Editors’ pickHealth

HPV Vaccine Uptake Low Despite Prior Calls to Action

The human papillomavirus (HPV) vaccine continues to be underused in eligible adolescents. Thus, it continues to fall short of its potential to protect against HPV-related cancers in the United States. Such cancers include cancer of the cervix, oropharyngeal cancer, and penile, vulvar, and vaginal malignancies, according to a new report from the President’s Cancer Panel.

“We have a safe, effective vaccine that protects against a cancer-causing virus, and we applaud the efforts of cancer and immunization leaders joining forces and rising to the challenge of accelerating HPV vaccine uptake,” Barbara Rimer, DrPH, chair, President’s Cancer Panel, said in a statement.

This vaccine remains seriously underutilized.
Dr Barbara Rimer

“Yet the fact remains that this vaccine remains seriously underutilized — we are still missing opportunities to prevent cancer and save lives,” she added.

The President’s Cancer Panel report was published online November 1.

In an earlier report published in 2012-2013, the President’s Cancer Panel called for more widespread uptake of the HPV vaccine among eligible recipients.

Since then, the percentage of adolescents who have begun receiving the HPV vaccine series has increased by five percentage points each year.

Nevertheless, as of 2017, fewer than half of eligible adolescents in the United States had been fully vaccinated against HPV. The level falls far short of the Healthy People 2020 goal of vaccinating 80% of adolescents aged 13 to 15 years with the full vaccine series.

Thus, the panel issued a renewed call to action to amplify and expand efforts to increase HPV vaccination rates both at home and globally.

Renewed Call to Action

As part of the panel’s renewed call to action, the authors singled out four key goals that they felt could bolster HPV vaccine uptake rates across the country and elsewhere.

The first goal is for providers to reduce the number of missed opportunities to recommend and administer the vaccine to eligible adolescents.

“Too many adolescents continue to leave their doctors’ offices without receiving the HPV vaccine, even when they have received other recommended vaccines,” panel members write.

The panel suggests that, rather than broach the subject in an open-ended way, providers assume parents are ready to have their child vaccinated and strongly recommend HPV vaccination for both boys and girls in unequivocal language.

Strongly worded statements help reassure parents that HPV vaccination is the social norm and that providers themselves believe in the vaccine, the panel members state.

Providers should also target all 11- and 12-year-old patients unless there is good reason not to, they add, because the vaccine is most effective when given before a child’s sexual debut.

As an added incentive, adolescents who are vaccinated before the age of 15 only need two doses instead of the usual series of three.

At the same time, providers may have to convince parents to accept HPV vaccination for their child.

“Parents and legal guardians are the primary decision makers about adolescent vaccination,” the panel members note.

“If parents are initially reluctant to have their child vaccinated, providers need to emphasize that HPV vaccine prevents cancer and to continue to recommend it, because, given time, many parents eventually accept vaccination,” the report comments.

The HPV vaccine is among the most expensive vaccines currently available in the United States, but through private and public funding, the cost is usually covered for eligible recipients.

If not, there are sponsored patient-assistance programs, including one provided by Merck & Co, the manufacturer of the quadrivalent vaccine (Gardasil).

“Offering and promoting HPV vaccination in schools, pharmacies, and other sites within the medical neighborhood may be particularly useful in rural areas, which have fewer primary care physicians per capita than urban areas and greater obstacles to access,” panel members suggest.

The potential impact of HPV vaccination is greatest in less developed countries, where cervical cancer rates are higher, the authors also note.

A number of coordinated initiatives are called for in low- and middle-income countries to make the vaccine more accessible and more affordable.

“Progress and momentum built over the past half decade have created a compelling opportunity to increase HPV vaccine uptake further and dramatically reduce — and perhaps eventually largely eliminate — the preventable burden of HPV cancers,” the panel members state.

“All should rally without hesitation around the ultimate goal of cancer prevention,” they conclude.

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