The Indiana State Department of Health regularly sends out thousands of letters, reminding parents to vaccinate their kids against various infections.
The letters are generated by the state's vaccination registry, which tracks who has gotten what shots.
Recently though, one of those letters stirred up a controversy by encouraging parents to vaccinate their kids against the human papillomavirus, or HPV.
A few weeks ago, Micah Clark received one of the reminders, stating his 14-year-old daughter hadn't yet been vaccinated. He was not happy about it.
Clark is the head of the American Family Association of Indiana, a conservative advocacy group, and he decided to send an email to his supporters. He called the letter intrusive, and said he was frustrated by the state government acting as what he called a "papa bear."
Gov. Mike Pence said he would look into it, and days later, the State Department of Health changed the language.
The letter now will remind parents that the vaccine, like all vaccines in Indiana, is technically optional as is their participation in the state vaccination registry.
But even though it's optional, it's widely recommended by organizations like the Centers for Disease Control and Prevention.
"The viruses themselves are very common," says Dr. Dennis Fortenberry, the director of the Center for HPV Research.
Fortenberry says the viruses are so common, that almost everyone will get exposed to HPV at some point.
Those infections cause thousands of cases of cancer every year, in both males and females.
"So we're talking about a substantial number of people who have cancers that are nearly 100 percent preventable through the use of this vaccine," said Fortenberry.
Reminder letters like the one sent out by the health department have been shown to work - parents see the letter and take their kid to get the shots.
But Indiana's vaccination rate against HPV is especially low -- less than half of teenage girls and only 13 percent of teenage boys get all three shots in the series -- and experts worry the new language will be even less effective than before.
"I'm concerned we'll see other kids remain unprotected against this cancer," says Beth Meyerson, who heads the the Rural Center for AIDS and STD Research.
Meyerson says the new version of the letter downplays the risks of HPV, and instead, makes too big a deal of the fact that it can be transmitted sexually.
"What we've really done is undercut public health entirely," Meyerson adds. "When we say, ‘Hey this is about sex, not about cancer,' we've just completely lost all the parents that really when they've got young kids, that's not what they would want to think about with their kids. So they would likely wait."
But again, unless kids choose a life of celibacy, they'll likely be exposed to HPV at some point. So unlike Micah Clark, Beth Meyerson does plan to vaccinate her own kid against HPV.
The new letter also makes a point of telling parents they can opt out of the state's vaccination registry.
In fact, it does that before it even mentions any risks associated with HPV.
If enough people do that and that, Meyerson says, could diminish a really important public health tool.
