A groundbreaking study has uncovered hidden 'vaccine deserts' across the United States, identifying pockets of the country where teenagers are missing out on a cancer-preventing jab at dramatically higher rates than elsewhere. Researchers behind the first-ever state-by-state ranking of HPV vaccination found that a child's location strongly predicts whether they receive the shot.
HPV Vaccine: A Critical Cancer Prevention Tool
The HPV vaccine protects against strains of human papillomavirus responsible for the majority of cervical cancers, as well as many throat, vulvar, vaginal, and penile cancers. It has been routinely recommended for children and teenagers for years and can be administered from age nine onwards. Despite its widespread availability, the US still falls short of the federal Healthy People 2030 goal of vaccinating 80 percent of adolescents. Nationwide, roughly one in four teenagers remains unvaccinated against HPV. In some states, however, the figure rises to more than one in three.
Study Methodology and Key Findings
Using 2023 survey data from more than 16,000 teenagers aged 13 to 17, researchers published their findings in JAMA Pediatrics, mapping HPV vaccination uptake across all 50 states. The results revealed enormous differences across the country. A child's likelihood of receiving protection against HPV depends heavily on their state of residence.
Rhode Island emerged as the strongest-performing state in America. Just eight percent of adolescents there had never received a single dose of the HPV vaccine. Teenagers in the state were three times more likely to be vaccinated than those in Alabama, which researchers used as the study's reference state.
At the opposite end of the rankings sat Mississippi, which researchers effectively described as a true 'vaccine desert'. Nearly 39 percent of adolescents aged 13 to 17 there had never received even one dose of the vaccine. Oklahoma and Georgia also ranked among the worst-performing states, with 36 percent and 35 percent of teenagers unvaccinated respectively. Kentucky and West Virginia rounded out the bottom five, both with around a third of adolescents lacking protection against HPV.
Regional Disparities and Surprising Variations
The researchers said the findings confirmed long-standing regional divides in US healthcare, with Southern states generally performing worst. However, they also uncovered major disparities hidden inside regions previously considered relatively successful overall.
In the Northeast, Massachusetts and Rhode Island recorded some of the strongest vaccination rates in the country. Yet neighbouring New Jersey performed dramatically worse. More than one in three New Jersey adolescents remained completely unvaccinated against HPV. Researchers said its vaccination levels now more closely resemble those seen in Southern low-performing states than in nearby Northeastern ones.
The West also showed surprising variation. Hawaii performed strongly, with just 14 percent of teenagers unvaccinated. Nevada, however, emerged as a significant weak spot within the region. Nearly 29 percent of adolescents there had never received the HPV vaccine.
Even within the South, there were exceptions to the broader trend. Virginia and Delaware both achieved vaccination rates similar to the best-performing Northeastern states. In both places, only around 14 percent of adolescents remained unvaccinated.
Implications for Public Health Policy
The researchers argued that broad regional comparisons are no longer sufficient for public health officials trying to improve vaccination rates. Knowing that the South underperforms compared with the Northeast or West may help identify national trends, but state-by-state analysis is far more useful when targeting interventions and identifying communities where adolescents are most vulnerable.
The study also highlighted how areas struggling with HPV vaccination often overlap with America's biggest sexually transmitted infection hotspots. Mississippi, Louisiana, Georgia, and South Carolina all record some of the nation's highest rates of STDs including gonorrhea, chlamydia, and syphilis. Researchers suggested this reflects broader weaknesses in preventive healthcare infrastructure and access.
Gonorrhea rates remain especially high in the District of Columbia, Alaska, and Louisiana. Chlamydia, the most commonly reported STD in America, is particularly widespread in Alaska, Mississippi, and Louisiana. Meanwhile, primary and secondary syphilis, the most infectious stages of the disease, are rising sharply in several states, including South Dakota, New Mexico, and Nevada.
Researchers noted that these same jurisdictions frequently fail to meet federal HPV vaccination targets, leaving large numbers of adolescents vulnerable both to HPV-related cancers and to other sexually transmitted infections.
HPV and Cancer Risk
HPV is one of the most common sexually transmitted infections in the world. In most people, the virus causes no symptoms and clears naturally. However, persistent infection with certain strains can trigger cellular changes that eventually develop into cancer. The virus is responsible for the overwhelming majority of cervical cancer cases and is also linked to many cancers of the throat, anus, penis, vulva, and vagina.
Public health experts have long viewed widespread HPV vaccination as one of the most important cancer-prevention measures available. The CDC currently recommends routine vaccination at ages 11 or 12, although the vaccine can be given earlier and is also recommended for some adults who missed it when younger.
The study's authors warned that America is not facing one single nationwide vaccination problem, but rather a patchwork of localised 'vaccine deserts' where preventive healthcare is hardest to access and vaccine uptake remains stubbornly low.
