A Preponderance of Missed Opportunities to Administer the Human Papillomavirus Vaccine

Despite the current recommendation by the Centers for Disease Control and Prevention (CDC) that the human papillomavirus (HPV) vaccine be routinely administered to adolescents and young adults in order to prevent cervical cancer and genital warts, statistics indicate that administration of this vaccine lags far behind that of other recommended vaccines. To better understand this gap and the reasons behind it, researchers at the University of Utah and Huntsman Cancer Institute set out to examine data on more than 47,665 clinical visits made by girls and women ages 11 through 26 years over a 4-year period in Utah. The study sought to identify “missed opportunities,” which were defined as any clinical visit during which a patient received a vaccine but not did get the HPV vaccine.

Out of those 47,655 healthcare visits during which a patient received a vaccine, the study authors discovered 20,911 missed opportunities for the HPV vaccine, translating into a missed-opportunity rate of 43.87%. However, the missed opportunities were not “equal opportunity:” white females and those living in rural areas were more likely to miss the opportunity for the HPV vaccine than Hispanic females and those living in urban areas. In addition, researchers found that preteens were more likely to miss the opportunity than older teens.

Although the HPV vaccine was first introduced roughly 10 years ago, the Utah study reveals that, nationwide, only about 39% of adolescent females have completed the three-dose vaccination series recommended for them. Last month, the CDC announced that girls who receive the vaccine at 11 or 12 years of age need only two doses, while girls ages 13 and over should still receive the previously suggested three doses. Utah had one of the lowest rates—26%–in 2014, a percentage that is far below the CDC’s goal of 80% HPV coverage among adolescent girls by the year 2020.

The Utah study offers only hard data on missed opportunities, and not the reasons behind them, but researchers have some theories as to why the HPV vaccination rate is lagging. “What we do know is that the number-one factor as to when the kids get the vaccine is a strong provider recommendation,” said Deanna Kepka, PhD, an assistant professor at the University of Utah and Huntsman Cancer Institute, and an author of the study. In the more rural (and Caucasian) precincts of Utah, she explained, it’s possible that smaller medical practices and local health departments are less informed about the HPV vaccine and are less trained when it comes to the questions of how and why to administer it. Dr. Kepka does not discount finances as a reason certain small practices may not offer the HPV vaccine. “It could…be more costly for them to stock it,” she explained, alluding to the higher economic burden such a vaccine would place on a practice that does not see many adolescents. Additionally, rural families may face difficulties getting to a doctor’s office three separate times for the three suggested doses.

It is also possible that the more conservative values that tend to prevail in rural areas are an impediment to the administration of the vaccine, which is designed to prevent diseases contracted through sexual contact. Religious parents, especially those of younger girls (for whom the vaccine is especially efficacious), may be particularly reluctant to acknowledge the possibility that their children could be exposed to a sexually transmitted virus.

In addition to the generally higher rate of support for vaccinations in the Hispanic community, Dr. Kepka noted that Hispanic children tend to be of lower socioeconomic status and may qualify for the CDC’s Vaccines for Children program, which offers free vaccines for all children up to age 18.

Researchers are hopeful that the recent downscaling of the dosing schedule for preteens from three vaccines to two will enable and encourage more of them to take advantage of this potentially life-saving vaccine. However, they acknowledge that public health efforts are key in helping this vaccine go from underused to regularly used.

Laurie Saloman, MS, is a health writer with more than 20 years of experience working for both consumer and physician-focused publications. She is a graduate of Brandeis University and the Medill School of Journalism at Northwestern University. She lives in New Jersey with her family.