Earlier this month, one of our Public Health interns, Nicholas Hatch, attended the HPV National Roundtable. This roundtable was held on June 9th and 10th and aimed to address the low adolescent rate of full Human Papillomavirus (HPV) immunization in the United States. Vaccination is down 11 million doses from the goal of 80% of adolescents aged 12-13, and this has suffered even more due to the COVID-19 pandemic. The pandemic decreased the number of vaccinations given by 18% in 2020. The goal of this roundtable was to address the causes of decreased vaccinations, discuss the barriers adolescents and their parents face towards getting the HPV vaccinations and offer some solutions to increase the immunization rates in this critical age group.
HPV is a sexually transmitted virus that causes common, plantar, and genital warts and is spread through skin-to-skin contact. Previously, HPV was only thought to potentially cause cervical cancer, but recent data have found that, in addition to cervical cancer, HPV is also linked to oropharyngeal cancer and cancers of the vulva, vagina, penis, and anus. Approximately 35,900 HPV-attributable cancer cases occurred in 2020, with 33,000 of those cases being potentially preventable with HPV immunization. While the HPV vaccine was initially created to reduce the spread of Human Papillomavirus, it was found to also decrease the rates of cancers attributable to the virus as well. These cancers primarily include cervical cancer and oropharyngeal cancer, but evidence indicates it has the potential to prevent 12 different kinds of cancers and several other chronic diseases.
The COVID-19 pandemic led to a severe reduction in the number of administered vaccines due to a significant decline in well-child visits. Because this is the primary avenue that adolescents receive the HPV vaccine, 11 million doses less than average were administered. Additionally, several other disparities exist that contribute to fewer vaccines being administered. Although Hispanic populations are the most likely to receive a single dose of the vaccine, black and Hispanic populations are less likely to receive both vaccines and be completely vaccinated. While this disparity is still being researched, the lack of completion might be attributable to these communities receiving less education about the vaccine. In many communities, the HPV vaccine is still falsely seen as something only women need to worry about, and many individuals might not understand that two doses are required for complete immunization. It has been found that some of the determinants of full vaccination are providers using Spanish and English in both spoken and written communication to the patient and increasing the patient’s knowledge of what the vaccine does, how susceptible the patient is to HPV and HPV-related cancers, and how safe the HPV vaccine is. With these changes, the complex issue of racial disparities in HPV vaccination can be reduced.
In addition to racial disparities, the Southern United States has consistently shown to have the lowest vaccination rates in the United States as well as the highest prevalence of HPV-associated cancers. This is largely due to the lack of Medicaid expansion in the area and the lack of coverage in Southern rural areas. In order to tackle this issue, a complex intervention that includes establishing a definition of what constitutes a rural community, improving the measurement and reporting of vaccinations, and increasing the impact of community clinics is necessary. In addition, reducing out-of-pocket costs for vaccinations, promoting free vaccination programs such as the CDC’s Vaccines for Children program, and increasing accessibility are important to tackle this geographic disparity.
In order to get HPV vaccination back on track, catch-up vaccination for this age group is necessary, especially as these adolescents return to in-person classes. This can be accomplished in many ways, but the three measures highlighted at the HPV National Roundtable were (1) beginning vaccination at age 9 instead of 11, (2) administering vaccines before the well-child visit, and most importantly, (3) ensuring providers give a strong recommendation for the vaccine. By decreasing the starting age to 9 years old, the topic of sex is completely avoided by the doctor, increasing parent and child comfort with the vaccine. Data have shown that parents are just as likely to have their child get the vaccine at age 9 as at age 11. In addition, this gives hesitant parents more time to accept the vaccine, as well-child visits decrease in frequency at age 13. Administering the vaccine before the visit reduces children’s stress and increases their happiness. Children are more likely to respond positively to the provider knowing the worst part of the visit is over. Finally, a strong recommendation by health care providers was found to be the most important measure that can be taken, as it suggests the vaccine is necessary and required for a healthy child rather than something that is optional. Provider recommendation stresses the importance of the vaccine to parents, who are therefore more likely to consent to their child receiving the vaccine. A combination of all three of these measures has been shown to dramatically increase HPV vaccination rates and enacting these measures can reduce the incidence of HPV-related cancers drastically and lead to increased health equity in the United States.