MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Oncologists and other cancer experts are traveling around the country in a campaign to try to get more pediatricians to recommend the HPV vaccine. The immunization shots have the potential to prevent tens of thousands of cancer cases. Here with me to talk about why some doctors do not recommend the vaccine, Laurie McGinley of The Washington Post, Dr. Linda Fu of Children's National Health System, Sherrie Wallington of Georgetown University.

MS. DIANE REHMAnd joining us by phone from Houston, Dr. Louis Ramondetta with the University of Texas MD Anderson Cancer Center. I do invite you, as always to be part of the program. Give us a call at 800-433-8850. Send your email to drshow@wamu.org. Follow us on Facebook or Twitter. And welcome to all of you.

DR. SHERRIE WALLINGTONThank you. Delighted to be here.

MS. LAURIE MCGINLEYThank you.

DR. LINDA FUThanks for having us.

DR. LOIS RAMONDETTAThank you.

REHMDr. Ramondetta, if I could start with you. I wonder if you can tell us how strong that connection is between the HPV, the virus itself, and cancer.

RAMONDETTASo the connection between HPV virus and cancer is stronger than between smoking and lung cancer. We are dealing with a cancer that -- I'm sorry, a virus that causes almost 99 percent of HPV cancers of the cervix. We believe it causes at least 70 percent of Oropharyngeal cancers, 90 percent of anal cancers and the majority of vulvae, vaginal and penile cancers.

REHMAnd these studies have emerged in, what, the last ten years?

RAMONDETTAWe've known about cervix and HPV cancer for quite a long time, decades. We have really become familiar with the shifting in the epidemiology of HPV and oropharyngeal cancers whereas in the past, it was usually an older, male, smoking or drinking, we are now noticing that it is younger males, usually in their 50s and 60s, often Caucasian and we noticed that they are beginning to have more HPV-related cancers.

RAMONDETTAAnd, in fact, the majority, at this point, we suspect that by 2020, there will be more HPV related oropharyngeal cancers than new cervix cancers.

REHMSo tell me, Dr. Fu, for the most part, this is -- this virus is translated sexually. The HPV vaccine is aimed at what?

FUThe HPV vaccine is aimed at the virus. And it's so important to give the vaccine before people become sexually active because it isn't effective on existing disease or infection.

REHMSo once you've already got the HPV virus, the vaccine will not help you?

FUWell, we still recommend the vaccine for people who are infected because they may be infected with a type that isn't covered in the vaccine and so the vaccine can protect you from other types. But it is important to get the vaccine early on because it protects you only if don't have that type in the vaccine and, plus, it's more effective in younger adolescents. It seems to cause more antibody response so it's important to get it at the recommended age of 11 to 12 years for boys and girls.

REHMAnd Laurie McGinley of The Post, tell me where the resistance is coming from on giving this vaccine to a child as young as 11.

MCGINLEYThere have been several surveys about this, some of which came out just last year. And what they're showing is that there is a substantial minority of pediatricians who are not recommending this vaccine strongly enough, the way that they would recommend the meningitis vaccine or a different type of vaccine. And the resistance seems to be that there is concern about discomfort talking about sexual matters with children who are preteens, as well as perhaps anticipatory concerns that the parents will disapprove about bringing up the subject.

REHMAnd have you talked with the parents as well as pediatricians?

MCGINLEYWe talked to a lot of people for the story and what I concluded was, and this is also based on a lot of the research and survey work that's been, is that in some cases, the pediatricians are overly sensitive to what they think the parents are going to say and the parents, actually, respond very well to a strong, confident, matter of fact recommendation from the pediatrician. Once the pediatrician start treating this as something that's different or exceptional or something that the parents should be concerned about or something that is optional, then that's where the vaccination doesn't take place.

REHMSo to you, Dr. Wallington, what does Georgetown University recommend to its pediatricians?

WALLINGTONWell, as a researcher, I work very closely with pediatricians at Georgetown as well as also Linda Fu, pediatricians across the country as well. But it's important to remember, as far as Georgetown and what we're doing here locally, that we have to work across multiple stakeholders so that means working in partnership with the D.C. Department of Health. They have a great immunization office. Also pediatricians at other community health clinics as well.

