.png)
A Dose of Optimism
A Dose of Optimism is a podcast dedicated to exploring the world of healthcare innovation and the optimists driving meaningful change.
Hosted by Omkar Kulkarni, this show shines a light on bold ideas, transformative solutions, and the passionate individuals working every day to make healthcare better for children and their families.
Each episode dives into the real-world challenges facing the healthcare industry and highlights the people and organizations pushing the boundaries of what’s possible. From tackling mental health and food allergies to reimagining hospital care and harnessing Artificial Intelligence for better outcomes. Listeners will discover game-changing solutions, hear stories of creativity and resilience, and gain inspiration from leaders who believe in building a healthier, more hopeful future.
From medical professionals and entrepreneurs to patients and community advocates, the podcast brings together diverse voices united by a shared commitment to improving healthcare delivery. Whether you’re working inside the industry or simply curious about the innovations shaping tomorrow’s care, A Dose of Optimism offers insight, connection, and inspiration.
“The content, views, opinions, and information presented on this podcast do not reflect the views of Children’s Hospital Los Angeles or of the sponsors of the podcast. CHLA does not endorse the views, opinions and information presented on this podcast and CHLA specifically disclaims any legal liability or responsibility for the podcast’s content.”
A Dose of Optimism
HPV Vaccine 20 Year Anniversary Episode
Use Left/Right to seek, Home/End to jump to start or end. Hold shift to jump forward or backward.
Twenty years ago, the HPV vaccine was approved in the United States. It is one of the most powerful cancer prevention tools ever developed, protecting against 90% of HPV-related cancers, with a safety record spanning more than 500 million doses worldwide. And yet today, only about 63% of eligible adolescents in the US are fully vaccinated.
In this special anniversary episode, six voices from across the HPV prevention landscape share what 20 years of this vaccine has taught us, and what still needs to happen.
Dr. Heather Brandt, Senior Director of the HPV Cancer Prevention Program at St. Jude Children's Research Hospital, explains what HPV is, how the vaccine works, what the science says about safety and efficacy, and how to address the most persistent myths, including the infertility myth, the promiscuity myth, and the "it's too new" myth.
Antoinette Barrett, Nurse Practitioner with Cedars-Sinai's COACH for Kids mobile health program, shares 30 years of frontline experience vaccinating underserved children in Los Angeles, and how the conversation around HPV vaccination has shifted over two decades.
Cynthia Au and Catherine Peters of the American Cancer Society Cancer Action Network discuss the policy landscape, including Guam's new school entry requirement, what states with mandates have achieved, and the full range of levers available to close the vaccination gap.
Dr. Paul Offit, Director of the Vaccine Education Center at Children's Hospital of Philadelphia and co-inventor of the rotavirus vaccine, offers a candid reflection on where the HPV vaccine recommendation worked, what works to drive uptake, and what vaccine advocates need to do differently in an era of growing anti-vaccine sentiment.
Judy Klein, founder of Unity Consortium, makes the case that framing matters enormously, that calling this a cancer prevention vaccine, not an STI vaccine, is the message that breaks through, and that community-level trust is the most powerful lever we haven't fully used.
Episode Resources:
20 years of HPV vaccination in the U.S. - Join us on Friday, June 12 from 12-1 pm Central Time
History Of HPV Vaccination - St. Jude Children's Research Hospital
Prevent 6 Cancers with the HPV Vaccine - American Cancer Society
Know Your Vax - Recommended Vaccines Schedule for Adolescents and Young Adults, Unity Consortium
Connect with Dr. Heather M. Brandt:
Heather M. Brandt Faculty Profile
St. Jude Children’s Research Hospital Website
St. Jude Children’s Research Hospital LinkedIn
St. Jude Children’s Research Hospital Instagram
Connect with Antoinette Barrett:
Connect with Cynthia Au:
American Cancer Society Website
American Cancer Society LinkedIn
American Cancer Society Instagram
Connect with Catherine Peters:
American Cancer Society Cancer Action Network (ACS CAN) Website
American Cancer Society Cancer Action Network (ACS CAN) LinkedIn
American Cancer Society Cancer Action Network (ACS CAN) Instagram
Connect with Dr. Paul Offit:
Dr. Paul Offit - The Children's Hospital of Philadelphia
The Children's Hospital of Philadelphia Website
The Children's Hospital of Philadelphia LinkedIn
The Children's Hospital of Philadelphia Instagram
Connect with Judy Klain:
Connect with us:
Children's Hospital L.A. Website
Children's Hospital L.A. Instagram
Children's Hospital L.A. LinkedIn
It's a miracle in many ways, even though technically a miracle is only things that can't be explained by the laws of nature. This can be explained by the laws of nature. But nonetheless, it is remarkable that this single protein, the so-called L1 surface protein of human papillomavirus, will protect you for the rest of your life against the cancer-causing virus.
SPEAKER_01Welcome to the Dose of Optimism, where I talk to the optimists in healthcare. My name is Omkar Kulkarni, and I work at one of the world's best children's hospitals where I lead innovation. I started Kids X, which is a premier international startup accelerator for pediatric innovation. And over the years I've met thousands of startups, investors, and innovators. Every one of them has a story, and every one of them is optimistic about the problems they're solving. On this podcast, you'll meet amazing people who will share their stories and what makes them optimistic about the future of healthcare. A little note before we get into this episode. Alright, let's get started. This week's episode is a special one. We're celebrating one of the greatest innovations in pediatric care of the 21st century. Today is the 20th anniversary of the release of the HPV vaccine, one of the first vaccines designed to prevent cancer in children. The story of the creation of the vaccine is remarkable, involving collaboration from researchers in Australia, the United States, and Germany. We don't have the time on today's show to dive into the history, but we put a link in the show notes highlighting the work involved in bringing this important vaccine to life. Today, we're going to focus on the 20 years since the release of this vaccine, which was back in June 2006. We talk about why this vaccine is important from a public health standpoint. We highlight places in the world that have done an exceptional job in promoting the vaccine in the last 20 years and how we can learn from what they've done. We clarify some myths and misconceptions about the vaccine, talking to experts in the field, and finally we look to the future to see how we can better utilize this incredible vaccine in preventing cancers in our kids and adolescents. My first guest is Dr. Heather Brandt, the Senior Director of the HPV Cancer Prevention Program at St. Jude Children's Research Hospital. Her research program in cancer prevention and control is focused on examining and intervening upon cancer-related health disparities through innovative and engaged approaches in partnership with the community. Dr. Brandt helped me understand the vaccine, how it works, and she clears up some important myths that are swirling around the vaccine. So, what is HPV? What kinds of cancers can it cause?
