Author: Charles Bankhead, Staff Writer, MedPage Today
Immunization against human papillomavirus (HPV) infection continues to lag behind rates for other vaccine-preventable diseases, primarily because of lost opportunities in the clinic, according to participants in a national conference.
Primary care providers have yet to get onboard with HPV immunization with their critical recommendation to patients or parents. Enthusiasm for HPV vaccination also has taken a hit because of its portrayal as a means to prevent a sexually transmitted disease (STD) instead of a vaccine to prevent cancer, speakers said during an HPV vaccination “summit” at Moffitt Cancer Center in Tampa, Fla.
“The most important problem is that many healthcare providers are not making a strong recommendation for the vaccine in the same way that they recommend other recommended vaccines,” said Melinda Wharton, MD, of the Centers for Disease Control and Prevention (CDC) in Atlanta. “That’s fundamentally what we think the biggest problem is.”
“We’re hurting ourselves by approaching it differently and talking about it differently than we’re talking about the other vaccines,” said Ailis Clyne, MD, of the Rhode Island Department of Health, which has mounted one of the more successful HPV immunization campaigns in the U.S.
Not only have the primary “pitch men” not been getting the message out about HPV, too often the sales pitch has focused on the wrong disease, said Otis Brawley, MD, chief medical officer for the American Cancer Society (ACS).
“We need to start talking about [the vaccine] as a cancer vaccine, instead of a vaccine for sexually transmitted disease,” said Brawley.
The focus on HPV vaccination as protection against an STD helped create and perpetuate a stigma associated with the vaccine. Moreover, focusing on the STD angle obscures the bottom-line benefit of preventing cervical and other cancers, Brawley and other speakers at the conference emphasized.
The conference brought together dozens of representatives of cancer and public health organizations to compare notes on how to improve HPV vaccination rates. In addition to the CDC and ACS, conference participants included the National Cancer Institute, National Partners for Comprehensive Cancer Control, and representatives of the nation’s comprehensive cancer centers.
Since 2006, the CDC Advisory Committee on Immunization Practices (ACIP) has recommended HPV immunization as a part of routine care for all girls ages 11 to 12, extending the recommendation to 11- and 12-year-old boys in 2011. According to the latest estimates from the CDC, 57% of adolescent girls and 34% of boys have received at least one of the recommended three doses of HPV vaccine. If every girl born in 2000 had received at least one dose of vaccine, coverage would have exceeded 91% by now.
Presentations and discussion at the HPV conference highlighted a number of obstacles to HPV vaccine uptake. Currently, a majority of states (29) have no formal policies regarding HPV immunization. Conference participants appeared divided about the effectiveness of vaccine mandates, as some speakers said mandated HPV immunization (along with other childhood immunizations) is the only way to ensure uptake, whereas others said experience to date suggests mandates have had limited success in improving the vaccination rate for HPV.
Clyne provided a few insights into potential pathways to improved vaccine uptake. The state health department had the autonomy to mandate HPV vaccination without seeking approval of the state legislature. Additionally, Rhode Island directly purchases all state-mandated vaccines and distributes them to healthcare providers free of charge.
Clyne’s bosses at the Rhode Island Department of Health refused MedPage Today’s request to interview her about the state’s HPV immunization program.
Discussants repeatedly returned to the issue of providing support and encouragement to clinicians, whose recommendations have proven critical to a wide range of healthcare actions.
“One of the things we can do at the community level is to help physicians make that strong recommendation,” said Anna Giuliano, PhD, of Moffitt Cancer Center. “When they have families in their offices with age-eligible boys and girls, they should take that opportunity to make the recommendation for HPV vaccination.”
Public education also will play a major role in improving vaccine uptake, Giuliano added. Parents need clear, accurate, and concise information to make an informed decision about HPV vaccination.
Education for the public and healthcare professionals should emphasize the wide range of cancers that can be prevented by HPV immunization, said Jennifer Smith, PhD, of the University of North Carolina School of Public Health at Chapel Hill. Although cervical cancer has received the most attention, HPV also causes anal, penile, and vulvar cancer, as well as oral cancer.
“Increasing the uptake of the vaccine will be followed by reductions in all of the HPV-associated cancers,” said Smith.
The conference ended with agreement to prepare a written summary of the conference proceedings, develop an agenda for action, and revisit the issues, obstacles, and progress related to HPV immunization at a future date. Additionally, several working groups have taken shape to address specific issues in greater detail.
“The top priorities are really about that provider recommendation, making sure that it is strong and it is consistent,” Susan Vadaparampil, MD, of Moffitt Cancer Center, told MedPage Today. “Another important priority is to emphasize that we need to vaccinate not only our adolescent girls but also our adolescent boys. Finally, the message about the benefits of this vaccine are around cancer prevention.”