Twenty years ago, the United States approved the first vaccine specifically designed to prevent cancer. It works remarkably well. It has been given more than 500 million times. It is safe. And it is still not reaching more than a third of the eligible adolescents in this country.
This episode brings together six people who have spent their careers working on that gap, from the laboratory and the clinical trial to the mobile health van, the state legislature, and the community living room.
What the HPV Vaccine Is, and What It Isn’t: Dr. Heather Brandt
HPV is one of the most common viruses in the world. Almost everyone will have it at some point in their lifetime. In most people, it resolves without causing any harm. In some, it leads to six types of cancer: oropharyngeal, cervical, anal, penile, vulvar, and vaginal, as well as genital warts and other conditions.
The HPV vaccine, predominantly Gardasil 9 in the United States, protects against nine strains of the virus, including seven high-risk cancer-causing types. It prevents approximately 90% of HPV-related cancers. When given at the right age in the right number of doses, it is nearly 100% efficacious. Some countries are now on track to eliminate certain HPV cancers entirely because of how well it works.
Dr. Heather Brandt, who leads the HPV Cancer Prevention Program at St. Jude, walks through the science clearly: this is a virus-like particle vaccine, a copycat of the virus with nothing inside, so a person cannot get HPV from the vaccine. Two doses are sufficient for children vaccinated between ages 9 and 14, when the immune response is strongest; three doses are needed for those 15 and older. The vaccine is recommended for both boys and girls.
She also takes on the myths directly. The “wait until they’re sexually active” myth misunderstands the vaccine’s mechanism, it is prophylactic, meaning it works only before exposure. The “it causes promiscuity” myth has been studied and definitively disproven. The “it causes infertility” myth has no mechanistic foundation and has been refuted by multiple meta-analyses. And the “it’s too new” myth is worth a direct rebuttal: Instagram is newer than the HPV vaccine. The iPhone launched in 2007. Over 500 million doses have been administered worldwide with an exceptional safety record. Scientists have reviewed close to 300 studies including millions of people, with no evidence of unexpected health problems.
The most recent data adds urgency. A study published in 2025 showed that for every 10% increase in vaccination coverage, cervical cancer risk falls by 12%. After 18 years, antibody levels remain sufficient for protection. The science is unambiguous. The gap is not scientific, it is communicative, structural, and political.
Thirty Years at the Frontline: Antoinette Barrett
Antoinette Barrett has been vaccinating underserved children in Los Angeles for 30 years through Cedars-Sinai’s COACH for Kids mobile health program, visiting homeless shelters, housing projects, WIC centers, and schools to reach children who are uninsured, underinsured, or unable to access their regular providers.
She remembers clearly what the conversation around HPV vaccination looked like when the vaccine launched. Skepticism. Fear. Why does my child need this? Is it going to make them sexually active? Over 20 years, she says, the conversation has shifted enormously, driven by cumulative evidence, broader public education, multilingual outreach, and a change in how providers frame the vaccine: not as an STI-related shot, but as a cancer prevention tool bundled alongside meningitis and whooping cough protection.
The most recent new question she’s hearing: infertility. It’s a concern she hadn’t encountered before, and she addresses it with the same clarity as the others, no evidence of impact on ovarian function or sperm production, and the pointed observation that the cancers this vaccine prevents are the ones that actually threaten fertility.
Her magic wand wish: that every eligible child, starting at age nine, would have access to the vaccine and that every parent would at least have access to accurate information to make an informed decision.
Policy, Mandates, and the Road to 80%: Cynthia Au and Catherine Peters
The United States has a national goal of 80% HPV vaccination coverage among 13 to 15-year-olds by 2030. Currently, it’s at 63%. The gap between those numbers is the terrain that Catherine Peters and Cynthia Au work in every day.
Catherine, who works on state health policy for ACS CAN, describes the landmark achievement of a handful of states that have implemented school entry requirements for HPV vaccination. A study released in 2025 showed that these states have seen declines of more than 50% in cervical cancer incidence rates, among the most compelling outcome data yet published on the real-world impact of HPV vaccination policy.
But she is also candid about the challenges. The political climate around vaccine mandates has shifted significantly since the COVID pandemic. States have expanded exemptions, medical, religious, and increasingly vague “conscientious objection” categories, in ways that can undermine a requirement before it takes hold. And mandates are only one tool: Massachusetts, with no mandate, is close to 80% coverage, suggesting that access, provider behavior, EHR reminders, and community education matter enormously.
Cynthia brings the story of Guam, a territory with cervical cancer rates nearly twice the national US average, geographic isolation, and limited access to follow-up care, where an administrative policy change announced in March 2025 will make HPV vaccination a school entry requirement beginning in August 2027. The Gardasil 9 vaccine will be available at no cost through existing immunization programs for families without insurance.
