The invention of the HPV vaccine should have been treated as nothing short of a miracle. Here was a shot that, if administered properly to every girl in her pre-teen/early teen years, would effectively wipe out cervical cancer and all attendant problems with diagnosing and treating it. Unfortunately, doing that means making sure girls actually get the series of three shots, and that’s where we as a society are falling down on the job. Research reported in the American Cancer Society journal Cancer found that the share of girls who completed the three-shot series declined dramatically from 2006 to 2009, from 50 percent of girls getting the initial shot to 20 percent of girls, leaving 80 percent of girls who initiated the course of treatment still vulnerable to contracting HPV and the possibility of developing cervical cancer.

There’s a number of reasons for this decline, some of which could be addressed pretty easily with simple interventions. Researchers found that girls who started their series with ob-gyns instead of pediatricians did a better job of completing the series. This is probably in part because girls around this age are often transitioning out of seeing a pediatrician regularly, making it harder to remember the shots. Additionally, gynecologists have to deal with the effects of HPV as part of the job, so the importance of finishing the series likely weighs more heavily on them. The fact that the Gardasil ads don’t mention that it’s a three-shot series isn’t helping matters.

Part of it probably has to do with anti-shot propaganda from the religious right anti-choicers, who are willing to use any angle they can to make sure that girls don’t have access to prevention, period, even for cervical cancer, and are willing to punish sexually-active women with pain and even death for having sex. All vaccines hurt and all vaccines have side effects, but to hear people carry on, you’d think Gardasil was somehow the scariest and worst ever. And that’s not even to mention the pure misinformation, with claims of side effects that aren’t even attributable to the vaccine. 

In my experience, some of the apathy towards the vaccine is also due to the fact that people are confused about what exactly it prevents. The vaccine was touted as prevention for cervical cancer, but most people assume that we already have prevention for cervical cancer, the Pap test, which is actually a diagnostic tool that can reveal early signs of cervical cancer and lead to early treatment; it is not truly a prevention method. Though Pap smears do allow doctors to find identify pre-cancerous cells and remove them before they metastasize, it does not prevent future recurrences. But when these two are confused, it can seem like the vaccine isn’t that necessary for prevention.

Let’s not mince words here: The Pap test is not an adequate substitute for the HPV vaccine, and medical authorities need to be more adamant about this. I can personally attest to how true this is. I’ve been good about getting Pap tests, something I have to do every year because I’ve had some bad ones. Regular Pap tests are why I’m almost certainly not going to develop cervical cancer, much less die from it. But that doesn’t mean that illness and suffering has been adequately prevented. Pap tests didn’t prevent me from developing abnormal cervical cells from HPV. The Pap test just helped detect them. Now they have to be removed, with an outpatient surgical procedure that isn’t a big deal in terms of surgery, but is in fact a big deal compared to the mild pain and side effects of the HPV vaccine. 

Knowing what I know personally about what can happen to you if you don’t get the vaccine — even if you have access to medical care that prevents HPV from turning into cancer — I’m pretty sad that I didn’t have a chance to get a vaccine and prevent this disease. I’m also baffled that anyone would neglect to get their daughters these shots, all three of them. Unlike some diseases like measles and whooping cough that are now rare because of widespread adoption of vaccines, HPV is as common as dirt. If you don’t get the vaccines, you can basically count on getting one or another strain of HPV at some point in your adult life. But once you do get it, there’s no way really to make sure you have not contracted one of the strains of HPV that causes cervical cancer or other problems, as opposed to a more benign strain. The only real prevention is the vaccine.

Perhaps education about the vaccine needs to be more expansive. Parents don’t just need to be told it prevents cervical cancer, which may seem alien and far off compared to some of the more immediate effects of HPV. Doctors could also explain how the vaccine prevents the development of abnormal cells that lead to painful surgeries, and in some rare cases, infertility. Dangling the carrot of grandkids in front of parents to remind them to get their daughters vaccinated couldn’t hurt. It also couldn’t hurt to point out that the ill effects of HPV can often show up in relatively young women, even as cervical cancer tends to be more common in middle age. Parents need to have full information about what this vaccine provides in order to be vigilant.

Additionally, pediatricians need to be more mindful of the gap in a girl’s care between when she eases out of being a child but before she’s really old enough to see a gynecologist. It’s easy to see how that ambiguity can cause girls to fall through the cracks. Perhaps the low uptake rate of this vaccine can create an incentive for the medical community to address the larger problem of handling care for this group that’s in between childhood and physical maturity.