Goals and Opportunities to Increase HPV Vaccine Uptake
The Panel’s 2012-2013 report identified three goals to increase HPV vaccine uptake in the United States: reduce missed clinical opportunities for HPV vaccination, increase parents’ acceptance of the vaccine, and maximize access to HPV vaccination. A fourth goal was to promote global HPV vaccine uptake. While there has been progress toward these goals, HPV vaccine coverage is still too low to achieve its cancer prevention potential. The benefits of HPV vaccination have become even more evident over the past five years. Several organizations—including the World Health Organization, American Cancer Society (ACS), National Cancer Institute (NCI)-designated cancer centers, and International Papillomavirus Society—have concluded that HPV vaccination could dramatically reduce or even eliminate cervical cancer as a public health problem when used in combination with cancer screening.1-5
Research and discussions with key stakeholders on the current landscape of HPV cancers and HPV vaccination led the Panel Chair to conclude that the goals outlined in the 2012-2013 report are still relevant. The following sections describe priorities and strategies—informed by research and real-world experiences over the past five years—that will help achieve these goals. Several research priorities also are highlighted throughout the report, complementing research gaps that have been identified by others.6
The coalescence of a critical mass of dedicated stakeholders (see Partnerships and Collaborations Are Essential to Promote HPV Vaccine Uptake), accumulation of data on the benefits of HPV vaccination, and increasing awareness and acceptance of the vaccines among healthcare providers and the public has created momentum and opportunity to achieve the goals outlined in this report. This opportunity must be seized to accelerate HPV vaccine uptake and achieve the potential of vaccination to reduce dramatically the number of HPV cancers in the United States and around the world. Efforts to increase HPV vaccination should consider the changing landscape of healthcare delivery in the United States. Trends such as the increasing popularity of retail clinics7 and the consolidation of providers within larger healthcare systems8 may present both challenges to and opportunities for increasing HPV vaccination.
Partnerships and Collaborations Are Essential to Promote HPV Vaccine Uptake
In its earlier report, the Panel stated that increasing HPV vaccine levels would require concerted action by multiple organizations and individuals. Since that time, many key stakeholders have forged or enhanced collaborations and partnerships to identify and take concrete steps to address barriers to HPV vaccination. These have included unprecedented partnerships among cancer control and immunization experts. A few examples of partnerships and collaborations—catalyzed, in part, by the 2012-2013 Panel report—are described below.
The Panel Chair urges continued stakeholder collaborations and partnerships in implementing proven strategies to increase vaccination rates among all populations to target levels. Local and regional partnerships will be particularly important for identifying local barriers and solutions to HPV vaccine uptake. Partner organizations should include state immunization and cancer control programs, state cancer plans, providers and provider organizations, survivors, advocacy organizations, vaccine manufacturers, and others. The Centers for Disease Control and Prevention (CDC), National Cancer Institute (NCI), and other funding organizations should continue to support partnerships and collaborations aimed at HPV vaccination.
National HPV Vaccination Roundtable
The National HPV Vaccination Roundtable—hosted by the American Cancer Society and funded in large part by CDC—was formed in 2015 to convene stakeholders, facilitate information exchange, identify gaps, and catalyze efforts to increase U.S. HPV vaccine coverage. More than 75 organizations representing public health, academia, advocacy organizations, professional societies, industry, and state and federal agencies participate in the Roundtable. Task groups bring together member organizations to work on key topics, such as provider training and state HPV coalitions. The Roundtable also maintains a resource library with materials for a variety of stakeholders and audiences.
NCI-Designated Cancer Centers
The NCI Cancer Centers Program provides support for 70 centers across the country that meet rigorous standards for transdisciplinary research programs focused on developing new and improved approaches for cancer prevention, diagnosis, and treatment. In July 2014, NCI provided supplemental funding to 18 NCI-designated cancer centers to help address HPV vaccination in their respective catchment areas. Each cancer center conducted an environmental scan to identify local barriers and facilitators to HPV vaccination and developed linkages with existing coalitions and programs in the state or region (e.g., healthcare providers, health departments, immunization coalitions).
Although funding was for only one year, the cancer centers have maintained their commitment to increasing HPV vaccination. Each year since 2015, a different cancer center has hosted a meeting to enable centers to learn from and work with one another. State and regional coalitions formed during the funding period—including the Alabama HPV Vaccination Coalition and the Intermountain West HPV Vaccination Coalition—are still active. NCI provided funding to an additional 12 cancer centers in 2017 to promote HPV vaccine uptake.
Sources: Saslow D, Sienko J, Nkonga JLZ, Brewer NT. Creating a National Coalition to Increase Human Papillomavirus Vaccination Coverage. Acad Pediatr. 2018;18(2S):S11-S3. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29502628; National HPV Vaccination Roundtable. Home page [Internet]. Atlanta (GA): the Roundtable; [cited 2018 Jul 6]. Available from: http://hpvroundtable.org/; National Cancer Institute Division of Cancer Control and Population Sciences. Administrative supplements for NCI-designated cancer centers to support collaborations to enhance HPV vaccination in pediatric settings: a summary report. Bethesda (MD): NCI DCCPS; 2016 Jun. Available from: https://healthcaredelivery.cancer.gov/hpvuptake/DCCPS_HPVvax-report_FINAL_508compliant.pdf; National Cancer Institute. HPV vaccine uptake in cancer centers [Internet]. Bethesda (MD): NCI; [cited 2018 Jul 6]. Available from: https://healthcaredelivery.cancer.gov/hpvuptake
- NCI-designated cancer centers endorse goal of eliminating HPV-related cancers. Available from: https://moffitt.org/media/8151/hpvconsensusstatement-2018.pdf
- American Cancer Society. American Cancer Society launches campaign to eliminate cervical cancer [Press Release]. Atlanta (GA): ACS. Available from: http://pressroom.cancer.org/HPVcancerfreelaunch
- Aranda S, Berkley S, Cowal S, et al. Ending cervical cancer: A call to action. Int J Gynaecol Obstet. 2017;138(1 Suppl):4-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28691327
- Garland SM, Giuliano A, Brotherton JML, et al. IPVS statement moving towards elimination of cervical cancer as a public health problem. Papillomavirus Res. 2018;5:87-8. Available from: https://www.sciencedirect.com/science/article/pii/S2405852118300132
- World Health Organization. WHO Director-General calls for all countries to take action to end the suffering caused by cervical cancer [Internet]. Geneva (CH): WHO; 2018 May 19 [cited 2018 Jul 6]. Available from: http://www.who.int/reproductivehealth/call-to-action-elimination-cervical-cancer/en
- Reiter PL, Gerend MA, Gilkey MB, et al. Advancing human papillomavirus vaccine delivery: 12 priority research gaps. Acad Pediatr. 2018;18(2S):S14-6. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29502629
- Kalorama Information. Retail clinics 2017: the game-changer in healthcare. New York (NY): Kalorama Information; 2017 Apr 17. Available from: https://www.kaloramainformation.com/Retail-Clinics-Game-10780773
- Fulton BD. Health care market concentration trends in the United States: evidence and policy responses. Health Aff (Millwood). 2017;36(9):1530-8. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28874478