SPEAKER_03First, HPV is a very common virus. In fact, almost everyone at some point in their lifetime is going to have HPV. It's just that common. And second, the reason why we're concerned about HPV is because in some people, HPV leads to six types of cancer and other conditions. So the types of cancer that are caused by HPV include oropharyngeal cancers, which happen at the base of the tongue and tonsil area, cervical cancer, anal cancer, penile, vulgar, and vaginal cancers in the anal genital region. HPV also causes precancers of the cervix and can cause genital warts and recurrent respiratory papillomatosis, just to name some of the major impacts of HPV.
SPEAKER_01What is the vaccine and how does it help with prevention of cancers and other secondary illnesses that come out of HPV?
SPEAKER_03So the HPV vaccine is one of the most powerful cancer prevention tools that we've ever had available and certainly is so powerful that in some countries around the world currently, they are on track to eliminate some types of these cancers because of how well the vaccine works. So, first let's talk a little bit about the vaccine. So the HPV vaccine in the US is predominantly the GARDACIL vaccine, which protects against nine types of HPV. And that includes seven high-risk types, those types that are linked to causing cancer, and then two other types that are linked primarily to causing genital warts. So, in terms of the protection from cancer that's afforded by this vaccine, it protects against 90% of the HPV cancers here in the US. This is a really powerful vaccine from that standpoint. Second, in terms of how well it works, it reproduces in humans a really robust immunogenic response. That means that when our body gets this vaccine, it activates our immune system to develop antibodies so that if and when we are ever exposed to HPV, our body will know what that is and protect us against those types of HPV. It is almost 100% efficacious in that regard when you get the right number of doses at the right age. And then thirdly, this vaccine is a preventive vaccine or what is known as a prophylactic vaccine. So that means it's very important to get protected with the HPV vaccine before you might be in a situation where you could acquire an HPV infection. And that's why the focus is on primarily nine to 12-year-olds for that reason. And then in case anyone is super interested in the type of vaccine that this is, because I do think sometimes this is fun and interesting because of some of the myths and misconceptions that can come from vaccines, this vaccine is a virus-like particle vaccine or a protein subunit style of vaccine. So what that means is that this virus-like particle vaccine is a mimic or a copycat. It looks enough like the virus. It looks so much like the virus, but there's nothing inside. So you're never going to get HPV from getting this vaccine. This vaccine at worst may not work completely to protect you. But as I said, it's almost 100% efficacious when you're getting the right number of doses at the right age.
SPEAKER_01And it's three doses?
SPEAKER_03Well, that's another thing that is great about science and about vaccines, is we start out wanting to base our decisions on the best possible data that are available. And when this vaccine was first introduced, it was believed that three doses were needed to produce a sufficient immunogenic response or make our bodies produce enough antibodies to last us for a long time. And over time, through additional testing, monitoring, what we call surveillance, we discovered that if you get vaccinated between the ages of nine and 14, you need only two doses because at those younger ages, your immune system responds so strongly that two doses are sufficient. And then for people who are 15 to 45, three doses are needed to make sure that our bodies have a strong response. No matter what age you are, if you have any effects on your immune system, for example, childhood cancer survivors, people who are living with HIV, other immunocompromised conditions, you're going to need three doses to make sure that your body produces sufficient immunity.
SPEAKER_01So two doses if you're able to vaccinate the patient between nine and 14, and three if they're over the age of 15.
SPEAKER_03Yes.
SPEAKER_01This is a vaccine that both boys and girls should get?
SPEAKER_03Absolutely. This vaccination is recommended routinely for boys and girls. And it's really important that it's boys and girls. In the United States, the most common type of HPV cancer is oropharyngeal cancers, those cancers that occur at the base of the tongue and in the tonsil area. And 85% of those cases are among men. So that is the most common type of HPV cancer in the US, and it most commonly occurs among men. Cervical cancer, due to screening programs, timely intervention, follow-up care and treatment, those cases have actually leveled off at around 11 to 12,000 each year. But oral pharyngeal cancer cases are much higher than that. And we continue to see those increases over time.
SPEAKER_01So as of last year, what proportion of our young people are vaccinated?
SPEAKER_03So in the United States, it's important to note as we are approaching the celebration of the 20th anniversary or birthday of the HPV vaccine first being made available here in the United States in June 2006. We have made progress. Our national coverage now, according to National Immunization Survey teen data, which are provided from the CDC, is that about 63% of 13 to 17-year-olds are fully protected. They've had the recommended number of doses. A higher proportion, about 78%, have had at least one dose. These data provide us with a good estimate of coverage. With that said, we also know that these data are often overrepresenting protection. In some parts of the US, we find that coverage is much lower, like in the southeastern United States, as one example. Also, children who are living in rural areas are much less likely to be vaccinated. So there are certainly gains to be acknowledged and celebrated. There also continues to be a lot of opportunity. We have yet not achieved the Healthy People 2030 goal of 80% of 13 to 15 year olds being vaccinated in the US.
SPEAKER_01All right. Can we play a little uh mythbusters here? Sure. Tell me if some of these things that uh you unfortunately see on social media are true or not. There's this myth going around that you you don't vaccinate kids until they're sexually active.
