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
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
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.
"CDC- Cervical Cancer." Centers for Disease Control and Prevention. 8 Feb 2018. Web.
Mullin, Emily. "Why HPV Vaccination Rates Remain Low in Rural States - MIT Technology Review." MIT Technology Review. 1 Sep 2017. Web.
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.