Mayo doc Minnesota’s HPV vaccine champion
If someone told you a routinely recommended vaccine could help prevent multiple types of cancer, would you get it? Would you wonder why you hadn’t been vaccinated a long time ago?
Robert Jacobson wants to make sure no more Minnesotans ask themselves that question.
Jacobson conducts research to improve vaccination rates in primary care populations, and leads an NIH-funded research grant to improve provider recommendations for the HPV vaccine.
Jacobson, a general pediatrician, professor of pediatrics, and longtime member of the Mayo Clinic consulting staff, was named Minnesota’s HPV Vaccine is Cancer Prevention Champion.
In short, his work is in encouraging doctors to strongly recommend HPV vaccines — and at a young age.
“We need providers, the nurse practitioners or physicians, to strongly speak up and say, ‘I really recommend you get this vaccine. This is one of our routinely recommended vaccines,’” he said.
Human papillomavirus is a group of more than 150 sexually transmitted virus. It’s easily spread and extremely common in the U.S.
Many people will be infected with HPV briefly, then the virus will go away on its own. But if it doesn’t go away, HPV can cause a host of problems, ranging from the merely uncomfortable — like genital warts — to many types of cancer in men and women.
Gardasil, the first HPV vaccine, was licensed for use in June 2006. Long before then, Jacobson took part in early studies at Mayo Clinic studying early versions of the vaccine.
“It was at that time that I began to learn how ubiquitous the virus is,” he said. “Over the years, I have come to appreciate how devastating the virus can be.”
Early on, researchers estimated that HPV might cause 8,000 cancers a year, Jacobson remembered.
They knew it was common, and that not everyone who got HPV showed symptoms.
Instead, HPV is linked to around 30,000 cancer cases a year in the U.S. And in the states, 80 percent of people will have been infected with a strain of HPV before they’re 50.
“Most will clear it in a year or two, but will never know they had it and won’t know if they spread it or not,” Jacobson said. “Some people, it will linger, and then start making cancer-causing changes.”
Gardasil had its own advertising wave around the time of its licensure, but despite the fact that it’s a recommended routine vaccination for ages 9-26, not all physicians pushed it to their patients.
“I think where we went wrong is that teenagers, unlike young children, rarely come in for check-ups,” he said. “So they’re not hearing a recommendation from their doctor or nurse practitioner.”
When they do, teens tend to come in for injuries or unusual problems. And when they’re not seeing their usual practitioners or broadening visits to include general well-being, recommending vaccines took and takes a back seat.
Which is why Jacobson teaches doctors how to make strong recommendations to parents and teens, and talk vaccine-adverse families through the benefits of HPV vaccines.
“Every visit needs to become a visit where you review someone’s vaccine status and make recommendations,” he said. “You can’t just depend on the parent, because the parent may not know it’s recommended. You can’t depend on the child.”
Talking about HPV is different than talking about meningitis or the Tdap vaccine, though. Like influenza vaccines, HPV vaccines aren’t required for daycare or school attendance.
“Most parents, when they’re notified that they’ve missed a required vaccination, rush to get that done,” Jacobson said. “That it’s not required makes parents think it’s optional. And that’s hurt our vaccination rates.”
Physicians also tend to present vaccines to very young children (infants to age 8) in the “language of need, and due … which signals a strong recommendation,” Jacobson said.
But with adolescents and teens, physicians tend to ask “what are your thoughts on this vaccine?” Or “what do you want to do about this vaccine?”
When combined with lack of education about HPV-related cancers, that wording makes the vaccines seem unnecessary.
“We rightfully expect our clinicians to recommend vaccines to us,” Jacobson said. “We’re vaccinating on the premise that this is safe, effective, necessary, and without alternative.”