SPEAKER_03And let me say that I want anyone who's making a decision about HPV vaccination or for any vaccine, any medication, any procedures, anything to have the best possible information for them to be comfortable with the decision they ultimately make. So I appreciate this opportunity to take on some of these myths. So this myth has been one that's been around in various formats since the vaccine was first introduced in the US. Again, this is a preventive vaccine. It works best when it is given before someone would be in a situation by choice or force when they could acquire an HPV infection. So this decision was made based on behavioral data about at what age are young people becoming sexually active, for example, and understanding some behaviors that are a normal part of child growth and development, our growth as humans may occur before then. And then looking at the science of how well the vaccine works, what number of doses are going to be needed to fully protect someone. And so that is when the nine to 12-year-old age group was identified as the ideal time at which children would be given this vaccination. So that would make sure that they would be fully protected before they would enter into that time period. Another myth that derived from this is that if you give someone the vaccine, they will become sexually promiscuous as a result of being given the vaccine. That if given the vaccine, they will think, I'm protected, I can engage in these behaviors. And that's called sexual disinhibition or behavioral disinhibition. This has long been disproven. It's actually one of the reasons why there were concerns about giving women, people who are pregnant, having babies, giving them analgesic or pain relief during the course of labor, which if it didn't quote unquote hurt to have a baby, there would be no population controls in place. So these are the types of myths that then take on legs of their own. So the one you just said, there are several different versions of that.
SPEAKER_01Thank you. I've got two more. One, because it's so new, as you mentioned, 20 years old compared to perhaps some vaccines that are even older. The myth is that it's so new that we don't know if it's safe or effective.
SPEAKER_03So 20 years is a long time for a vaccine to be available. There are several vaccinations that are routinely administered that are newer than HPV vaccination. And just as a sidebar before I take on your question, we hear this so often that earlier this year in our St. Jude HPV Cancer Prevention Program newsletter, we started a feature, things older than HPV vaccination or things newer than HPV vaccination, just to give people some cultural points of reference.
SPEAKER_01A smartphone, I imagine the iPhone is probably newer than the HPV.
SPEAKER_03Yes, we've yes, 2008. We used that one earlier this year. This month, we used Instagram. So Instagram is newer than we've been double tapping screens far less than the other. So first let's take on safety. This is a continued concern for those who are making a vaccine decision for HPV or other vaccines. HPV vaccine has an incredible safety record. It is a very strong safety record. And while I say that, and we'll provide some data to back that up, the risk is not zero. And if your child is the one who experiences something out of the normal when choosing a vaccine, that really can change your entire perspective on vaccination. We understand that, but it is exceedingly rare that it is going to happen. So over 500 million doses of this vaccine have been given worldwide. And as we take a look recently, and just this week, the Vaccine Integrity Project published an updated safety and effectiveness systematic review, the results of this. So this is all consistent with even the latest information. So scientists have reviewed close to 300 studies that have included millions and millions of people in these studies. And there's been no evidence of autoimmune, neurological, venous thromboembolic, or any other unexpected health problems due to HPV vaccination. The only serious adverse events that have been reported are those that are seen for other vaccines in children, adolescents, and adults. And that's the rate of anaphylaxis, as one example. So the rate of anaphylaxis is less than two cases per million doses given. And early on, when this vaccine was first introduced, there were some observational data reported following use that some of the adolescents were fainting after getting the vaccine, experiencing syncope is what we would call that in clinical terms. And that is when there was a waiting period after vaccination put in place, just to make sure this wasn't due to the vaccine. And ultimately it was determined it's a good practice, but this is not due to the anything in the vaccine itself. It's the fact that you're 12 years old and you're getting a vaccine, you're very aware this is very different from when you're younger. So this is a very safe vaccination. And then recently, the Vaccine Integrity Project, as I mentioned, published their updated review. And the ACS or American Cancer Society National HPV vaccination roundtable also put out an updated safety and effectiveness guideline about the vaccine. Now, how well does this vaccine work? It works really well. As I noted, many countries on track to eliminate HPV cancer, starting with cervical cancer because of how well it works. And a new study was published in February of this year that showed that for every 10% you increase vaccination coverage in a population, you reduce cervical cancer risk by 12%. Every 10% up is 12% down in terms of risk of cervical cancer. And I want to mention as well that this vaccine is very durable. It has long-lasting protection afforded. In fact, a study that was published in February as well showed 18 years following vaccination that the titer levels or your antibody levels, your immunogenic response was still sufficient to protect you from acquiring an HPV infection. A very powerful cancer prevention tool. One of the things about fertility is it derived from anti-vax organizations as what can we do to really scare moms and dads about doing something related to this at this age group? So it really has no mechanistic foundation. And multiple meta-analytic studies, so studies looking at all of the data that are available, have continued to find zero effect on ovarian function in females, sperm production in males, there just has not been any evidence of influence on fertility. So to take another approach, HPV vaccination preserves your child's decisions about their fertility. Because if your daughter ends up with precancers of the cervix or cervical cancer, fertility choices will be taken away from them. If your son ends up in a similar situation, also those choices could be taken away from them. So HPV vaccination preserves your choices about having a family in the future by protecting you from things that could negatively influence your fertility. So that's really the message that is central to taking on some of these fertility myths.
SPEAKER_01So we have a cancer vaccine that data shows works very well. Many countries around the world, the vaccination rate is over 90%. And through your work, we're increasing the awareness and successful vaccination of eligible patients in this country. If you have a message for parents who are who have kids that are about to enter this window, what a message do you have for them?
SPEAKER_03Get the information you need from reliable sources. Identify who you trust. Hopefully a healthcare provider that you have a relationship with, a local hospital that's serving children, some organizations like St. Jude, for example, the American Cancer Society, get information about HPV vaccination in advance of making the decision. So I think getting informed is an important first step. And second, I think it's having a conversation with your child's healthcare provider, allowing the healthcare provider to respond and react to questions that have emerged during your process of getting informed. Our data are endlessly supportive of the safety, effectiveness, and durability of HPV vaccine. Our greatest threat and challenge centers from the misinformation and disinformation about this cancer prevention tool. We want to make sure that everyone has the information they need, has these important conversations with their child's health care provider to helpfully choose HPV cancer prevention through HPV vaccination.
