Vaccination rates against HPV remain low in South Carolina, according to the national Blue Cross Blue Shield association, despite a wide acceptance by doctors as a key in preventing cervical and other types of cancer.
Gardasil had been administered in three doses until 2016, when the Centers for Disease Control and Prevention recommended two doses of the same vaccine for adolescents. The Blue Cross study examined the percentage of children who got the first dose by the time they were 10 and the percentage who had gotten the final dose three years later.
In South Carolina, the most recent numbers suggest while 28 percent of children get a first dose, only about 9 percent had completed the vaccination by the time they were 13.
Unlike some other vaccines, the HPV vaccine is not required for public school students. HPV is a group of about 200 related viruses, some of which are sexually transmitted, according to the National Cancer Institute.
Dr. Linda Bell, an epidemiologist with the Department of Health and Environmental Control, said the vaccine protects against the strains most likely to cause cancer.
"If there is something we can do when the children are younger to prevent them from suffering a serious complication later in life, that parents should understand the opportunity to do that," Bell said.
Vonda Evans, a senior manager with the American Cancer Society in South Carolina, works with physicians in federally qualified health centers. She said South Carolina's low rate stems from a lack of education.
"It is a cancer vaccine," Evans said. "Sometimes we fail to educate parents and providers that that’s what it is."
Evans said low rates also may stem from parents' unwillingness to accept the idea that their children may soon become sexually active.
Her approach has been to tell health care providers to group the HPV vaccine with other vaccinations, and explain why doctors recommend them. Evans said a physician's recommendation is the No. 1 deciding factor in whether a parent will agree.
The vaccine is recommended for all males and females between 9 and 26 years old. Though it is better to get the vaccine earlier, Bell said, it is still worth completing the vaccine even in your early 20s.
"The earliest you can get the protection, the better," she said.
Men also can contract several other types of cancer from HPV. Florida's legislature is considering a bill that would make vaccinations against the virus mandatory for children enrolled in public school.
Rates have improved in South Carolina and in the country, but 25 percent of all American children get their first dose but not the final one, the Blue Cross research showed. Bell said reminders to parents of when vaccines are due are important.
Coastal Pediatric Associates reports better numbers. Among their active patients ages 11 to 18, about 43 percent of them had completed the vaccine.
Dr. Kacey O'Malley, a pediatrician with group, said much of their success is due to the CDC's 2016 recommendation that adolescents should only receive two doses. That's easier on parents with busy lives, she said.
O'Malley said she dispels any myths that the vaccination can cause HPV infection, noting that is impossible.
But she said misconceptions about vaccines are not the only reason parents avoid Gardasil, adding that some insurance companies do not cover it, or only cover it for girls.
O'Malley said people can finish the last round of Gardasil even years later, though it is preferable to complete it before becoming sexually active.
"Our goal is to vaccinate before any sexual activity is an issue," O'Malley said. "Just starting that conversation is uncomfortable for a lot of parents."
HPV is the culprit behind 31,500 cancer cases each year, according to the CDC. Cancer is not the only risk of HPV: Pregnant mothers can pass the virus to their children through the birth canal. Those babies can be susceptible to a life-long condition that renders their voice permanently hoarse.
O'Malley said parents should think of it less as combating sexually transmitted infections and more as reducing the risk that their child may one day contract a far more deadly disease.
"What we're protecting against is cancer," O'Malley said.