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Routine HPV Vaccination Reminder Sparks Controversy In Indiana

Ed Uthman/Flickr
A group of HPV-infected cells, shown in red.

A few weeks ago, Micah Clark, head of the conservative American Family Association of Indiana, received a letter from the Indiana State Department of Health that troubled him. It stated that his 14-year old daughter hadn’t yet been vaccinated for human papillomavirus, or HPV, and encouraged a vaccination to protect against various cancers.

Clark sent an email to his supporters calling the letter “intrusive” and saying he was frustrated by the state government acting as a “papa bear.”

The Indiana State Department of Health regularly sends out thousands of these letters, generated by the state’s vaccination registry, reminding parents to vaccinate their kids against various infections. But Clark’s reaction seems to have provoked a response from the state government.

A few days after Gov. Mike Pence said he would look into it, the health department changed the language. The letter will now remind parents that the HPV vaccine is optional—the state also allows exemptions for other vaccines on religious or medical grounds—as is participation in the state vaccination registry.

But even though it’s optional, it’s widely recommended by public health organizations such as the Centers for Disease Control and Prevention. Experts worry the new language will make the letter less effective at getting parents to vaccinate their kids--and thus protecting them from cancer.

The various HPV viruses are so common, that almost everyone will be exposed at some point, says Dr. Dennis Fortenberry, director of the Center for HPV Research at the Indiana University School of Medicine.

The viruses are commonly known to cause cervical cancer in women, but are also responsible for other cancers: approximately 27,000 cases every year, in both men and women.

“So we’re talking about a substantial number of people who have cancers that are nearly 100 percent preventable through the use of this vaccine,” says Fortenberry.

Reminder letters like the one sent out by the health department have been shown to work. But Indiana’s vaccination rate against HPV is especially low: Less than half of teenage girls and only 13 percent of teenage boys get all three shots in the series.

“I’m concerned we’ll see other kids remain unprotected against this cancer,” says Beth Meyerson, who heads the Rural Center for AIDS/STD Prevention. “What we’ve really just done is undercut public health entirely.”

Both Fortenberry and Meyerson say the new version of the letter downplays the risks of HPV, and instead,  overemphasizes the fact that it can be transmitted sexually. Meyerson argues that emphasis could cause parents to wait—if they believe their kids are not yet sexually active—when they should instead be  proactive in getting the vaccine.

Unless kids choose a life of celibacy, they’ll likely be exposed to HPV at some point, experts say, and it's better to be vaccinated well in advance of beginning to be sexually active. Unlike Micah Clark, Beth Meyerson does plan to vaccinate her own kid against HPV.

Both the Indiana State Department of Health and Gov. Mike Pence’s office declined to be interviewed for this story or to answer questions about these events via email. The full text of both the old and new versions of the state’s HPV vaccination reminder are below.


Jake Harper is an investigative reporter for Side Effects Public Media, and he is a co-host of the Sick podcast. He can be reached at