Increasing HPV Vaccine Rates One Family at a Time

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Increasing HPV Vaccine Rates One Family at a Time

Jane Goleman, MD, FAAP
December 15, 2017

She came back!

It still makes me smile, remembering a mother who returned to the office with her son for his recommended Human papillomavirus (HPV) vaccine.  She'd steadfastly declined it during a visit earlier that day.

One small victory. One patient, one family at a time. That's how we hope to see fewer lives lost to HPV-related cancers.

I was seeing this family for the first time. The daughter was there for her yearly physical exam and the son for flat feet.  As I was wrapping up the visit I saw that her 12-year-old son had never had the HPV vaccine, and so I recommended getting the vaccine that day.  I was surprised when the mother refused, because her daughter had completed the series.

"Are you sure?" I asked. "Your daughter has had both shots.  This is the vaccine that prevents cancer."

She said she had done her own research and she didn't want her son to have it.  Since we had had a good visit up to that point with honest patient listening, I decided to go for it. I asked where she looked for her research, and offered to provide additional sources.

"I could give you a handout and provide more information," I continued. "This vaccine has been out for over 10 years now.  It is very safe.  Over 100 million doses have been given.  This vaccine is so effective that now we only need two shots instead of three if we give it before 15 years of age."  

In the mid-1980’s, the vaccine for HIB was released and thirty years later we no longer see this disease. Because of the effectiveness of this vaccine my younger partners only know of HIB meningitis through textbooks (and some of my anecdotes).

This is the recurring story of vaccine preventable diseases.

- See more at:

"But success requires reaching individuals, one at a time." 

I could see her son was interested. "Have you seen the commercials on TV, where the son asks, "Mom, Dad . . . did you know?"  I asked them. They nodded.  I waited.

"What do you think?"

She still didn't want it.  I said, "OK, could I give you a handout about it?"  She agreed.  So when I printed off her after-visit summary, I also provided her with a handout on HPV. 

Later that morning, one of the nurses came to me and said, "She's back. The mother with the two kids is back, and she said you are right.  She wants the HPV vaccine.  Do you still want me to give it?"

"Are you kidding me? Woo-hoo!" I blurted out. "Yes, please give it."

Our efforts to protect kids from HPV are carried out on many different levels, from TV commercials and billboards to community presentations, and more.  But success requires reaching individuals, one at a time. 

"So, go ahead and strike that superhero pose and remember one of the most important things we do as pediatricians: giving life-saving preventive care in the form of vaccines. "

We do a lot of quality improvement work with the HPV vaccine in our primary care network. We use the announcement approach at our well visits, listing vaccines due that day and including HPV's just like the others. We give magnets and phone calls to remind families to complete the series.  We award incentives for clinics meeting the goal for captured opportunities and track data to provide feedback to clinics and individual providers. We set our electronic medical records to begin alerts at age 9 so we have more opportunities to encourage completing the series by 13.

We even have journal club meetings with role-play exercises so residents can learn to give more effective recommendations.  Perhaps most importantly, we changed the conversation from one about sexually transmitted infections to cancer prevention and saving lives.

Perhaps you saw the "Grey's Anatomy" episode where the surgeons all stood tall with legs akimbo, hands on hips, shoulders thrust back and chin raised.  A scientific study actually found that standing in a superhero pose for 5 minutes before an important interview or a big task can make you feel more confident and perform measurably better.

So, go ahead and strike that superhero pose and remember one of the most important things we do as pediatricians: giving life-saving preventive care in the form of vaccines.

The views expressed in this article are those of the authors, and not necessarily those of the American Academy of Pediatrics. ​​​

​​​Ab​out the ​​Author

​​Jane Goleman, MD, FAAP, is a member of the American Academy of Pediatrics Ohio Chapter and the ambulatory pediatrics section at Nationwide Children's Hospital, where she is the Medical Lead for Health Equity. She also serves as a clinical associate professor of pediatrics at The Ohio State University College of Medicine. Dr. Goleman was named a Department of Health and Human Services 2017 HPV Vaccine Is Cancer Prevention Champion.  




Additional Information

HPV Champion Toolkit

Are Your Kids Protected from Cancer Caused by HPV? (

Addressing Parent's Top Questions about HPV Vaccine