Jonathan Miller, MD, talks starting HPV vaccination earlier to improve cancer prevention

Human papillomavirus (HPV) vaccination remains a critical tool for cancer prevention, but timing plays a central role in its effectiveness. According to Jonathan Miller, MD, associate chief of primary care at Nemours Children’s Health in the Delaware Valley, the vaccine is most effective when administered before exposure to the virus. “The HPV vaccine prevents cancers due to human papillomavirus, and it only works if adolescents or children get the vaccine before they're ever exposed to that virus,” Miller said. As children age, the likelihood of exposure increases, underscoring the importance of early vaccination.

Addressing access and hesitancy

Miller described 2 primary groups of patients who experience delays in HPV vaccination: those with barriers to access and those with vaccine hesitancy. Families who live far from medical practices or miss routine well visits may have fewer opportunities to complete the vaccine series. Introducing the vaccine earlier creates additional chances to vaccinate before exposure.

For families who are hesitant, early conversations can be equally important. Miller noted that some families initially respond by wanting more time to learn about the vaccine. “By moving this discussion earlier in the child's life, it gives us more opportunities to have that discussion, to build trust, and ultimately, to get the child fully vaccinated before exposure to the virus,” he said.

Reframing the HPV vaccine discussion

Miller reflected on how early messaging around the HPV vaccine may have unintentionally created barriers. When the vaccine was first introduced nearly two decades ago, it was often framed primarily as protection against a sexually transmitted infection. This approach differed from how clinicians typically discuss other routine childhood vaccines.

“We don't really talk about the mode of transmission of the vaccine-preventable diseases” for vaccines such as diphtheria or polio, Miller explained. Instead, the focus is on disease prevention. He now approaches HPV vaccination in the same way, emphasizing cancer prevention rather than transmission, unless families specifically request more detail.

Population-level benefits of earlier vaccination

At Nemours, efforts to recommend HPV vaccination at younger ages have led to improved uptake across several populations. Miller highlighted significant gains among families living in rural areas, where access to care may be limited and annual visits less consistent. Earlier vaccination allowed more children to complete the series before the risk increased.

Unexpected improvements were also seen in practices that initially believed their patient populations were at low risk. With education about vaccine safety and effectiveness, these practices achieved meaningful increases in uptake. “When you are a trusted provider, and you buy into it, and you give a strong recommendation, families really believe in you,” Miller said.

A prevention-focused framework

Miller emphasized that pediatric care is fundamentally preventive and offered an analogy to illustrate his approach. Clinicians do not delay recommending bike helmets until children engage in dangerous behavior; helmets are advised as soon as children begin riding. Similarly, waiting to administer the HPV vaccine based on perceived sexual risk may result in missed opportunities for cancer prevention.

“There’s pretty strong data now that if you start earlier, you will end up with higher HPV uptake rates at later ages,” Miller said. He encouraged clinicians to familiarize themselves with the evidence supporting vaccination initiation at age 9, noting that earlier administration aligns with the goal of maximizing long-term protection and population-level uptake.¹

Disclosure:

Miller reports no relevant disclosures.

Reference

1. CDC. HPV Vaccination Recommendations. CDC. November 16, 2021. Accessed January 16, 2026. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html