According to the CDC, HPV vaccination rates are also lower in rural areas.5 The Journal for Specialists in Pediatric Nursing points out that primary care offices in many underserved areas limit requests for HPV vaccines from the state’s health department because the costs associated with stocking the vaccine must be offset by the amount of vaccine requested.7 Living in an urban area comes with greater proximity to major medical centers and free clinics, making it much easier for people to get the vaccine. In rural areas where HPV vaccine research has been conducted, boys and young men have to travel longer than an hour to access the vaccine. They have to be motivated to seek it out, making outreach efforts in those areas particularly critical. In lower income areas, a child might not be regularly seeing a doctor or have a doctor who is going to recommend the vaccine, but if the child and his or her parents are aware of the vaccine’s importance and free clinics where they could go to receive it, vaccine uptake would increase.
Strategies to Improve uptake of HPV vaccine
In thinking about ways to improve vaccination rates, the Journal for Specialists in Pediatric Nursing recommends a “family-centered approach.”7 This will increase parents’ knowledge of HPV and the vaccine, including current ACIP guidelines as well as benefits and risks. The journal also points out that many boys look specifically to their fathers for guidance in health and sex-related issues, and that father-focused health education interventions could lead to fewer misconceptions among young men about the vaccine and reduce some of the stigma associated with it. Educational efforts need to be targeted to underserved populations because geographic, economic, and cultural disparities all affect a boy’s awareness of HPV and his parents’ or caregiver’s decision and/or ability to get him vaccinated.
The CDC has noted some promising strategies that have been effective in increasing vaccination rates so far. The first is establishing links between cancer organizations and immunization groups to emphasize that HPV vaccination truly is cancer prevention.11 Another strategy is for healthcare providers to recommend the HPV vaccine to both their female and male patients at the same time as the other 2 vaccines routinely given to 11- and 12-year-old patients—the quadrivalent meningococcal conjugate and Tdap vaccines. Getting all these vaccines done in 1 visit relieves parents of having to take their children to multiple appointments. Administering the vaccines at the same time also places equal importance on each vaccine.
In addition, state and local health departments should continue to assess how HPV vaccination coverage levels change over time and keep track of which strategies work and which do not in order to best target improvement efforts. To make information on HPV widely accessible, more public communication campaigns should be established, both in the form of online informal discussions and in more structured educational campaigns created by state and local health departments.
Another helpful recommendation by the CDC is to create “reminder recall interventions,”11 which use immunization information systems to send reminders to parents about vaccinations. This is a quick and easy way to increase awareness and adherence.
The good news is that awareness of the importance of HPV prevention continues to grow, especially among the male population. Vaccination rates for boys are still lower than those for girls but they have been rapidly rising since 2011, and all healthcare professionals are responsible for ensuring that these numbers continue to rise.
1. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): HPV fact sheet. Available at: https://www.cdc.gov/std/hpv/stdfact-hpv.htm. Reviewed November 16, 2017. Accessed August 5, 2019.
2. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): About HPV. Available at: https://www.cdc.gov/hpv/parents/about-hpv.html. Reviewed April 29, 2019. Accessed August 5, 2019.
3. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV) Questions and answers. Available at: https://www.cdc.gov/hpv/parents/questions-answers.html. Reviewed August 23, 2018. Accessed August 5, 2019.
4. Immunization Action Coalition. Ask the Experts. Human papillomavirus (HPV). Available at: http://www.immunize.org/askexperts/experts_hpv.asp. Accessed August 5, 2019.
5. Centers for Disease Control and Prevention (CDC). Human papillomavirus (HPV): HPV coverage data. Available at: https://www.cdc.gov/hpv/hcp/vacc-coverage/index.html. Reviewed August 23, 2018. Accessed August 5, 2019.
6. American Cancer Society. HPV vaccination rates are rising among American teens. Available at: https://www.cancer.org/latest-news/hpv-vaccination-rates-are-rising-among-american-teens.html. Published August 14, 2017. Accessed August 5, 2019.
7. Thomas TL, Snell S. Ask the expert: Vaccinate boys with the HPV vaccine? Really? J Spec Pediatr Nurs. 2013;18(2):165-169. Erratum in: J Spec Pediatr Nurs. 2014;19(1):101.
8. Centers for Disease Control and Prevention (CDC). Chapter 11: Human papillomavirus. In: The Pink Book. Epidemiology and Prevention of Vaccine Preventable Diseases. Available at: https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html. Reviewed May 16, 2018. Accessed August 5, 2019.
9. American Journal of Managed Care (AJMC) 2006-2019 Clinical Care Targeted Communications Group, LLC. Dr. Anna Beavis discusses gender differences in HPV vaccination. Presented at: Society of Gynecologic Oncology (SGO) 2018 Annual Meeting on Women’s Cancer; March 24-27, 2018; New Orleans, LA. Available at: https://www.ajmc.com/conferences/sgo-2018/dr-anna-beavis-discusses-gender-differences-in-hpv-vaccination. Published March 25, 2018. Accessed August 5, 2019.
10. Kaiser Family Foundation. The HPV vaccine: Access and use in the US. Available at: https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in/. Published October 9, 2018. Accessed August 5, 2019.
11. Centers for Disease Control and Prevention (CDC). CDC Newsroom: Many adolescents still not getting HPV vaccine. Available at: https://www.cdc.gov/media/releases/2015/p0730-hpv.html. Reviewed July 30, 2015. Accessed August 5, 2019.