SPEAKER_01My next guest is a nurse practitioner who has spent the past 30 years in underserved parts of Los Angeles, helping provide children with important access to primary care. Antoinette Barrett is part of the Coach for Kids team at Cedar Sinai and has been administering the HPV vaccine to children in underserved communities since the first days of the vaccine coming out. She talks to me about the initial reaction she got back in 2006 and some of the questions and concerns that still pop up today when she talks to families about the HPV vaccine. So you've been doing this for 30 years. Tell me about the population that you serve with the coach program.
SPEAKER_04I work with the Coach for Kids program with Cedar Sinai, and we're a mobile health program. We've been out in the community since 1994, providing free medical services to underserved children throughout the Los Angeles area. We do preventive services, all the recommended immunizations, physicals, treatment of minor illnesses, and try to refer families to medical homes through our partner FQHCs. Most of them are below the poverty line. A lot of students from the Los Angeles Unified School District. We go to homeless shelters, housing projects, WIC centers. So we try to target those that are uninsured or underinsured or are having trouble with their Medical So really don't have insurance or have trouble accessing their providers.
SPEAKER_01So about 20 years ago, the HPV vaccine first came out. If you remember that time when it first came out, what was the reaction amongst parents and kids back then when you talked to them about this new vaccine?
SPEAKER_04There was a lot of skepticism, a lot of fear. People weren't really open to it. Anything new? Why does my kid need this? What are the risks of the vaccine since it's associated with sexually transmitted infections? Is it going to encourage my young child since we at that time we were given it at age 11, now age nine in males and females? Is it going to encourage my child to become sexually active?
SPEAKER_01How has that evolved and changed? I'm sure there's still some of that today in terms of some of the reactions you get. But you know, it's been 20 years.
SPEAKER_04It has shifted tremendously. I think just because of the time that the vaccine has shown that so many people worldwide have gotten a vaccine with minimal side effects. And there's been commercials and a lot of education and a lot of outreach, targeting families in different languages and different cultures. So there's a whole different culture, even for me as a provider around HPV and how it's presented, really presenting it as a cancer prevention mechanism and bundling them with those preteen vaccines, telling parents this is your opportunity to get your child vaccinated, prevent against whooping cough, meningitis, and HPV causing cancer. So we're really trying to get your kid protected before they come in contact with HPV, which is really common and can cause a number of cancers.
SPEAKER_01And what is the reaction amongst the kids?
SPEAKER_04Some of the older kids, the teenagers are more interested. More, we talk more about them, about the how it's contracted and things like that. They'll ask more questions along those lines as we're doing more sensitive subjects with some of the preteens and teenagers. The younger kids that we're given at nine years old, they're really not asking the questions. It's mostly the parents. They're just taking it as another vaccine. And if my parent feels like I need to get it, then I'll get it. So we're doing more education with the older preteens.
SPEAKER_01Anything surprise you these days about questions you get or reactions you get when you bring up the vaccine?
SPEAKER_04Only surprising one lately has I've got a couple questions regarding infertility. And I hadn't heard that before that some of the teenagers or even the parents were concerned about infertility related to receiving the vaccine. So just educating around that, that there hasn't been any studies or any problems with infertility for the vaccine, but a lot of these cancers can lead to cancers that the vaccine prevents can lead to infertility and other problems.
SPEAKER_01Yeah, I think the challenge is there's so much misinformation circulating on social media. And a lot of the target demographic for this specific vaccine are kids that are starting to use social media or they're around it, right? Especially the preteen kids. And so it's tough. There's a lot of information that's not accurate that's swirling out there.
SPEAKER_04Immunization programs, they have a lot of good materials and things geared toward the kids that kind of simplify it to really talk about the vaccine and how it works. So we try to mitigate those rumors with social media and things they may hear from their friends and just give them the right information.
SPEAKER_01Now, if you had a magic wand and you could change something about the way things are and find a way to make this HPV vaccine more successfully administered, what would your magic wand wish be?
SPEAKER_04Well, I think my magic wand would go to a whole gathering of preventive health care with HPV right in there. Just that everyone had access to the vaccine, that people had the education, people who maybe aren't on social media or don't have TV and aren't looking at the billboard. There's still parents who really don't know about HPV vaccine, um, even though we are seeing more. It's a lot better than it was 20 years ago. So I guess my magic wand would be that it would be accessible to all kids that are eligible starting at age nine, that at least their parents would be able to get the information, consider it, and get them vaccinated at least by the time they're 10 or 11.
SPEAKER_01Thank you so much for all the work you're doing and come coming on the show to talk about the way in which you're specifically engaging with these communities that really need the vaccine. So, as we've talked about so far, there are a handful of states and territories in the U.S. that have enacted policies mandating HPV vaccine as a requirement for middle school enrollment. Rhode Island was the first, and now Virginia, DC, Hawaii, and Puerto Rico all require it. And the results so far have been promising. A few months ago, Guam joined the list, and they were supported by advocacy efforts from the American Cancer Society. Now, the American Cancer Society and its Cancer Action Network have been strong advocates for the HPV vaccine since it first came out. I sat down with Katherine Peters, she's the strategic director of the ACS Cancer Action Network, and Cynthia Al, who is the director of government relations there, about their perspective on the new Guam policy. Tell me a little bit more from your organization's perspective. Why is this vaccine so important?
SPEAKER_06Obviously, the vaccine is proven safe and effective, and it's able to prevent six types of the HPV virus that are linked to six different types of cancer. And we just are obviously very invested in making sure that we can prevent as many cancers as possible and rather than detecting them later. So the vaccine has really created an opportunity that I don't think really existed before to prevent cancers before they start.
SPEAKER_01It's one of the first vaccines that's been released that is designed around cancer prevention, which is pretty remarkable.
SPEAKER_06Yes, definitely. And before the vaccine, there was obviously screening for cervical cancer, and that screening test could detect pre-cancers before they became cancer, which is obviously also a really good detection tool. But having a vaccine that is preventing illness altogether is obviously the preferred route.