WALLINGTONAnd what we recommend -- our strategy is that pediatricians -- not only pediatricians, but family physicians, also I speak -- talk a lot with gynecologists who say although I don't see the children, I see their mothers. And so we have to make sure that we're educating at every opportunity and so some of the -- what the recent surveys have shown is that there is a huge missed opportunity. And so when the vaccine was first approved, June 8, ten years ago -- we're celebrating the anniversary of Gardasil.

WALLINGTONThe pediatricians at Georgetown, they got together and said, this is going to be our strategy. But we also have to understand that not every practice is the same. There are differences in practices sizes, differences in the resources that medical provider offices has and sometimes that makes a difference in the recommendation practices that physicians give.

REHMWould you agree with Dr. Fu that sometimes there is a certain reluctance on the part of pediatricians to talk about such sexual matters with, say, an 11-year-old or even find resistance from the parents?

WALLINGTONI think there's a perception -- and it has to do with the framing. And there's a lot of research done on how to communicate about the vaccine. But we have to keep in mind that we should talk about HPV vaccine, about just what it is. It's a cancer prevention vaccine. And sometimes, I think, that a lot of emphasis is placed on the fact that is a sexually transmitted virus, but the most important thing is that we should talk about it and present it, you know, for what it is. And it's a cancer prevention vaccine.

WALLINGTONSo that's one strategy that national health organizations, like the National Cancer Institute and also the Centers for Disease Control, is that we should promote this as a cancer prevention vaccine. And, you know, I was just recently -- when we all listened to Vice President Biden about the moon shot initiative, you know, this is a scientific discovery that we should be proud of, you know, for eradicating cervical cancers and other types of HPV cancers.

WALLINGTONSo I think that when I work in the District of Columbia, I do a lot of interventions with parents and adolescents and providers. You know, my best advice is to meet parents, providers where they are, help them to have accurate information so that they can make sure that they are giving parents that information so they can make an informed decision about HPV vaccination.

REHMOf course, Laurie McGinley, you may not even have those parents taking their daughters and sons to doctors at that early age.

MCGINLEYWell, one of the reasons why they recommend that the vaccine be given between the ages of 9 and 12 and completed by 13 is because especially as kids get a little bit older, many times they don't visit the pediatrician or the family physician as regularly as they do when they're children. They don't...

REHMYeah, there's sort of a cut-off, isn't there?

MCGINLEYRight. There is. And then, so there's a high attrition rate in pediatric practices as kids get older and they don't have to -- and there aren't as many shots required so -- or other things required by the schools so then they're not seeing the pediatricians as often. So that's why there's such a huge missed opportunity if they don't get them at the early age.

REHMLaurie McGinley, she's a health and medical reporter for The Washington Post. We're going to take a short break here. When we come back, we'll answer your questions, take your calls. I hope you will heed the message that you're hearing this morning, a very important one. Stay with us.

REHMAnd before we resume our conversation about the HPV vaccine and its connection to the reduction in cancer rates in both women and men, FBI Director Comey has concluded the investigation into Hillary Clinton's emails. He said, he thinks, the FBI thinks no charges are appropriate in this case. There is, quote, "evidence," unquote, that Clinton and her team were, quote, "extremely careless with handling classified information," says Comey, but we find, quote, "no reasonable prosecutor would bring," unquote, a case against Hillary Clinton in this case. Those are the findings of the FBI and Director James Comey spoke this morning.

REHMNow, let's get back to the connection between the HPV vaccine and cancer. Dr. Fu, has there actually been shown a reduction in cancer rates because of use of the HPV vaccine?

FUWell, as Dr. Wallington had said earlier, the vaccine has been approved in the U.S. for 10 years. And HPV infection is followed by many years and most people cleared on their own. But decades later is when the cancers, the cervical cancer and other types of cancers can occur. So what we have seen in the U.S. is a reduction in infections. So a 56 percent reduction in HPV infections in teen girls in the United States, which is pretty impressive given that it's only been out for 10 years.

REHMAnd you're saying that the infection itself has been prevented because of the vaccine. But now we're back to the question that Dr. Ramondetta brought up, which is the connection to cancer.

RAMONDETTASo, yes, she's absolutely right, that we've already seen a decrease in the prevalence of the infection. But we've also seen the decrease in the precancerous lesions. And so using scientific facts and our knowledge of how cervical cancer develops, we have seen not just a decrease infection, but a decrease in warts and a decrease in precancers. And because of that, we believe strongly that we will see within the next hopefully five to ten years a significant decrease in the effects -- the prevalence and incidents of cervix cancer.

