I think the two "biases" mentioned are far off the mark. In family medicine, where we DO see the repercussions of non vaccination, the majority of times we "fail" to provide HPV vaccination is the decision to wait until later than 12 to immunize - this is harshly criticized, but it may take time to discuss and alleviate concerns. The very high pressure practices of the pharmaceutical industry including the ridiculously accusatory commercials about "how could my mother allow me to get cancer?" have turned off thousands of parents who see this as just another marketing tool.
Several points should be considered, though the advocates for vaccination will likely have just as closed ears as the Luddites who would never vaccinate at any point:
1. This vaccine can be helpful but it not a God send. I see many breakthroughs despite adequate vaccination.
2. Some of this failure may due to "amount of exposure" but it shouldn't be. Whenever I try to discuss this with ID or vaccine reps, the issue is pooh-pooh'd.
3. The vaccine visits are promoted as being "quick and you don't even need to see them." This is horrible advice. What we try to do in our practice is to use these visits to create dialogue with parents and the patients about WHY we need this vaccine, the need to delay sexual activity, and the fact that it is 70% effective - which means it is not 100% effective. Almost every Merck rep I have talked to and most ID people smile condescendingly at the preventive practices discussion we try to have, saying that "they will be doing it anyway."
While unfortunately true in some cases, it a) assumes the kids are animals without any level of self control, b) the parents can't be supported and empowered. This sounds like all they want to do is sell the vaccine. Given that OCPs do nothing to prevent HPV and may allow increases in exposure, and that condoms provide inadequate protection against HPV, there should be far better resources to accompany the vaccine, and use these 2-3 opportunities to educate and empower teens and their parents to avoid early sexual activity and make far better choices. Otherwise the cynicism that is in the provider and parental community will continue.