In 2007, two governments initiated a massive public health experiment. One was the state of Texas, where lawmakers rejected a mandate to vaccinate adolescent girls against human papillomavirus, or HPV, a sexually transmitted infection that causes cervical cancer. HPV is highly contagious, and spread through skin-to-skin contact, and can be found almost everywhere. More than a decade later, the number of Texas adolescents vaccinated against HPV still remains low.
Australia is a country with roughly the same size population and economy as Texas. Australia’s public health leaders embraced a nationwide program that offered free HPV vaccines to girls at their schools. The optional, but popular program was later expanded to boys. Vaccine coverage grew rapidly, with up to 80 percent of teens becoming immunized over the next decade.
In the 12 years since, Texas and Australia first took polar opposite courses regarding HPV prevention, their gap in health outcomes vastly differ. Australia is on track to become the first country to eliminate cervical cancer, possibly within a decade. Conversely, Texas has hardly made a dent in its rate of cervical cancer — which remains one of the highest in the United States, with an incidence resembling that of some developing countries.
According to the U.S. Centers for Disease Control and Prevention (CDC), the vaccination rate for adolescents 13-17 years of age in Texas in 2018 was 44 percent, just over half of Australia’s HPV vaccination rate for the same age group. Texas also lags behind the national rate of 49 percent. Texas women continue to suffer from cervical cancer at a higher rate than all but four other states (New Mexico, Alabama, Florida, and Kentucky) with 1,266 new cervical cancer cases reported in 2016.
The CDC recommends that boys receive the HPV vaccine at age 11 or 12, but boys’ vaccination rates have lagged behind girls. Only 39 percent of adolescent boys in Texas were up to date on HPV immunization in 2018 compared to 48 percent of girls.
Vaccinations are always a hot topic, and the HPV vaccine has surfaced as a highly-recommended immunization for adolescents and adults.
In 2015, 406 Texas women died of cervical cancer, according to the Texas Department of State Health Services. Total hospital charges for cervical cancer hospitalizations in Texas that year were approximately $41 million.
HPV also causes cancers in the vagina and vulva in women; the penis in men; and the anus and back of the throat in both women and men. In addition, HPV infections are so common that nearly all men and women will get at least one type of HPV in their lifetime.
Because it takes several years for persistent HPV infection to manifest as precancerous lesions on the cervix, not all of Texas’ high cancer rate can be attributed to low vaccination rates. But experts say the best way for the state to significantly reduce its cervical cancer rates is to boost HPV immunizations. In 2019, of the 1,395 estimated cases of cervical cancer in Texas, 447 women were expected to die.
In February 2007, months after the U.S. government approved a vaccine to protect adolescent girls against HPV, then Texas governor Rick Perry announced an executive order requiring girls to receive the vaccination; similar to a bill authored by Houston Representative Jessica Farrar. Within weeks, Texas lawmakers revolted, and the Legislature voted overwhelmingly to ‘torpedo’ the mandate.
Some Texas policymakers say it’s time to revisit the state’s HPV vaccination requirements. Perhaps they should do more than “revisit” requirements and instead pass laws that ensure Texans are protected against cancer causing diseases. During this Cervical Health Awareness Month, call your representatives and ask them to support the HPV vaccine.
Editor’s Note: Credit for the main image accompanying the above guest column goes to The Colorado Center For Gynecologic Oncology.