat, who heads the CDC National Center for Immunization and Respiratory Diseases, says in a statement. "Our progress is stagnating, and if we don’t make major changes, far too many girls in this generation will remain vulnerable to cervical cancer later in life. Now that we have the tools to prevent most cervical cancers, it is critical that we use them.”
At the same time, CDC officials should not be surprised. A report last fall found that only 27.3 percent of eligible teenage girls and young women chose to begin the three-dose series of an HPV vaccine. And of these, 39.1 percent completed just one dose, 30.1 percent got two doses and 30.7 percent finished the series, according to research presented at the American Association of Cancer Research annual meeting (read here).
So why are HPV vaccination rates trailing? The CDC does not say anything specifically about the cost of the vaccines, but the data makes it clear that poor and minority teens are not getting vaccinated as fast as other groups. "Hispanics had higher coverage for one dose of MenACWY and HPV, but third-dose HPV coverage lagged for blacks and Hispanics compared with whites," the CDC reports. And "girls living in poverty were also less likely to complete the HPV series."
Last year, the CDC found that there were no coverage differences seen between racial or ethnic groups who received one dose, but coverage was higher among teens living in poverty compared with those living at or above the poverty level. For all three recommended doses, there were coverage differences last year between racial and ethnic groups, including significantly lower coverage for blacks and Hispanics, according to the agency.
The CDC notes that families who may need help paying for vaccines can ask their doctors for information about the Vaccines for Children program, which provides vaccines at no cost to uninsured children younger than 19 years. However, this does not help those with some form of insurance, but high co-pays or little free cash. Three shots of Gardasil, for instance, can cost nearly $400, although Merck offers a rebate program (see here).
There may be other reasons, though, contributing to the lagging HPV vaccination rates. A group of moms last fall formed a non-profit advocacy group to protest widespread use of Merck’s Gardasil vaccine for HPV over side effect worries (read here). And there remain concerns among some parents that vaccination may be seen by some teenagers as a green light to pre-marital sex.
Recently, the California Catholic Conference urged residents to contact their legislators to oppose a bill that would remove parental consent for vaccinating children 12 and older against sexually transmitted diseases. Two weeks ago, Texas governor and Republican presidential candidate Rick Perry declared it was a mistake when he bypassed his state legislature and signed an order requiring HPV vaccination for school-age girls. He flip-flopped in order to appeal to social conservatives (see this and this).
The lagging vaccination rate is the latest sign that Merck will continue to struggle with Gardasil. Last year, the vaccine generated $988 million in revenue, an 11.6 percent drop from the year before. The drop was due to various factors, including competition from the Cervarix. Since then, sales have rebounded 8.6 percent in the first half of this year (see page 34), although the FDA recently refused to approve the use of the Gardasil vaccine for preventing HPV in women ages 27 to 45 (back story). At the same time, though, Canadian regulators endorsed Gardasil for this population (see this).