Teen girls are not getting the HPV vaccine

Why not? Doctors are not talking to their patients about it.

As reported by The New York Times, the Centers for Disease Control (CDC) has concluded the following:

The very low vaccination rate for teenage girls against the human papillomavirus — the most common sexually transmitted infection and a principal cause of cervical cancer — did not improve at all from 2011 to 2012, and health officials on Thursday said a survey found that doctors were often failing to bring it up or recommend it when girls came in for other reasons.

Only 33 percent of teenage girls had finished the required three doses of the vaccine in 2012, officials said, putting the United States close to the bottom of developed countries in coverage.

Dr. Thomas R. Frieden, head of the Centers for Disease Control and Prevention, said on a call with reporters that coverage for girls “has not increased at all from one year to the next. Zero.” Coverage rates for new vaccines typically increase by about 10 percentage points a year, he said.

It is interesting that doctors themselves could be the problem. In the past few years, debates over giving young adults the HPV vaccine revolved around possible parent resistance. The idea was that parents would resist having their tween/teenage daughter vaccinated because it implies permission for her to have sex (because she won't get the virus unless she is sexually active).

So why are doctors as a whole failing to discuss the HPV vaccine sufficiently? Three guesses:

1. Even if parent attitudes about the giving the vaccine to girls and boys at a young age have improved, doctors might not know that. Doctors may sense-- correctly or not-- that this is controversial and don't want to appear to be 'pushing something' on their patients. 
2. Doctors might sense the big push for the HPV vaccine as driven by pharmaceutical business interests as much as real necessity-- that this is a lucrative solution to a ginned-up problem. Every single doctor I have talked to in the last five years is highly sensitive to health care politics, and their attitudes, tempered in the fires of experience, generally run toward the skeptical-to-cynical end of the spectrum. So it could be that many doctors are hanging back on having their own patients vaccinated until some time has passed and the HPV vaccine is seen as less cutting edge and more part of the conventional wisdom in patient care. 
3. There could be a class and cultural presupposition by many family doctors that their patients' children are not the 'kind of kids' who are likely to be sexually active in their early teens, so the need for this group of kids to be vaccinated early is relatively low. "This discussion can wait until they are older"-- which might not happen, as the NYT article indicates, because older teens are more autonomous and less likely to go through the three-shot treatment as they would when they more under the thumb of a parent at a younger age.

Clearly, a follow-up survey focusing on doctors' attitudes needs to be done to figure out what is going on.

Links:

Article in The New York Times (July 26, 2013): HPV Vaccine Not Reaching Enough Girls, CDC Says

Centers for Disease Control (CDC) survey (July 26, 2013), published in Morbidity and Morality Weekly Report (MMWR), vol. 62, no. 29, p. 591: Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007-2012, and Postlicensure Vaccine Safety Monitoring, 2006-2013-- United States