SPEAKER_01Let's talk about Guam. Guam's an interesting place. It is closer to the Philippines and closer to Australia than it is to the mainland of the United States, pretty far out there. And uniquely, there's a really high incidence of cervical cancer, nearly twice the national U.S. average rate over in Guam, which creates a unique call for the value of this type of vaccine. There's also limited care options for folks because of the geographic isolation of the island. I know you all were involved in advocacy as that island and its government thought about how to mandate HPV vaccine in the schools there.
SPEAKER_02There is a high incidence of the cancer in Guam. And so the public health officials looked at what they could do to basically decrease that number, and they looked at various options. There was a champion in the legislature in 2023 who wanted to introduce a bill or legislation to basically require school before middle school entry. ACS Can was pivotal in working with the lawmaker at that time to work on model language to introduce the bill. But speaking with some of the different stakeholders and looking at some of the barriers that would happen with the introduction of legislation, we decided to just hold the introducing legislation as Plan B and see if administratively Guam could have the vaccinations as part of school entry requirements for middle school. And so that's where the department worked with the stakeholders and administration to basically make that happen. And we're just very excited that the announcement was made in March for the public to start the education process for school entry starting in August of 2027.
SPEAKER_01And now there's quite a lot of income inequality in Guam and the Gardasil 9 vaccine will be available to most of the population at no cost. Is that right?
SPEAKER_02Yes. So one of the discussions that took place was that Guam has a free cost immunization program for kids. And so there, if they don't have the insurance to cover it, there would be vaccinations that come out of that program. So everybody has an opportunity to have access to the vaccines.
SPEAKER_01We now have a handful of states that now Guam the territory that have introduced or have already implemented policies to mandate vaccines for school-aged kids at a certain age level. As other states start thinking about similar policies, what are the pros and cons as states think about introducing this type of policy?
SPEAKER_06I think one of the huge pros is we now have some data from a study that was released earlier this year from the American Cancer Society that actually shows a more significant decline in cervical cancer incidence among those states, those handful of states that have implemented a school entry requirement for HPV. And that data is the first of its kind because the vaccine is relatively new and school entry requirements obviously take a little bit to have an impact, but it's exciting because those few states have seen a decline of more than half in their cervical cancer incidence rates. Very exciting. And then I think one of the cons, or maybe a challenge, is the climate around vaccines is obviously just very challenging in state legislatures right now. And one of the things that a lot of states have done is provide a lot of exemptions for school entry requirements. Almost every single state has a medical and a religious exemption. And over the past few years, especially since the pandemic, states have expanded those exemptions to include things like personal conflict of interest or conscientious objection, just really vague and subjective exemptions that make it a lot easier for parents to opt their children out. And I think that will have an impact on any state that maybe down the road decides to add HPV to their schedule. Having a broad sort of exemption category will undermine that requirement before it even really gets started, which is a bummer.
SPEAKER_01Yeah. So I have some data here that's interesting as it relates to that, right? So the national average is around 63% as it relates to vaccination adoption or completion for the age range that we're talking about. So around 60, 65%. The states that have the mandates in place, Rhode Island being the oldest, 75 to 80% from what I can tell, probably around 75%. So about 10 to 15% higher. Obviously, Guam is new to that, but we'll see over time what that data looks like. The lowest state in the country, I believe, is Mississippi, and it's around 40%. But what's interesting is the state with the highest adoption is Massachusetts, nearing 80%. And there's no mandate there. I think it may just be one of those things where parents there are making a choice different than in other states, at higher rates, at least, to get their kids vaccinated. So it's interesting to see that it does appear that the mandate has some impact in the states that it's in effect to have a bit of a higher adoption rate for the vaccine than non-mandate states. But there's examples on either side in which mandates not required to have really high rates like Massachusetts.
SPEAKER_06Yeah. And obviously a school entry requirement is just one factor. So it could be that Massachusetts is doing something else that's really driving the uptake of the vaccine. Obviously, Massachusetts has been a pioneer in making sure people have good access to health coverage. That could be part of it. There could be what we call small P things that are going on in terms of electronic health record reminders or provider conversations are happening with parents. Like it's just there's just there's several levers, I think. And it's not totally clear which one Massachusetts is using. But like we said, school entry is is just one tool in the toolbox.
SPEAKER_01No, it's a good point. I think they offered for free to students, which is always helpful to have cost not be a factor. And I think there's a lot of other things they're doing up there as it relates to linking it into quality data that health systems and providers are being incentivized around. There's a lot of things that I think they're doing that are not requiring it, but creating incentives to make it easier or advantageous for providers to offer it or to encourage it. As we think about the next phase, how do we get from 60 to 65% now? PV, what are some things that we can do? And what are different levers that we can pull from a public health standpoint to help drive up adoption of this really important vaccine?
SPEAKER_06So the World Health Organization has the pillars to aimed at what they call the elimination of cervical cancer. And Australia, I think, is probably gonna be the first to get there. And so that means 90% of girls being vaccinated, and then 70% of women being screened for cervical cancer. So I think when we looked at that study that I mentioned that ACS released earlier in the year, that study just looked at the vaccination rate among girls. And Rhode Island was like over 90%. Hawaii was close to 90. So I think what you're gonna see is there's gonna be states. There may be a state that gets there before the US as a whole. And like we talked about, there's a whole bunch of different levers that can be pressed, whether that's improving access to free vaccine, requiring it as part of school entry, some of the provider conversations. There's obviously a stigma around the HPV vaccine because it's associated with sexually transmitted illness. So, what are the things that can happen to reduce some of those stigmas, addressing misinformation? There's a whole, I think, host of things that could be done. And we just need our policymakers to want to do them.
