When she was a college freshman, Joslyn Chaiprasert-Paguio was told by a doctor she had a common sexually transmitted infection called the human papillomavirus but not to worry. Four years later, a few days before her wedding, she was diagnosed with cervical cancer, which caused complications when she became pregnant. She had a hysterectomy eight years later, after the disease returned in 2021.

The 38-year-old medical journal editor of Menifee in Riverside County, California, hadn’t been immunized as a teenager because there wasn’t yet a vaccine for HPV, which causes nearly all cervical cancers and a handful of other potentially lethal forms of the disease in men and women. Now, her 10-year-old daughter, Samantha, is scheduled to get her first shot this month.

“This is the only vaccine that prevents cancer,” Chaiprasert-Paguio said.

A bill pending in the California legislature would require schools to notify parents that their kids are expected to be vaccinated for HPV before entering eighth grade, as part of a push to get more children inoculated against the cancer-causing strains of the virus, theoretically before they become sexually active. AB 659 stops short of mandating the vaccine for middle schoolers, as the bill originally proposed. Lawmakers stripped out that provision without any debate, reflecting the contentious nature of school vaccine mandates even in a state with some of the nation’s strictest immunization laws.

“Now is a tough time to be taking up that fight,” said Michelle Mello, a professor of law and health policy at Stanford University, noting that anti-vaccine sentiment has drawn more attention since the beginning of the covid-19 pandemic.

The proposed legislation by Assembly member Cecilia Aguiar-Curry would instead require public college students under 26 to provide proof of immunization against the virus, a more palatable idea for parents uncomfortable with a vaccine that links teens to sex.

Anti-vaccine activists pounced on the bill, denouncing it as an egregious example of government overreach. A group called the Freedom Angels claimed credit for pressuring lawmakers into dropping the vaccine mandate for young teens, calling it “a huge victory.”

Since its debut in 2006, the HPV vaccine has elicited unfounded rumors that the shots could cause neurological damage or make teens sterile. Fewer than 55% of kids in the U.S. ages 13-15 were vaccinated against HPV in 2020, a rate far lower than those for other routine childhood shots. By comparison, more than 90% of adolescents are up to date on the Tdap vaccine, which protects against tetanus, diphtheria, and pertussis. A single dose of the HPV vaccine has a list price of $268, according to drug manufacturer Merck.

Most states do not require HPV immunizations for school as for diseases like polio and chickenpox, which can spread easily in classrooms through the air or touch. Just three states, Rhode Island, Virginia, and Hawaii, as well as Washington, D.C., currently require student vaccination against HPV for sixth or seventh graders.

Mostly Republican pushback against covid vaccine mandates has spawned a spate of proposed legislation in conservative states, such as Montana and Idaho, which weaken or roll back government and private-sector requirements. In Iowa, which has the nation’s second-highest cancer rate, lawmakers are considering a bill that would strike a requirement that schools inform students about the HPV vaccine.

Even before covid, a rising wave of parents who refused to vaccinate their kids allowed diseases that had been all but eliminated decades ago — like measles and pertussis, or whooping cough — to return.

In this reality, passing good public health policy means long-term strategizing, said Crystal Strait, who leads the pro-vaccination group ProtectUS. That’s how she sees Aguiar-Curry’s amended HPV vaccination bill.

“It’s a step,” she said. “We have to do something. Too many people are being harmed by preventable cancer.”

Nearly everyone contracts HPV at some point, though usually without symptoms. But a handful of strains of the virus can linger in the body and develop into cancer of the cervix, vagina, vulva, penis, anus, or throat. Studies have confirmed that the HPV vaccine reduced the risk of getting cancer by nearly 90% when given to girls and boys in their early teens, likely before they’re exposed to dangerous strains of the virus.

Academic research shows that teens in states with HPV vaccine mandates have been much more likely to receive the shot.

“We’ve had this war against cancer for decades, and now we have a cancer vaccine and people are debating whether we should work to assure that everyone gets it,” said Dr. Jeffrey Klausner, a public health professor at the University of Southern California who previously served as San Francisco’s director of STD Prevention and Control Services. “It’s hard to wrap your mind around.”

Rates of cervical cancer, once a leading cause of cancer deaths for American women, have fallen with the vaccine and stepped-up Pap smears. Still, more than 37,000 cancers caused by HPV are diagnosed annually, and cervical cancer alone still killed more than 4,000 women last year.

By contrast, Australia is on track to become the first country to eliminate cervical cancer within the next two decades after launching a national school-based program in which school nurses administer HPV shots to 12- and 13-year-olds willing to get the vaccine.

Public health mandates work best when they require things that have already reached a certain level of social acceptance, like wearing a seat belt or not smoking indoors, said Saad Omer, who heads the Yale Institute for Global Health and has studied vaccine skepticism.

“Mandates are strong medicine, but like every strong medicine, they come with side effects,” said Omer.

Santa Clara graphic designer Gilma Pereda, who was always a little skeptical of vaccines, admits to not being crazy about mandates. On the other hand, since she was diagnosed with cervical cancer in 2016, she’s undergone numerous surgeries and repeated rounds of chemotherapy. She has lost her uterus, her eyelashes, and her waist-length brown hair. She reached a low point in 2021 upon learning the cancer had spread to her bones.

In deciding whether to vaccinate her daughter for HPV, the choice was clear. “I did not want my child to go through this,” she said.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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