RAMONDETTAWhat we can't say is the same for oropharyngeal cancer. Because although we know that the vaccine decreases the prevalence of the infection in the mouth, we have no precancerous lesion to look at. But we know that 70 percent of these cancers are also caused by HPV. And we suspect that we will also see their decrease. And we just don't feel that we have the time to wait.

REHMSo what you're saying, Dr. Ramondetta, is that oral sex is at work here and that is part of the big problem.

RAMONDETTAYes. And we said before, this is sexually transmitted. But when something is 80 percent of the population, it really is a different category than sexually-transmitted disease. I've said this before, but it's part of being human at this point, to be exposed to HPV. And so you get exposed because you're human. Most of them will go away. It can -- it is mostly spread by sexually-transmitted -- I'm sorry, intercourse. But it can also be transmitted by skin-to-skin contact, genital skin-to-skin contact, oral sex and, although we don't know it, we suspect that if you have an infection in your mouth that you could potentially spread it by kissing.

REHMAnd to you, Laurie McGinley, tell me about the boys in this case. What message are the young boys getting from pediatricians and from parents?

MCGINLEYWell, I think this is one of the most interesting parts of this and one of the reasons why I got interested in this story, because I think the whole need for boys to be vaccinated is quite urgent also and maybe not appreciated by pediatricians and parents to the extent that it should be. And it's not just a question of protecting partners that they may -- future partners that they might have. It's also a question of protecting themselves from throat cancer. And I have a friend of mine who's a pediatrician at Children's and I asked her what she tells 11- and 12-year-old boys.

REHMBoys.

MCGINLEYAnd, frankly, she says, I'm going to make -- she said they're not really all that concerned about cancer. They can't -- they don't really get it. But they'll say -- she'll say, I'm going to make sure you don't have warts on your penis. So that is the message that she gives them. And she said that they take that message very, very seriously.

REHMIs that a good message to give, Dr. Fu?

FUI think when parents have more concerns, definitely. But as Laurie had said earlier, as a pediatrician, what I do is I present it like every other vaccine. I have two boys and they're too young to receive the vaccine. But in a couple of years I'm definitely going to give them to my own sons. And it's not a question of this vaccine is different than the tetanus booster and the meningococcal vaccine. No. This is one of the vaccines that they need when they are 11 years old. And they're going to get this vaccine. And if I present it to my families as such, as something that I am going to do for my own children, I think developing that personal relationship and having that trust between us, it's not an issue.

REHMBut why are boys getting it -- getting the vaccine at such lower rates, Laurie?

MCGINLEYOne of the reasons is because when the FDA approved the vaccine in 2006, it was approved only for girls at that point, because there had not been sufficient studies to show its effectiveness in boys. It wasn't approved for boys until 2011. So this is a newer situation. And that's, I think, one of the reasons why the CDC has been pushing this and public health departments have been pushing this, as many of the pediatricians have in the American Academy of Pediatrics.

MCGINLEYBut I think that's one of the reasons why the -- they needed some reinforcements from the cancer doctors and the cancer researchers and the cancer community. Because the cancer doctors can say very persuasively, we're seeing the head and neck cancers that actually can be prevented. And I've seen -- I've talked to people who have actually seen Dr. Ramondetta's talks in Texas and she's very effective. And sometimes the cancer doctors bring along cancer patients who have had throat cancer, older men, and they've really undergone miserable treatments dealing with the disease -- surgery, radiation -- it's very difficult. And they have a very strong message to the doctors, which is these kids need to be vaccinated.

REHMAnd you can trace that back to, Dr. Ramondetta, to HPV?

RAMONDETTAAbsolutely. Absolutely, they can see that. We are having an epidemic of oropharyngeal cancers in men. And the rates are going up. So we expect that over the next few years we're going to see more and more of this. In fact, at MD Anderson Cancer Center, we now see more new cases of oropharyngeal cancer than we do of cervix cancer. Now I work in a county hospital where access to prevention is a bigger issue. And so I'm still seeing a lot of cervix cancer.

RAMONDETTAAnd I just think that we all recognize, especially the cancer centers that have kind of come together under this mission, that this is really something that we need to bring to the pediatricians. They know it's important but maybe they don't recognize how important it is. And we really feel like we have a voice to bring to the pediatricians.

