The Minnesota Department of Health is urging doctors to strongly recommend to their adolescent and teenage patients a vaccine that protects against one of the leading causes of some genital and oral cancers.
State health experts believe physicians' reluctance to forcefully recommend the vaccine for human papillomavirus -- HPV -- is one reason why vaccinations rates have stalled.
The Department will be offering a series of online and in-person information sessions for doctors that will focus on adolescent vaccination.
The vaccine has the potential to be a game-changer in the battle against new HPV infections. But public health officials say that message is not reaching enough families.
HPV is the primary cause of cervical cancer. In Minnesota an average of 45 women die from cervical cancer each year. A quarter of those women are under age 50.
"Forty-five deaths from cervical cancer annually is 45 too many when you have a tool that can prevent it," said Kris Ehresman, director of the Health Department's infectious disease division.
It's Ehresmann's job to promote the HPV vaccine, which also protects against cancers of the mouth, throat, vagina, anus and penis. But that's been a frustrating task. The vaccine hasn't been as widely accepted in Minnesota as most other childhood vaccines.
A 2012 survey showed that only 33 percent of young Minnesota women had received the full three doses of the vaccine. Among boys, the rate is barely over 20 percent.
It can be harder to persuade adolescents and teens to get shots when they are not required for school attendance, and Ehresmann suspects that's part of the problem. And the vaccine also has a few minor side-effects.
"This vaccine stings a bit, and there have been more reports of fainting," she said.
But those complaints aren't considered significant enough to explain the low vaccination rate. Ehresmann says it's more likely that patients and their families are skipping the HPV vaccine because of the unenthusiastic way many doctors are promoting it.
"With HPV I think they're much more tentative and that makes a huge difference in parents' decision-making," she said.
Talking about sexually transmitted diseases is uncomfortable for doctors, especially when the discussions involve 11- and 12-year-old kids and their parents, said Michael Garvis, a Plymouth, Minn. pediatrician.
"It's an icky thing to think about," he said. "Our own children are this age and we don't want to think about any sexual connotation of them."
But he says studies show that parents are much more willing to consider a vaccine when doctors don't appear hesitant to recommend it. So about a year ago, Garvis urged his colleagues at South Lake Pediatrics to talk about the HPV vaccine in the same way they encourage other childhood vaccines.
"We're just more matter of fact about it now," he said.
South Lake recently reviewed its charts to see whether the effort was making a difference. Garvis says the audit showed 70 percent of teenage boys attending the clinic had either started or completed their HPV vaccine series last year -- an increase of 17 percent from 2012. He says the vaccine uptake among girls in the clinic rose nearly 10 percent last year.
But even a strong recommendation from a physician is not enough to convince some families that HPV vaccine is necessary.
"If they're not engaging in sexual behavior or sexual promiscuity, there's no need for this," said Donald Raleigh of Circle Pines, Minn., whose teenage daughters have ignored their doctor's suggestion to get the HPV vaccine.
Fourteen-year-old Izabella Raleigh says she's not sexually active and doesn't plan to be for quite some time.
"It could be helpful to some other people that are doing stuff like that at my age, which they are, but we decided as a family that it's not really necessary for us," she said.
Her 16-year-old sister, Zophia Raleigh, feels the same way.
"If I decided that I wanted to get the vaccine, then I'd tell my dad that I did and we'd go and get it," she said. "But I don't want it."
Donald Raleigh says he has raised his daughters to consider the consequences of their decisions before they act. He says abstinence from sex is guaranteed to prevent sexually transmitted diseases such as HPV. Raleigh says the vaccine can't match that guarantee.
"I'm not against it," he said. "It's just it seems that it's a penalty that one has to pay for risky behavior."
The Health Department's Kris Ehresmann says she understands the Raleighs' perspective. She's had similar conversations with her kids about their family's values. But she also recognizes that they're teenagers and they may make mistakes, even if they agreed with her initially.
"Even the best kids will sometimes do things that weren't part of the things that they learned and if we can do anything to keep kids safe, that's our goal," Ehresmann said.
As part of its campaign to increase awareness about HPV and the HPV vaccine, the Health Department plans to send reminder cards to families of all 11- and 12-year-olds in the state, encouraging them to get vaccinated.