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2018 Public Health Perspective Essay Contest 2nd Place

Claire Molloy
Eastern Wayne High School
10th Grade

Claire received her 2nd place award from Board of Health Chair Robert Cagle, III and Charles T. Gibson. She received a $500 Educational Scholarship and a $50 Gift Card.


AN OVERLOOKED OR UNKNOWN HEALTH CONCERN

In rural Eastern North Carolina there is a significant deficit in awareness and accessibility to necessary healthcare. There are many concerns that, as a young woman entering college, are simply not discussed or taught by schools, health providers, or parents. A singularly overlooked or unknown health concern is the Human papillomavirus. According to the CDC, the Human papillomavirus (HPV) is a group of more than 150 related viruses:

"Each HPV virus in this large group is given a number which is called its HPV type. HPV is named for the warts (papillomas) some HPV types can cause. Some other HPV types can lead to cancer. Men and women can get cancer of mouth/ throat, and anus/rectum caused by HPV infections. Men can also get penile HPV cancer. In women, HPV infection can also cause cervical, vaginal, and vulvar HPV cancers. But there are vaccines that can prevent infection with the types of HPV that most commonly cause cancer."

HPV is the main cause of cervical cancer, which can be easily prevented with the HPV vaccine. Unfortunately, many parents and teenagers are unaware of the vaccine, and lack of accessibility often determines the void of the inoculation. There are several small steps that can be taken to decrease the ignorance of the HPV vaccine and raise accessibility rates to prevent a potentially fatal disease.

In ninth grade all freshmen are required to take the health portion of the physical education class that discusses sexually transmitted diseases and safe sex. As students we are taught basic information on the most prevalent STDs such as HIV, Chlamydia, and Gonorrhea. Howeve1; very little information is given about HPV, which is the most common sexually transmitted disease in the United States. It is concerning to think about the frequency ofHPVand the concurrent scarcity of widespread knowledge. In areas outside of the classroom, there is even less conversation about this deadly disease and it's vaccination. Following multiple visits to my routine pediatrician and other various doctors, I have not been assessed for risk factors or recommended any options for the vaccination. As a nurse, my mother has discussed the vaccination with my older siblings and I as ordinarily as any other vaccination like the measles or hepatitis. I often think about children who do not have a parent in the medical field and do not know the prevalence of this disease. How are parents gaining any knowledge about the disease if their child's pediatrician is not facilitating this conversation?

The absence of alertness regarding HPV and its vaccine can be easily confronted by several effective solutions. In schools, HPV needs to be talked about with the same urgency as common STDs. The virus needs to be put on the same scale as HIV, Chlamydia, and Gonorrhea. When equipped with the knowledge that nearly half of the total genital infections are HPV related, students would be able to make informed decisions regarding their personal health. To implement this change, the North Carolina and Wayne County Public Health Departments should cooperate with their respective boards of education to deliver CDC recommended HPVeducation to be taught along with the existing sexual education classes. In clinical settings, doctors need to discuss risk factors and the option of vaccination. A 2015 study published in the MIT Technology Review which surveyed 776 pediatricians and family physicians found that a little over a quarter of those surveyed do not strongly endorse the HPV vaccine. Stating, "about one-third of the total doctors surveyed said that having to talk about a sexually transmitted infection makes them uncomfortable." There needs to be transparent communication between the patient, parent, and doctor in assessing preventative need for care. The commonality in doctors experiencing hesitation to inform patients about HPV and its vaccination is unacceptably recurrent. In order to solve this dilemma, physicians and health professionals should attend seminars and trainings produced by the health department to educate them on methods of discussing these vital topics with their patients.

In addition to lack of education, accessibility rates are extremely low in rural areas such as Wayne County. According to the MIT Technology Review, only 40 to 49.9 percent of teenagers have up to date HPV vaccinations. A major hindrance to establishing a more prominent vaccination rate is the cost of Gardasil, the HPV vaccine. The total cost for the recommended three rounds of Gardasil is nearly six hundred dollars when paying out of pocket. The International journal of Obstetrics & Gynecology (2011, Crosbie) states, "in resource-poor settings, the huge financial outlay required to purchase enough vaccine to immunise a full cohort of pre-adolescent girls is prohibitively high. Compared with infant vaccines, HPV vaccines are extremely expensive, and considerable investment from charitable organizations will be needed to fund vaccination initiatives."

The Wayne County Health Department website designates that HPV vaccines are limited to VFC- eligible patients only. Expanding that program to children outside of the VFC-limitations could help mitigate this barrier and move our community one step closer to eradicating this disease. MERCK, the company that produces Gardasil, began donating the vaccine in 2007 to young boys and girls in countries with low public healthcare access. A feasible solution to low access rates would be coordinate with MERCK and discuss an actionable plan to aid young girls and boys in the United States with limited health care access to receive donated Gardasil.

Transportation is also an issue when confronting accessibility. For those who do not have a vehicle for transportation, reaching town from distant rural areas can be extremely difficult, particularly in regards to completing the three rounds of treatment in the full Gardasil Regimen. Only thirty percent of girls who receive Gardasil complete its full course, therefore decreasing the effectiveness of inoculation. In order to assist those who can not reach their local clinic, an effective solution would be to organize a network of volunteers to provide transportation for those in need of basic healthcare. Wayne County could implement this through high schools, churches, and other community based groups.

If there were a vaccine against breast cancer clinics would certainly provide an immediate plan for facilitating community-wide treatment. Why is a vaccine against cervical cancer not garnering a similar response? The HPV vaccine is a life saving injection that is rarely discussed and restricted from low income, rural areas such as Wayne County. Effective and actionable solutions to this rampant and ubiquitous disease are straightforward and necessary. The time to act is now.

Work Cited

"CDC- Cervical Cancer." Centers for Disease Control and Prevention. 8 Feb 2018. Web.
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Mullin, Emily. "Why HPV Vaccination Rates Remain Low in Rural States - MIT Technology Review." MIT Technology Review. 1 Sep 2017. Web.
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Crosbie, Ej. "Global human papillomavirus vaccination: can it be cost-effective? - Crosbie - 2011- BJOG: An International Journal of Obstetrics & Gynaecology- Wiley Online Library." Wiley Online library. 29 June 2011. Web.
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