REHMDr. Wallington, I understand that a study by the Harvard Medical School and the University of North Carolina reported last fall an online survey of some 7-, nearly 800 doctors, showed that many talked about HPV vaccine in a way likely to discourage parents from having their kids get the vaccine.

WALLINGTONYes. Communication in the messaging about the HPV is so important, because you may only get one opportunity to really talk to a parent about the HPV vaccine and how the language and the framing of the message about the vaccine is so important. So in my work in the District of Columbia, in training providers, many of them say they've heard their colleagues say, oh, you don't need to get your son or daughter vaccinated until they're 16. Or if they come in for, for instance, if they need a physical or a sheet form -- a form signed for school, you know, they don't take the time to talk to them about HPV vaccination or even check to see if they've had all of their vaccinations.

WALLINGTONAnd that's what we mean by missed opportunities, that every opportunity that a parent or child comes in for, whether it's their yearly physical, whether they need a form completed to play athletic sport, they should check to make sure that they're talking about HPV. And we should talk about the HPV vaccine like we do the other recommended childhood vaccines, as Dr. Fu mentioned, taking a bundling approach. For instance, here are the vaccines that your child needs today or that are recommended today, and talk about, again, as I said, talk about HPV vaccine as a cancer-prevention vaccine so that that resonates with the parents.

REHMAt the same time, Laurie, I mean, we've seen over the past few decades the resistance to vaccines on the part of some parents, feeling they may cause problems, kids don't need them. Of course, they cannot get into school without certain vaccines. But this is not one of them. So how -- why is it that these doctors are not taking that opportunity that Dr. Wallington talks about?

MCGINLEYI think we have to have a little bit of sympathy here for the pediatricians. After all, it was in the late '90s, not that long before the vaccine -- the HPV vaccine was approved, where the report came out of Britain that autism was caused by vaccines. Now that has long been discredited and retracted.

REHMExactly.

MCGINLEYBut it's all over the Internet. And people use the Internet now as ways to research this vaccine and other vaccines. And there are plenty of scary stories on -- about HPV vaccine on the Internet, including...

REHMSuch as?

MCGINLEY...people dying, girls dying and all kinds of things happening. And there have been many, many safety studies by -- not only by Merck, the manufacturer, but also by Oregon Health and Science University, by the European version of the FDA. The FDA and the CDC have looked at all of the incidents and they have concluded there is no cause-and-effect link here between the vaccine and the...

REHMDr. Fu.

FUAnd I just wanted to point out, before this vaccine was even licensed, it was tested in 75,000 people, the various vaccines. In addition, since 2006, there's been more than 80 million doses of HPV vaccine distributed in the United States alone and there have been, you know, no evidence of it being linked to common serious side effects. The most common side effect is a little bit of pain and redness at the injection site. And in some people, they -- some adolescents tend to faint afterwards and it may just be adolescence. So they do recommend having children sit for 15 minutes in the office afterwards. But it is a very safe and effective vaccine.

REHMDr. Linda Fu, she's a pediatrician with Children's National Health System. And you're listening to "The Diane Rehm Show." And now we'll open the phones and hear from our listeners. First, to Connie in Brookeville, Md. You're on the air.

CONNIEThank you. Thank you for taking my call.

REHMSure.

CONNIEI -- I'm concerned because I have some trust issues with the pharmaceutical industry. And in making a choice to vaccinate -- I have two four-year-old boys and I've chosen only to do the required vaccinations, those that are required for preschool or in kindergarten. And I think it does come from this lack of trust with the pharmaceutical companies and how they promote vaccinations.

REHMAll right. And Dr. Ramondetta, do you want to take a look at that?

RAMONDETTAYeah. I mean, I'll make a comment about that. You know, the issues about regulated vaccines versus recommended vaccines is -- very separate issues. Regulations is a government decision. But recommendation is something that comes from the providers and the physicians and the researchers. And we recommend all three of these vaccines that kids get at age 11, 12, equally -- the pertussis vaccine, the meningitis vaccine and the HPV vaccine. And it's a very separate discussion about what's regulated and what's not. But if you look at ACIP, American College of Immunization Practices, the American Academy of Pediatrics, even American Society of Clinical Oncology, we all recommend the vaccine at this age.

