In 2007, Texas lawmakers rejected a mandate to require adolescent girls to get the vaccine that would have protected thousands against human papillomavirus, or HPV, one of the nation’s most common sexually transmitted infections. Over a decade later, the state has one of the highest rates of cervical cancer in the country, the Texas Tribune reports.

In fact, Texas’s rates of cervical cancer, which studies show is linked to HPV in 99.7% of cases, is currently comparable to that of some developing countries. Data from the Centers for Disease Control and Prevention (CDC) also suggest that HPV vaccination remain low across Texas; in fact, only about 40% of Texans between 13 and 17 years were up to date on their vaccinations in 2017. That’s compared with a national average of nearly 49%.

Meanwhile, cervical cancer rates remain significantly higher in Texas than the rest of the country. In 2016, the age-adjusted rate of new cervical cancer cases was 9.2 per 100,000 women, higher than all but four states (New Mexico, Alabama, Florida and Kentucky). Persistent HPV infection can develop into precancerous lesions in the cervix, but the process can take several years, so not all cases in Texas can be attributed to low vaccine rates. But experts say the best way for the state to reduce its cancer risk moving forward is to push HPV vaccination.

How well does vaccination work? The Tribune article compares Texas’s rate to Australia’s, which in 2007 rolled out a nationwide program that offered the HPV vaccine for free to girls at their public schools. The nation is now on track to be the first country in the world to eliminate cervical cancer, and today, up to 80% of teens have been immunized against the infection.

“This is a preventable disease, and we should and could be doing more,” said Texas state Representative Jessica Farrar who has long advocated for more robust HPV coverage. “Here we are 12 years later and look where we could have been, but because of certain beliefs, we’re suffering from cancers that could have been avoided.”

Public health experts say offering vaccines in schools was key to Australia’s success, as was aggressively publicizing its program. Australia also encourages women to be tested for cervical cancer every five years from ages 25 to 74 in an effort to treat and keep track of cases before they progress.

The CDC recommends that both boys and girls receive the HPV vaccine at age 11 or 12. To learn more about HPV vaccination, click here.