SPEAKER_01Kathy and Cynthia, thank you so much for all that you're doing to help advocate for the vaccine and making sure as many kids who want the vaccine are vaccinated. Finally, no conversation about pediatric vaccines is complete without getting the perspective of Dr. Paul Offitt. He's the director of the Vaccine Education Center at the Children's Hospital of Philadelphia, and he's a co-inventor of the rotavirus vaccine, which coincidentally also came out in 2006. Big year for pediatric vaccines. He has served on the CDC's Advisory Committee on Immunization Practices, ACIP, from 1998 to 2003, and on the FDA's Vaccines and Related Biological Products Advisory Committee from 2017 until September 2025. Joining me in my conversation with Dr. Offitt is friend of the show Judy Klein, who was a guest on a previous episode. She is the president and founder of Unity Consortium, a key advocate for the HPV vaccine. So we're on the 20th anniversary of the HPV vaccine, and it is an important tool in terms of cancer screening prevention. Tell me about how important it is to frame it that way as a cancer screening tool, more so than any other vaccine that we have.
SPEAKER_00So this virus is acquired via sexual contact. But I think that when you're talking to a young adolescent, it's a lot easier to say this is a cancer-preventing vaccine. This is a vaccine to prevent among the 30,000 cases of cancer that occur every year, head, neck, anal, and genital cancers, two-thirds of which occur in uh young women and older women. Um, this is a way to prevent cancer. You know, the we talk endlessly about treating cancer. It's much better to prevent than treat it, and I think that's the way to go.
SPEAKER_05I totally agree. Actually, I've been working on this vaccine for probably 25 years before it even came to market. And um, even back then, the goal was to actually very directly link this vaccine with what it does, and that's prevent cancer. And I think today parents are surrounded by just so much health information and advice wherever they look, whether it's on social media, more looking on AI, and young people are consulting the sources even more. And it's often conflicting, right? I mean, we know that the messages often that the healthcare provider is telling is different than what they're getting from friends and family. So framing it as cancer prevention not only breaks through the noise, but it's very straightforward, very concise, very relevant, and it's evidence-based. It's easy to understand. We know from parents that they have a hard time understanding a lot of the health information regarding vaccine. And it gets to what really matters, which is protecting them from cancer. We also know that this message is proven to improve vaccine uptake and parental acceptance. You know, we always want to say, let's share the good news versus the negative. And the good news is it works. There's evidence to show cancers are prevented as a result.
SPEAKER_01Let's talk about that evidence. What has the benefit been in the last 20 years of this vaccine from a prevention standpoint?
SPEAKER_00Well, so the the most recent evidence is that you. You've decreased the cancer rate caused by human papillomavirus vaccine by a little more than 60%. And it could be much greater if everyone chose to vaccinate their child in early adolescence. I think there was some reluctance with this vaccine for just the reasons that you're implying here, which is the notion was that, you know, my child is never going to have sex. And you're really talking about immunizing a nine to 11-year-old, it's harder. Because I was actually on the advisory committee for immunization practices when we were discussing HPV, and I was on the HPV working group. And there was a person on that working group who worked for a group called Focus on the Family. George W. Bush wanted that person to be on this working group because his point of view was if you don't have sex before you're married, if you or your partner never also don't have sex before they're married, and you never stray from your marriage, you're not going to get a sexually transmitted disease. And that's true. But that probably describes about 1% of this country. So it wasn't the majority. But I think that's where they were coming from. They just didn't want to talk about sex. But um, when they presented data, I remember about how old people are when they first start to have sex, the answer was around 15. And so we're all sitting there around the table thinking, this is not my child. I don't know whose children they're talking about. But then when they went through the data and you saw that it was urban, rural, suburban, white, black, no difference. Everybody was, you know, starting to have sex then. So you need to make sure children were pr protected by them.
SPEAKER_01In the early days, the guidance was that it was to be given more to girls. And then I think it's shifted over time.
SPEAKER_00You're right. And that was a mistake. I think what you saw with the early data was that HPV vaccine could prevent something called cervical intraepithal neoplasia type two or three, which is a requisite to going on to develop cancer. And so it was clear that this vaccine would prevent cancer in girls, prevent cervical cancer in girls and young women. The data on boys, there was no clear data that the vaccine prevented, say, anal cancers or genital warts. And so they held up that for a couple of years. And that was a mistake because what was shown very early on in those first trials is that you could prevent HPV infection, that the HPV vaccine prevented HPV infectious. Well, if the cell's not infected, then it can't become cancerous. So I think it wasn't a leap that if you can prevent infection, then you could prevent cancer. We shouldn't have done that because I think what we did was, at least for those early years, gave the notion that this vaccine was more important for girls and boys. And that's not true. It was important for both.
SPEAKER_05Yeah. And vaccination, obviously, for boys and girls is now the standards. And because of what Paul just talked about, the disparities remain. So boys still lag girls in many states, and that kind of reflects those old notions and patterns about perceived risk.
SPEAKER_01And has the age range recommendations, it feels like they've also perhaps shifted over time.
SPEAKER_05Paul obviously has a lot of experience given his his. One of the things, Ancore, you had wanted to discuss is why do parents decline and therefore why are vaccination rates lower? I guess I always like to start with parents are doing the best they can for their children, but because of, as you said, all that information and often conflicting, they're confused. So many parents still trust their healthcare provider number first, number one. And we know that a strong recommendation from the physician offered results in vaccination, but very often the healthcare provider doesn't strongly recommend HPV the way they would recommend other adolescent vaccines like Meninja Caco or TDAF, or they put it back on the parent. And the parent is coming to the office with many different beliefs and intentions. And one of the sources we look at a lot is the Edelman Trust Barometer, who asked parents of young children about their intention to get the HPV vaccine. So before they even go into the office, and only six in 10 said they would. And we believe it's because of parents holding a lot more what we call divisive health beliefs now, like the risk of childhood vaccine outweighs the benefit. And they're trusting this broad assortment of voices on health matters, including people who are not experts, like friends and family. So a lot of that, you know, when they come into the office with those beliefs, if they don't get a strong recommendation, you could see why they are, you know, hesitating.
