AAP Voices Blog

Making a Difference Begins With One Recommendation at a Time

"If there was a vaccine against cancer, would you give it to your children?"

This seems like a rhetorical question, yet statistics say it is not so. Each year in the U.S., 47,200 people are diagnosed with HPV-related cancers. Of the 13,000 women diagnosed with cervical cancer, 4,000 die of the disease. Fortunately, we have a vaccine that is 99% effective against HPV- related cancers, yet only 54% of U.S. teens are fully vaccinated at age 13. Seven years after Dr. Jason Terk’s "Epic Fail " commentary (which underscored the disservice to patients in not recommending the HPV vaccine), we are still more than 30% behind the other routine adolescent immunizations - TDAP and Meningitis ACYW (89% vaccination rate for both). There seems to be a disconnect. If the other two adolescent immunizations are at 89%, one can assume they are being recommended equally, which means the HPV vaccine is not being recommended the same way. Why? Why is a vaccine that is 99% effective against certain types of cancer not being universally recommended?

One may use the excuse this vaccine may be considered "new" and in some circles has negative associations – since it helps develop immunity against a sexually transmitted virus. Communications research in the 17 years since the vaccine was introduced shows leaning into the cancer-preventing powers of the vaccine – rather than how the virus itself is transmitted – is a more effective communications strategy.

Even so, the far newer COVID-19 vaccine has a teen vaccination rate of 61%. More teens are vaccinated against COVID-19 than HPV! This should really make us want to do more to proactively protect our patients against HPV-related cancers. If we can vaccinate 61% of all teens in 1 ½ years against COVID, we can surely vaccinate at least as many in four years (ages 9-13) against HPV.

So how do we do it? How do we improve our HPV vaccination rates? Here are the steps our practice used to increase vaccination rates from 34% to 88% in under two years.

Communications research in the 17 years since the vaccine was introduced shows leaning into the cancer-preventing powers of the vaccine – rather than how the virus itself is transmitted – is a more effective communications strategy.

The first step is changing our own attitude. We are not universally recommending the HPV vaccine like we do for TDAP and MCV. At their 11-year visit, don't say "Your child is due for Tdap and meningitis vaccine, would you like to get the HPV as well?" Say "Your child is due for Tdap, HPV and meningitis. " Start offering the HPV shot at age 9. Better yet, tell parents when their children receive childhood boosters at age 4, that their next vaccine will be the HPV vaccine at age 9. When the HPV vaccine is normalized and routinely recommended, rates will go up.

When my now teenager got his HPV vaccine at age 10, the next day I got a call from school telling me he told all his friends he "got a shot against penis and butt cancer." I proudly replied, "He sure did, hopefully all the kids in his class will get this shot." Later that week two parents from his class called me to ask if I recommended it for their kids, because their pediatrician told them it was optional. "Of course, I recommend it. It's a vaccine against cancer!" Consequently, both of those families had their children vaccinated. Something as simple as a clear recommendation can make a huge difference.

Step 2. If the first time you recommend (not offer but recommend) the HPV vaccine to a family and they choose not to get it, the next time you see them ask again. "Remember last time we talked about the HPV vaccine, the vaccine against cancer, have you had a chance to think about it? Do you have questions about it? I would still recommend your child receive the vaccine. In fact, my children or grandchildren have all been vaccinated."

Step 3. Do not wait for a well check. Every visit should be a vaccine visit. Any reason the child is in your office, whether for ADHD, asthma or a rash is a great time to recommend the vaccine if they are not up to date. This is especially true for the second dose of the vaccine since nearly 15% of teens with the first vaccine don’t have the second.

Step 4. Schedule that second vaccine. When patients get their first vaccine, give them an appointment for their second before they leave.

Step 5. If your practice has low HPV rates, consider doing a vaccination clinic much like you do for the flu and COVID.

Our families trust us. Our families know we want the best for their children as much as they do. We can work on better messaging around the HPV vaccine by telling them about our children receiving the shot. Tell them about the toddler we saw last week who lost her mom to cervical cancer. We can improve our HPV vaccination rates. We can protect our patients from HPV-related cancers and, most importantly, we can decrease the 47,200 HPV-related cancers a year to a much smaller number.