Transcript for the Piece Audio version of The HPV vaccine demographic

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A country band plays near a busy intersection in Chapel Hill. The famed white steeple glows in the distance through a calm spring breeze.

A woman walks by carrying a Styrofoam container with leftovers from dinner. She is tall with chin-length dirty blond hair. At the age of 27, it would be hard to consider this woman named Katie to be ?too old? for anything. According to most insurance companies, however, she is too old for a new vaccine that protects young women against cervical cancer.

Katie says that most of her friends in their late twenties aren?t too worried about getting the disease.

?If you?ve gotten this far without an abnormal pap, then you?re sort of in the world of ?well, it?s not going to happen.??

But it did happen to Katie when her healthcare provider found abnormal cervical cells on a pap smear. When a woman is infected with certain strains of HPV, one of two things can happen. The first and most common is that the woman will never develop any health problems. The second possibility is that the virus can cause cancer, but it?s a slow process. In the decades it takes for an initial HPV infection to become cervical cancer, routine pap smears help detect and treat women at high risk for developing the disease. Katie?s case was caught early.

?I?ve had a colposcopy, I?ve had cryo burn off part of my cervix, and that was really expensive and really emotionally taxing.?

Each year in the US, around 3 million women receive an abnormal pap smear result like Katie?s. The hope with the new vaccine Gardasil is that reducing genital HPV infections will decrease the number of women who get cervical cancer.

Dr. Mary Schlegel, Director of women?s services at UNC?s student health center, says she gets three to five inquiries a week from older women about whether they should get Gardasil.

?The context that I see it most commonly is Thursdays when I do my abnormal Pap smear clinic and I?m doing colposcopies and biopsies, which are not fun and usually, you know, make people anxious and upset and brings out a lot of tears. And we talk about sexual behaviors. A lot of people feel empowered after that conversation, if they had to undergo a biopsy that was unpleasant, they want to do something, you know? It?s not personally satisfying to just sit back and do nothing. And this is something that they actually could do.?

But Schlegel says the vaccine?s cost stops most women in their tracks. The drug is given in a three-shot series, with a total cost of over $300. Most insurance companies and government programs do not currently cover Gardasil prescriptions for women over 26 because this is a non-FDA approved use of the drug.

The vaccine-maker Merck recently announced that it is conducting clinical trials for use in older women.

Dr. Charles Livengood, an OB-GYN professor at Duke Medical School was a principal investigator in the original clinical trials of Gardasil. He believes older women who get vaccinated may be throwing their money away.

?Frankly, the people out in the world who haven?t acquired genital HPV infection are probably few and far between.?

He says by age 26, at least half of women have been infected by at least one of the HPV strains covered by Gardasil. If a woman gets the vaccine after being infected by one of these strains, the drug will not treat this infection. Rather, it will only protect her from future exposure to other strains of the virus.

?It?s pretty clear reality that if you?ve already acquired an HPV type then this vaccine isn?t going to protect you against it.?

In the end, Katie did not have cervical cancer. But when Gardasil became available last year, she quickly decided that the benefit outweighed the cost.

?The cost of writing that check was pretty damn easy. The idea of having to go through that again was significantly worse than writing that check.?

Katie says her experience has gotten her older sisters considering the vaccine as well. Katie?s bought herself peace of mind, but whether she?s bought herself a healthier future is an open question.

This is Jung Eun Lee reporting for Next Generation Radio.