SPEAKER_01It sounds like if you were to ask a pediatrician about the TDAP and the MMR and all the early childhood vaccine schedule, that there is much more strong recommendation about that than there is the HPV vaccine, where that strong recommendation just isn't as universal. Is that what you're saying?
SPEAKER_05Yes. And that's been an issue for many years. And I think two things go into it. I'm sure more than two, but two come to mind. One, HPV is not recommended across the states. Only five states recommend it or required for school entry. So they will put it on a different tier in their head. But I think even more importantly, they are anticipating pushback from the parents, even if there isn't going to be any. So they're a bit afraid to have that conversation. And therefore, they kind of don't do it as strongly as some of those.
SPEAKER_01And is that because of the sexual activity conversation or afraid of pushback variety?
SPEAKER_05I mean, I think now a lot of it's safety, right? Like does HPV vaccination cause fertility, or you know, will it increase promiscuity? Per what you just said. So it could be in many different forms, but they don't, they're not trained. And I'm gonna put this back on Paul as a healthcare provider who's trained. They're not often trained on having these discussions in a successful way.
SPEAKER_00I think the only thing I would add to that is that pediatricians see measles, mumps, German measles, chicken pox. I mean, they they see those. These are childhood diseases. When HPV causes cancer, it can occur 15, 20, 25 years after the original infection for those cells to become cancerous. So they don't see those cancers as much as, say, the adult physicians will see it. So I think that makes it less compelling for them. I think it's part of it.
SPEAKER_01So, Paul, yeah, we're we're only 20 years into this journey. And so it's not that long ago that we remember when it was uh approved and then when it was rolled out. As we think about the rollout of this vaccine, one tool that's been used over time. I think Judy mentioned it's four or five states now, starting with Rhode Island and others, where mandating it for school entry has been one tool that those states have used. How do you think that's gone as it relates to the overall uptick? It seems like those states have higher rates of vaccination, but there are other states like Massachusetts where it seems like they are also highly vaccinating their kids without having a mandate.
SPEAKER_00Yeah, generally mandates work and generally mandates increase on vaccine uptake. I do think there's been, especially in the first two years of the COVID pandemic, I think there's been a pushback against mandates. Or we're now in this sort of age of medical freedom, which is I will make the right decisions for my child. I don't want the government to tell me what to do. So I think that's part of it too. But this vaccine prevents known causes of cancer, like the hepatitis B vaccine. You know, there's we talk recently, you hear all this talk about how there's breakthroughs now in treating uh, you know, uh pancreatic cancers, these amazing breakthroughs. Well, you know, if you had a vaccine to prevent pancreatic cancer, you'd like to think that would be the first step. Much better to prevent something than treat it. The thing is, there's this kind of myth of invulnerability. You always assume it's never going to happen to you or never gonna happen to your child. You can't imagine your child actually having those cancers. But they do, like 30,000 people roughly would have cancers every year, about two-thirds in in women, and and uh this can prevent it. And I think we just have to be far more compelling advocates. I mean, I agree with Judy that there's sort of this feared uh pushback, but here's the vaccine that you're getting today, and here's why you're getting it. Because the default position is always, you know, we have this vaccine if you want it. And that comes off as a very soft sell, as if it's not that important.
SPEAKER_05So state requirements are one thing. Some states, Massachusetts, so great job without them, but I just want to point to a recent American Cancer Society study that found that declines in cervical cancer varied substantially by states and the vaccination rates. So the highest vaccination coverage is Massachusetts with about 80%, Mississippi the lowest with about 40%. But what they found is every 10% increase in vaccination was associated with an 11% reduction in cervical cancer. So states that have the lowest vaccination rates have the highest levels of cancer. And that's creating a disparity, right? So where you live now makes a difference in health equity and disparity in getting cancer.
SPEAKER_01The 20-year life of this vaccine is now giving us that type of longitudinal data, perhaps, that you know, somebody who develops cancer in adulthood, you could trace back as to whether or not they got that vaccine. So that's really sobering data, but helpful data. Uh, you know, sort of one other thing.
SPEAKER_00When when we were considering this vaccine back in the year uh sort of around two between 2006 and 2008, in terms of how it was going to be recommended, I remember the concern was raised so much so that people did studies on it, and you alluded to it, that by preventing this form of cancer that you would call increased sexual promiscuity, which of course on its face is ridiculous. The vaccine doesn't prevent chlamydia, it doesn't prevent syphilis, it doesn't prevent gonorrhea, it doesn't even prevent all zero types of human papillomavirus. So that was silly. It's sort of like the notion that, you know, now that I've gotten a tetus vaccine, I can run across a bed of rusty nails with impunity. But in any case, there were studies done actually. There were a couple studies done looking at that question. Did it increase sexual promiscuity? And the answer was obviously no, but it's amazing that that was an issue.
SPEAKER_01And then if we look to other countries for maybe inspiration or options, it seems like Australia's done a pretty uniquely uh impressive job uh and they may achieve some milestones from a public health standpoint. What can we learn about a place like that or other countries that have, you know, really excelled in the same timeframe that we have generally in terms of vaccine uptake?
SPEAKER_00I think one we thing we've learned is we should all move to Australia, really for a lot of reasons. But that aside, I think they don't, they're actually much better at beating down the anti-vaccine activity there than we are here. We're much more lenient at letting people be misinformed and disinformed and make terrible decisions for themselves and their families. They're they're much better about cracking down on that in Australia.
SPEAKER_05Yeah, and I'm um all ready to move there myself. And OmCard, the yeah, Australia is the first country that is on track to eliminate cervical cancer. And what they have found is that in 2021, since their records began, I guess back in the early 80s, there were no cervical cancers diagnosed in women under 25. So that's amazing. The second country that I'll I'll just mention is Scotland. And you say, why look at these other countries? Because it's part of the experiment, if you will, right? Like if if you can look at naturally different occurring vaccination rates for whatever reasons, right? Um, there's different cultures everywhere. But in Scotland, they too did a great job of routinely vaccinating girls. And this was with the bivalent vaccine. Now we have a nine-valent vaccine, and it led to this dramatic reduction in cervical disease. And not only that, but it protected the unvaccinated women. And because of this, there is now this hugely reduced prevalence of high-risk HPV in Scotland. So add that to um the Australia case study there.
