Women in Alabama are more likely to die from cervical cancer than most other states in the nation, yet few young people are getting vaccinated against the disease.

Less than 40% of 14-18 year olds have received the human papillomavirus vaccine as of 2024, according to the Alabama Department of Public Health. Among 11-13 year olds just 19% have received the vaccine. The HPV vaccine is generally recommended for children at age 11 or 12.

HPV can cause cervical cancer. And it’s the most common sexually transmitted infection in the country, with about 80% of women estimated to get it at some point in their life.

“A lot of parents in Alabama are choosing the vaccine for their kid but we’re still not at that 80% range that would provide herd immunity, or protect kids who are not able to receive the vaccine because of a difficulty with their own immune system,” said Jennifer Young-Pierce, a gynecologic oncologist at University of South Alabama.

Vaccine rates in Alabama have gone up slightly since 2021, when only 35% of 14-18 year olds and 17% of 11-12 year olds received it. But that’s still not enough, Young-Pierce told AL.com, and it lags behind the national vaccination rate.

On average about 63% of teenagers were vaccinated across the United States as of 2022, according to the most recently available data from the Centers for Disease Control and Prevention.

Compared to other vaccines, HPV has the lowest rate of vaccination in the state, according to ADPH data.

“Barriers to HPV vaccination reported by parents include lack of knowledge and lack of a recommendation by their pediatrician. Pediatricians report that parents are often reluctant to vaccinate against an STD, and some parents express safety concerns,” a 2022 ADPH report said.

From 2017-2021, Alabama had the sixth highest rate of cervical cancer in the country, behind only Oklahoma, West Virginia, Kentucky, Texas and Arkansas, according to the National Cancer Institute.

“Unfortunately, Alabama is significantly higher in both cervical cancer incidence and mortality rates when compared to the U.S. Fortunately, HPV vaccination can eliminate the vast majority of cervical cancer cases,” State Health Officer Scott Harris said in the 2022 ADPH report.

“Increasing HPV vaccination rates along with increasing access to appropriate screening could greatly reduce the number of women being diagnosed with cervical cancer as well as the number of women that die from cervical cancer in Alabama,” he added.

On average, 33 women die from the disease every year in Alabama, according to ADPH.

Black women in the state have a significantly higher rate of getting cervical cancer and dying from it compared to white women. And women in rural communities have a higher rate than women in urban communities.

The counties where women get the disease at the highest rates include Walker, Etowah, Randolph, Chambers, Chilton, Dallas, Macon and Randolph.

The HPV vaccine is considered to be “safe, effective, and lasting protection against the HPV infections that most commonly cause cancer” according to the CDC. It is recommended for both boys, who can carry and pass on the virus, and for girls.

Doctors say cervical cancer is preventable and along with HPV vaccination, routine screenings can also help.

Young-Pierce said women who never get a pap smear screening account for 50% of cervical cancer diagnoses in Alabama. But even those who do get screened need to follow up if their test comes back as abnormal.

“A lot of people feel like their work is done when they’ve had their Pap test, but that’s the first step. If that is abnormal, you need to work with your doctor to get whatever testing and treatment done until it goes back to normal,” she said.

“Many women were never really told you have to get this biopsy or you could get cancer. They were told some sort of euphemism, like, you have abnormal cells or they are a little bit atypical, so we should see you again. But every single woman I’ve talked to said, ‘if they told me that if I didn’t come back, I’d have cancer, I would have come back.’”