Friday, April 16, 2010
William Schaffner, MD
A USA Today news story recently reported what
many of us anticipated — girls and young women from less affluent households have lower HPV
vaccination rates. While any health care disparity that turns on income
is unacceptable, this particular one was compounded by the fact that this
population also has less access to cervical cancer screening.
This explains the most troubling detail in the story;
two of the poorest states — Mississippi and Arkansas — have the
lowest HPV vaccination rates and, no surprise, the highest death rates from
cervical cancer.
So the most high-risk segment of our population is the
least likely to receive the benefits of vaccine prevention. That’s the
reverse of how we want our prevention programs to work. Around the time the HPV
vaccine was approved, I predicted that these types of assessments would start
in a few years.
At that time, I said that such data should be our
’report card‘ and should restimulate a discussion of whether our 21st
century society is comfortable with this state of affairs. Our first explicitly
anti-cancer vaccine is being delivered sub-optimally to those young women who
need it most.
The Vaccines for Children Program eliminates cost as a
barrier, so vaccine cost is not a factor. So what is it? Does the mode of virus
transmission play a role? Is it an issue of general access to health care? Can
we explain this through differences in awareness and education about infectious
diseases?
This is, of course, a delicate subject. I’m not
advocating mandates, at least not now. But we need to start mulling over the
implications of the failure to optimize this great advance in women’s
health.
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