SPEAKER_01So island nations in somewhat geographic isolation tend to do well, but beautiful places to potentially move to.
SPEAKER_00I think one thing that should be considered actually is so the serotypes that are contained in this now non-vanolent vaccine include serotypes that cause anal and genital warts. So um show a picture of that to the parents, you know. I think that would be very convincing.
SPEAKER_01Yeah. So as we zoom out a little bit, I mean, you talk about this era of medical freedom, if we want to think about it that way. There's also obviously misinformation. I do think the COVID pandemic, I think, has unfortunately, even though I think there are tremendous breakthroughs that came out in terms of vaccine production and deployment, I think culturally there seems to be, coupled with social media and other things, this belief that vaccines are optional and that we should ignore years of science. How do we navigate that as kind of public health professionals and advocates of vaccines as we think about particularly pediatric vaccines? What are some tactics we should think about from a public health standpoint?
SPEAKER_00Anti-vaccine activism has now moved from the sidelines to making public policy. So that's what you're up against. I think what we need to do is we need to make people feel like what these diseases are like. And so, for example, we're we're very good about putting numbers out there. I mean, how many people got measles last year, how many people died from measles last year, um, how many people were hospitalized with measles last year, how many people died from hooping cough last year, how many people died from influenza last year? But the numbers are numbing. We need to feel what this is like. Those two little girls, a healthy six-year-old and eight-year-old girl that died in West Texas of measles, what did that feel like? What did that look like? What did those girls go through? And I think we're not good at that. And as so there's a woman, for example, named Alyssa Kanowitz, who's head of the Amanda Canowitz Foundation. I'm sure Judy knows her, but she's um she gets up on stage and she shows pictures, videos of her daughter interacting with friends and family and relatives, this cute little four-year-old girl, and then she tells the story of what it was like to watch her daughter fall off a cliff in slow motion and die from influenza, who was, and she hadn't received an influenza vaccine. And it takes a lot of guts to do that. It does. There is nothing worse than losing your child. The only thing that's possibly worse is that you might have had something to do with it or that you could have prevented it. And that's why it's very hard to get these parents to talk often.
SPEAKER_05People don't trust, a lot of people don't trust federal government structures anymore. So bringing it down to the local level, the personal level is obviously very good. But if you look even at the community level, Ankar, you know, I think I talked to you before about our trusted teen leader program, and we work a lot with young people. And when we talk to them, you know, they believe in vaccines, but when they hear all of these different stories, you know, misinformation stories, they think, okay, you know, how could this affect me if I if something happens and I'm not able to go to work or school or whatever? So educating people at the community level through the networks that they trust, whether that's their friends or their family, I also think is the key, versus having it from a public policy really up high, make that public policy at the community level so that the people that you trust are saying those things that can protect you from, in this case, cancer.
SPEAKER_01I think we should all become aware of the people who are driving policy at public health in our states or our counties. I think there's a lot of important advocacy work that needs to happen there as we think about at least our local level, because I think a lot of these decisions will need to be perhaps advocated for by local leaders. And the other, I think, is our physician advocates. I think, you know, we need to fight misinformation with accurate information in the same places and venues that this information is being put out there. Social media, different. Wherever we hear and see people putting doubt in vaccines, I think we need educated leaders who have clinical expertise with data, with information, but presented in a way that it ref uh achieves the same goal, which is giving people the right information. So I think there's a lot we can do there. This whole podcast is focused on innovation in pediatrics. This vaccine, the creation of it, is quite innovative or was quite innovative at its time. I mean, it was one of the first kind of cancer-preventing vaccines for children. What makes this such an innovative vaccine in in its entirety from when it was first introduced?
SPEAKER_00The vaccine made using recombinant DNA technology. Hepatitis B vaccine was the first. And I think what we learned from the hepatitis B vaccine was that here, this single protein vaccine made with recombinant DNA technology, given as a series of three doses in the first, you know, few months of life, could protect you for the rest of your life. You had a relatively long incubation period disease, so all you needed was immunological memory, meaning you didn't eat antibodies in your circulation for long, which is good because they only live in your circulation for about four to six months before they start to fade, at least against these specific viruses. But that that here were those first three doses that you could induce protection for the rest of your life. I think that's probably true with this vaccine too. I think if you gave this as a birth dose vaccine and then gave it, you know, sort of two months later and six months after that, you probably would also get protection for the rest of your life, which is probably in part why it worked better when you were younger than when you were a little older. But it's a miracle in many ways, even though technically a miracle is the only things that can't be explained by the laws of nature. This can be explained by the laws of nature, but nonetheless, it is remarkable that this single protein, the so-called L1 surface protein of human papillomavirus, will protect you for the rest of your life against the cancer-causing virus. That should be a very easy sell for the physician.
SPEAKER_05How innovative is it that a vaccine is so effective? It's like more than 99% effective against preventing cancers, HPV-caused cancers. I think right there, that's the innovation.
SPEAKER_01In today's episode, we've talked about the HPV vaccine and its benefits. If you have a child, boy or girl, in elementary, middle, or high school, please talk to your pediatrician about the HPV vaccine. Do your research, get your questions answered from credible sources. We put some important sources in the show notes. Alright, thank you for joining us for your dose of optimism. Make sure to check out our show notes to get more information about our guests and the work they're doing. Visit our podcast page on the Kids X website to join our podcast community and to learn more about pediatric innovation. Thank you to our sponsors and to our presenting partner, Kids X. Please subscribe wherever you get your podcasts. And remember, it takes a village to make sure our kids grow into healthy adults. So volunteer at your local library, help out at the community center, and if you're so inspired, donate to your local children's hospital. Alright, see you next time. The content, views, opinions, and information presented on this podcast do not reflect the views of Children's Hospital Los Angeles or of the sponsors of the podcast.