Achieving widespread HPV (human papillomavirus) vaccination is one of the most profound opportunities for cancer prevention, according to a report released today by the President’s Cancer Panel. The Panel’s report, Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer, issues an urgent call for energizing efforts to reach the HPV vaccines’ potential to save lives and prevent millions of avoidable cancers and HPV-related conditions in men and women. One in four people in the U.S. are infected with at least one type of HPV, a group of viruses linked to multiple cancers and other diseases. The report examines underuse of HPV vaccines, identifies key barriers to increasing vaccine uptake, and provides actionable recommendations for overcoming these obstacles.
“Today, there are two safe, effective, approved vaccines that prevent infection by the two most prevalent cancer-causing types, yet vaccination rates are far too low,” said Barbara K. Rimer, DrPH, chair of the President’s Cancer Panel. “We are confident that if HPV vaccination for girls and boys is made a public health priority, hundreds of thousands will be protected from these HPV-associated diseases and cancers over their lifetimes.”
According to the report, based on data from the Centers for Disease Control and Prevention, in 2012 only about one-third of 13- to 17-year-old girls in the U.S. received all three recommended doses of HPV vaccine. These rates fall considerably short of the U.S. Department of Health and Human Services Healthy People 2020 goal of having 80 percent of 13- to 15-year-old girls fully vaccinated against HPV. Immunization rates for boys are even lower – less than 7 percent of boys ages 13-17 completed the vaccine series in 2012 (although the vaccine was approved for males more recently than for females).
The CDC estimates that increasing HPV vaccination rates from current levels to 80 percent would prevent an additional 53,000 future cervical cancer cases in the U.S. among girls who now are 12 years of age or younger, over the course of their lifetimes. Thousands of cases of other HPV-associated cancers in the U.S., a growing proportion of which will occur in males, also likely would be prevented within the same timeframe.
The Panel’s report outlines three critical goals that must be achieved to increase HPV vaccine uptake – Reducing missed clinical opportunities to recommend/administer HPV vaccines; Increasing parents’/adolescents’ acceptance of HPV vaccines; and Maximizing access to HPV vaccination services – with the ultimate goal being completion of the full three-dose series by all age-eligible adolescents.
Key Findings and Recommendations:
According to the CDC, missed clinical opportunities are the most important reason why the U.S. has not achieved high rates of HPV vaccine uptake. As many as two-thirds of 11- and 12-year-old vaccine-eligible girls may not be receiving HPV vaccines at healthcare visits during which they receive at least one other vaccine. The Panel recommends targeted efforts, including communications strategies for physicians and other relevant health professionals, to increase dramatically the proportion of health providers who strongly recommend HPV vaccines for age-eligible adolescents. Use of EHRs (electronic health records) and immunization information systems can help to avoid missed opportunities for HPV vaccination and facilitate completion of the three dose regimen.
Parents’ and other caregivers’ knowledge, attitudes, and beliefs affect whether children receive vaccines, including HPV vaccines. Studies have provided insights into parents’ views, including that some parents of young adolescents may believe they can wait to vaccinate their children against HPV. To increase HPV vaccine acceptance among parents, caregivers, and adolescents, the Panel recommends targeted efforts, including the deployment of integrated, comprehensive communications strategies, using social media, print, electronic communications and the persuasive authority of health care providers interacting with empowered patients.
Vaccines should be available where adolescents receive healthcare. It should be convenient to initiate and complete the HPV vaccine series, and cost should not be a barrier. The Panel recommends increasing the range of venues and providers for HPV vaccination, including venues outside the medical home, such as pharmacies. A 2012 survey of representatives of state pharmacy organizations in all 50 states and the District of Columbia found that pharmacists in more than one-third of states were not permitted to administer HPV vaccines to 12-year-old girls, though many of these states allowed pharmacists to provide HPV vaccines to women ages 19 and older.
Additionally, the burden of HPV-associated cancers extends beyond the borders of the United States, affecting populations in every country. The Panel calls for continued investment in and implementation of HPV vaccination programs in low-and middle-income countries, where the majority of HPV-associated cancer cases occur.
Starting on February 10, 2014, the complete report can be accessed at http://deainfo.nci.nih.gov/advisory/pcp/annualReports/HPV/index.htm. Hard copies may be requested by writing to email@example.com or President’s Cancer Panel, 9000 Rockville Pike, Building 31, Room B2B37, MSC 2590, Bethesda, MD 20892.