Twenty Years of Getting It Right and Wrong: Dr. Paul Offit and Judy Klein
Dr. Paul Offit was on the ACIP working group when the HPV vaccine was first being considered for recommendation. He has a front-row seat to both the scientific triumph and the sociopolitical complications of the past two decades.
His most candid reflection: the early decision to delay recommending the vaccine for boys was a mistake. The vaccine prevented HPV infection, and if a cell isn’t infected it can’t become cancerous, that logic should have been sufficient from the start. The delay embedded a perception that the vaccine mattered more for girls than boys, a misconception that still shows up in coverage disparities today.
On the current landscape, Dr. Offit is direct: anti-vaccine activism has moved from the sidelines to making public policy. The “medical freedom” framing has made mandates politically difficult. And he argues that vaccine advocates have been too reliant on numbers, how many cases, how many deaths, and not compelling enough about what these diseases actually feel like. He points to parent advocates who share their personal stories of loss as models for the kind of communication that actually changes minds.
On Australia, which is on track to become the first country to eliminate cervical cancer, with no cervical cancer diagnoses in women under 25 reported in 2021, he observes that they are simply better at addressing anti-vaccine misinformation than the US.
Judy Klein, who has worked on HPV vaccination for 25 years, frames the communication challenge clearly: parents are doing the best they can with conflicting information from social media, friends and family, and AI tools that often pull from uncredentialed sources. Only six in ten parents say they intend to vaccinate their children before they walk into the clinic. And too many healthcare providers give a soft recommendation, “we have this vaccine if you want it”, rather than the strong, presumptive recommendation that the evidence warrants.
Her prescription: frame it as cancer prevention, always. Get the recommendation right at the provider level. And build trust at the community level, through networks people already trust, not through top-down public health messaging. Every 10% increase in vaccination coverage is associated with an 11% reduction in cervical cancer. The math is simple. The work is human.
Key Topics Discussed:
- What HPV is and which cancers it causes
- How the Gardasil 9 vaccine works and what it protects against
- Dosing: two doses for ages 9–14, three doses for 15 and older
- Why the vaccine is recommended for both boys and girls
- Current US vaccination coverage: 63% fully vaccinated
- Myth-busting: promiscuity, infertility, safety, “too new”
- 500 million doses and the HPV vaccine’s safety record
- Frontline vaccination in underserved communities in Los Angeles
- School entry requirements: state data and real-world outcomes
- Guam’s new HPV vaccination policy
- The role of exemptions in undermining vaccine requirements
- What Massachusetts is doing without a mandate
- Australia and Scotland as international models
- The delay in recommending HPV vaccine for boys — and its lasting impact
- Anti-vaccine activism entering public policy
- Provider recommendation behavior and its effect on uptake
- Framing HPV vaccination as cancer prevention
- Community-level trust as a driver of vaccine acceptance
About Dr. Heather M. Brandt:
Heather M. Brandt, PhD is the senior director of the HPV Cancer Prevention Program at St. Jude Children’s Research Hospital. She is co-associate director for outreach in the St. Jude Comprehensive Cancer Center and full faculty member in the department of epidemiology and cancer control. As a social, behavioral, and public health implementation scientist, her research program focuses on addressing cancer-related health disparities, specifically on HPV vaccination. This research includes working with subject matter experts, thought leaders, and partners – those who have professional and lived experiences – to effectively implement evidence-based interventions and strategies to increase HPV vaccination coverage.
About Antoinette Barrett:
Nurse Practitioner, Cedars-Sinai COACH for Kids
About Cynthia Au:
Cynthia Au is the ACS CAN Government Relations Director for Hawai’i and Guam. She manages a network of volunteer advocates in both areas and builds bridges with lawmakers to pass policies that help fight cancer.
About Catherine Peters:
Cathy Peters is a Senior Director of State and Local Campaigns for the American Cancer Society Cancer Action Network — or ACS CAN for short. Her portfolio includes access to care issues including vaccine policies and HPV.
About Dr. Paul Offit:
Paul A. Offit, MD is the Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia as well as the Maurice R. Hilleman Professor of Vaccinology and a Professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He is a recipient of many awards including the J. Edmund Bradley Prize for Excellence in Pediatrics from the University of Maryland Medical School, the Young Investigator Award in Vaccine Development from the Infectious Disease Society of America, and a Research Career Development Award from the National Institutes of Health. Dr. Offit has published more than 160 papers in medical and scientific journals in the areas of rotavirus-specific immune responses and vaccine safety. He is also the co-inventor of the rotavirus vaccine, RotaTeq, recommended for universal use in infants by the CDC in 2006 and by the WHO in 2013.
About Judy Klein:
Leader and expert in the healthcare industry. Deep experience and a proven record with diverse organizations to realize their goals and aspirations. Applies strategic marketing, innovative and analytical thinking, and a practical lens to create and implement vaccines and pharmaceutical solutions.