RAMONDETTAAnd so I can -- I think there's a lot of confusing information out there. People have access to information that isn't scientifically proven. With access to the Internet comes good and bad. And so I'd say to try to remember that these are recommended by professional societies who have evaluated the data.

REHMDr. Wallington.

WALLINGTONAnd I would add to that, in the District of Columbia, HPV vaccine is a school requirement. But the caller is in Maryland and her concerns about pharmaceutical trust issues are real. And I would encourage her to still talk to her child's pediatrician, you know, about those trust issues that she has about the vaccine. Sometimes many providers can share additional information that will help to allay those concerns. So I would encourage the caller in Maryland, we have a lot of great providers in Maryland, a lot of community health clinics that would welcome the opportunity to talk to her about that.

REHMAnd, Laurie, what about the idea that pediatricians and parents do not wish to encourage sexual activity on the part of the child and therefore even talking about that vaccine makes that somehow more real?

MCGINLEYThis seems to be one of the big issues and barriers in terms of vaccinating children who are 9, 10, 11 or 12. But the truth -- the idea that perhaps it's some kind of a green light for them to go out and have sexual activity or -- but, in fact, there has been quite a bit of research and some very large studies, including one that came out of Canada two years ago, that showed that it did not encourage risky sexual practices.

REHMLaurie McGinley, health and medical reporter at The Washington Post. Short break. Right back.

REHMAnd welcome back. We're talking about the HPV vaccine, which is not recommended for children between the ages of, what, eight and 12, or nine?

FUIt's as early as age nine. It's great to talk about this so parents know. Children at risk can get it as early as age nine, and it is recommended for children at ages 11 to 12 and can be given up through age 26.

REHMAll right, and here's an email from Bill (PH) in Washington, Dr. Ramondetta, who says your guests have mentioned cancer among older males. Should older single sexually active men get the HPV vaccination? What about men 50-plus?

RAMONDETTAIt's a great question. You know, as you hear, it is recommended and approved for ages nine to 26. However, decision to do it in other time should be based on a discussion with your physician, and that -- really what you need to know is you need to get the vaccine before you're exposed for it to be really protective. That said, if you've been exposed to one or more virus subtypes, you may not have been exposed to the ones protected maybe by Gardasil 9. And so there may be some effectiveness, and that really has to be a personal decision. But the effectiveness significantly drops off the older that you are.

RAMONDETTAAnd I wanted to make one point that although we have kind of been a little hard on the pediatricians, we have great champions among the pediatricians who are really recommending this vaccine, and it's the partnership between the oncologists, the survivors and the pediatricians that we're hoping will make the difference as we move forward.

REHMAll right, here's a caller who is a pediatrician, Jean in Ann Arbor, Michigan. You're on the air.

JEANHi Diane. Thank you for taking my call.

REHMSurely.

JEANI was hoping your experts would comment on -- as mentioned, I'm a general pediatrician. I am also a general internal medicine doctor. So I see patients of all ages and do spend a fair amount of time counseling about the HPV vaccine between ages nine and 26. What I do see a lot of in social media is people referencing a particular group called the American College of Pediatricians, which is not the American Academy of Pediatricians.

JEANThe American College of Pediatricians is a splinter group that has a very anti-HPV stance, and my concern or something I hope your experts can comment on is because they use a medallion or -- their sites look very official and I think further kind of propagate this fear based on really bad information.

REHMDr. Fu, do you want to comment?

FUYeah, as Laurie had mentioned earlier, there are so many things that people can find on the Internet, and it doesn't necessarily lead you to positive, good information. And so what I usually recommend to my patients who want to look things up on their own, start a reputable source, so the Centers for Disease Control and Prevention, the American Academy of Pediatrics. Those have wonderful websites with lots of information.

REHMSo why has the American College of Pediatrics taken such a different stance, Dr. Ramondetta?

RAMONDETTAYou know, as best that I know this group, they have a different agenda than the American Academy of Pediatrics. They are very -- feel very strongly about abstinence and some religiously related decisions, and they have splintered off for that reason. It's important to recognize that, you know, we would all like abstinence to be an important part of growing up. Unfortunately, that's not the case for many children, who either engage in early sexual behavior or have unwanted sexual behavior, perhaps even in their college years.

