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Public health advocates are flummoxed by the persistently low rate of teens who receive the medically-recommended HPV vaccine.

“We think the rates are dismally low and very alarming,” Amy Pisani, the head of Every Child by Two, a nonprofit focused on increasing vaccinations, told the Pew Charitable Trusts. “We clamor and clamor for a vaccine to get rid of these terrible diseases and yet we aren’t implementing them.”

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