To the Editor: An estimated 6,2 million women are infected every year with the human papillomavirus (HPV) in the United States, but the acceptance of the HPV vaccination is low; therefore, improving vaccination uptake is a demanding issue.1,2
Compared with several countries and especially the developing world, where the costs of the HPV vaccine must drop for access to improve, in the United States most large insurance plans cover the costs of approximately $125 for each of the 3 doses, and children (up to 18 years old) may be eligible through the Vaccines for Children program.
In Germany, the cost is currently approximately $235 US for one dose; however, according to the National Committee on Vaccination, for girls in the 12- to 18-year-old age group the statutory health insurance covers the costs completely, and, on request, also provides coverage for older women.3 A study conducted in March 2010 among 298 female high school students in Leipzig, Germany, shows that 59% of the participants were aware of the coverage by health insurance. Nonetheless, the acceptance of the vaccine is suboptimal. Despite complete financial coverage, in 2007 only 3.51% of 147,014 girls eligible for Gardasil received the vaccine.4
Although the use of the HPV vaccination has been improving recently, this finding is, unfortunately, similar to that of numerous other industrial countries (eg, Austria reported a vaccination rate of 4% in 2010).5 Information about the vaccination is widely spread in Germany, mainly by the media; however, 21.8% of the participants in our study had been informed about the vaccine by their family physician. Furthermore, 56.7% of the students indicated that they would prefer to be approached and counseled by their family doctor. Several studies revealed that parents value the information and recommendations provided by their children's health care providers.6 Although each encounter with an eligible patient might be considered an opportunity to encourage HPV vaccination, recent data show that family doctors are reluctant to recommend the vaccination mainly because of the controversial discussion in Germany about the benefits and efficacy and the concern of the vaccine's possible negative, long-term side effects.7,8 In addition, several family doctors feel uncomfortable about discussing sexuality issues with adolescent patients.9 Compared with South Korea, where the first cohabitation takes place, on average, at age 20, in Germany the average age is 15.1 years, according to the Federal Center for Health Education.10 Therefore, if family physicians would consider approaching young women—focusing on those younger than 15—to help them make informed decisions, it might contribute to an increase the level of vaccination.
Notes
The above letter was referred to the author of the article in question, who offers the following reply.