RAMONDETTABut the concept is really that this is a protection for life. We -- as best as we know, this will protect for life. We may found out that a booster is needed. We don't at this point think there will be. But the important thing to remember is that this is for later on in that child's life, and the reason to give it early is because they haven't been exposed and because also their immune system may work better at that point to keep them protected through marriage potentially to someone else who they don't even know had a previous partner.

RAMONDETTAAnd this -- to not make the decision to protect the child is really a very unfortunate decision on the part of the practitioner and shouldn't -- shouldn't be happening.

REHMDr. Wallington?

WALLINGTONOh thank you, Diane. I just wanted to also highlight that we're talking a lot about pediatricians today but also to keep in mind that other providers, such as family physicians and adolescent health physicians, also have joined in helping to educate parents and also vaccinate, you know, patients, as well, and then also to encourage pediatricians, all types of medical providers, as well as parents, to really take advantage of all the work and science that the Centers for Disease Control and Prevention -- they have wonderful fact sheets, wonderful information on their website, which they have tested with different audiences to make sure that this information is culturally and linguistically appropriate for all the different stakeholders.

WALLINGTONThey can just visit the website. Many of these materials can be downloaded so that physicians can use in their practices, as well as parents, and also these materials are in different languages.

REHMAll right, to Tim in Chambersburg, Pennsylvania. You're on the air.

TIMHi Diane, good morning.

REHMHi.

TIMI just wanted to weigh in on this from a personal experience. My son received the vaccine at age 11, and shortly after that his pancreas failed, he became type 1 diabetic. I do not have an agenda here. I just -- it's a personal observation. I have two other children and certainly would -- there was no other outlier involved in his situation. He was a very healthy young man. And so I would hesitate, almost, to get my other children vaccinated because of this. Is there -- could you weigh in on that, that issue?

REHMSure.

TIMMaybe your experts there could weigh in on that, and I'll take my answer off the air here.

REHMThanks for calling, and I'm sorry about your son.

TIMThank you.

REHMDr. Ramondetta?

RAMONDETTASo yeah, I'm very sorry to hear about your son. You know, the -- as we've said before that over 200 million doses have been given worldwide and almost 90 million in the U.S. This is an extensively studied vaccine both before it was originally approved and afterwards. And it continues to collect data. Multiple studies have been designed to look at -- and non-funded, non-funded studies, and it's important to know -- I mean, I need to say, too, that I am not supported by any drug companies. I work solely on behalf of MD Anderson Cancer Center, that these studies are being done regularly both during, before and afterwards to look for trends in abnormalities that occur after the vaccine.

RAMONDETTAAnd there have been at this point no proof other than the side effects that were previously mentioned of any relationship. Unfortunately, coincidence, you know, when something occurs afterwards, is not the same as causation.

REHMLaurie, do you want to weigh in on that?

MCGINLEYI think I'll leave it to the doctors.

REHMAll right, and let's go to Sara in Houston, Texas. You're on the air.

SARAHi, thanks so much for having me.

REHMSure.

SARAIt's great to hear from all these wonderful experts, especially the one from MD Anderson. I have a background in -- a degree in molecular and cellular biology and a background in virology research, and I also have a six-year-old boy, a three-year-old girl and a two-year-old boy. So maybe my thoughts on this have changed a little bit than they would have pre-kids.

SARAI just have two comments or one main comment that I think that scientifically everything that's been presented has been really interesting and sound, and I do think one thing I had a little bit of contention with was the presentation that, oh, that the HPV vaccine is the same as the whooping cough vaccine, it's the same -- you know, that they're all recommended together, that there really is a differentiation.

SARAI give my -- you know, my children are born, they can contract whooping cough in a waiting room. None of...

REHMMeasles.

SARAI know it's said that HPV could potentially transmitted through kissing. I don't know if that was a bit of a jaunt. But there is a very large difference in transmission susceptibility for a child or a young adult between, say, the flu, I give my kids the flu vaccine. That is something that could, if they contract it, could kill them. That the transmission of HPV is inherently different. And it doesn't mean we shouldn't be preventative. I do think, though, there is a responsibility to say there are possibly other ways that it could be avoided because these are serious chemicals we're putting in our kids' bodies, that yes, there's been a lot of research but we don't know the 30-years-from-now research.

REHMThat's true, Laurie?

MCGINLEYI think the caller makes a really good point, which is this goes way beyond a scientific issue to really involve social issues and social values. And I think in Rhode Island, for example, there's -- that is -- Rhode Island is one of the states that has a mandate, one of the few states that has a state mandate, and there is a group of parents who are trying to repeal the mandate.

MCGINLEYAnd many of them are not wild about the vaccine, but what they're really concerned about is they feel as though they've lost parental choice and the ability to talk to their children more extensively about other ways to avoid this through abstinence. And I think that in Utah, this is an issue, also. So I think it's something that people have to keep in mind in terms of talking to parents and to children.

REHMSo there's another aspect here, which is more political. We have a tweet from Kate, who says, can you address how people in political office have hurt this vaccination campaign? Rick Perry in Texas was involved in this, Dr. Ramondetta.

RAMONDETTAYes, so some people feel that this was an extremely unfortunate way to go about it. Rick Perry tried to make this a mandate and perhaps, you know, whether for the right or wrong reasons, it may not have been the right time. Since that time we've re-addressed this in the legislature in Texas, and we've worked together with the DSHS and multiple representatives in order to have a law that just passed this August that requires DSHS to work with other organizations in Texas to develop a plan to improve vaccination minus making it mandatory.

RAMONDETTABut that said, there have been multiple opportunities that politicians have taken that have really hurt this, and they've hurt vaccinations in general by re-claiming that there may be a question between autism and vaccination, which of course there isn't. And now I think, even, I mean, I hate to even mention any names so that people look for it, but to suggest that there was a question with developmental delays of some sort.

RAMONDETTAThese are -- yes, people really need to do their work before this happens, before they say anything.

REHMAnd you're listening to the Diane Rehm Show. And a caller in Jupiter, Florida. Susan, you're on the air.

SUSANWell thank you so much for taking my call, Diane.

REHMSurely.

SUSANTwo points I'd like to make. First, my husband is battling oropharyngeal cancer and has been for two years that is caused by HPV. And it's -- it's real. We go to support groups. They are full of middle-aged men and women, and it's not just a young disease because they didn't have this vaccine back then. So I would strongly urge all parents to seriously consider this for their children because it's not something you want your child to go through in their 50s. Also...

REHMOh Susan, I am so sorry about your husband. That has to be so difficult for you and him.

SUSANIt truly is. And secondly, the mother who spoke just a minute ago who said there are other ways to battle this, I'm a public schoolteacher, and I have to say whether parents want to admit it or not, their children are sexually active, and they just have to understand that this is not for their child when they're 12 but when they're teens and in their 20s, and they're going to be sexually active, and to prepare them for that is showing how much you care about them.

REHMIndeed.

SUSANSo I would encourage everybody to speak to their pediatrician about how best to approach vaccinating their child.

REHMWell, there is no one who can speak more forcefully than one who has seen it in her own family. Thanks for sharing that, Susan. Dr. Wallington?

WALLINGTONSusan makes a very important point. And certainly, you know, our hearts go out to her.

REHMI should say.

WALLINGTONBut I would say, too, that in some of the work that we're doing at Georgetown with adolescents, a lot of the adolescents feel that oral sex is a safer form of sex, and that's a very important information that we need to reach our adolescents.

REHMTo explain that that is not the case.

WALLINGTONRight, and there are such huge knowledge gaps, and then earlier Dr. Fu mentioned about all of the misinformation out there on social media. And so that's why it's important that we do interventions, not just with the providers but with the parents and especially the adolescents because there's such a huge knowledge gap around HPV.

REHMLaurie, did you have an opportunity to talk to very young people about their sexual activity and their perhaps belief that oral sex was safe?

MCGINLEYI didn't talk to young people for this story because I was focusing primarily on the cancer center's involvement and how they got so involved in this campaign.

REHMWell, it sounds as though pediatricians have one more piece of information to transmit, which is that it's not safe.

MCGINLEYWell, and I'd like to emphasize that prior to the vaccine, this was -- this infection was ubiquitous. So it's not a matter of sexual promiscuity. You know, you could have your first encounter after you're married, but if your partner, you know, had previous encounters. So you're protecting your child for what we believe a lifetime of -- against HPV-infected cancers.

REHMAll right, and we'll end on that. Dr. Linda Fu, Laurie McGinley, Dr. Sherrie Wallington and Dr. Lois Ramondetta. Thank you all so much, very important program. Thanks for listening, all. I'm Diane Rehm.