HPV Vaccination:

A National Crisis

in Cancer Prevention

Noel T. Brewer, PhD

University of North Carolina

Disclosure: Grants and/or advisory boards

American Cancer Society

CDC

GlaxoSmithKline

FDA

Merck

National Cancer Institute

Pfizer

Robert Wood Johnson Fdn

HPV vaccination guidelines

On-time 3 doses, ages 11 or 12

Better immune response in younger adolescents

Universal vaccination is most effective

Late Females to age 16

Males to age 21 (MSM to 26)

3

0

10

20

30

40

50

60

70

80

90

100

07 08 09 10 11 12 13 14

% V

accin

ate

d

Year

Data from NIS-Teen as reported in MMWR.

Assessment methods changed in 2013. Slide courtesy of M. Gilkey.

Healthy People 2020 Goal

Tdap

Meningococcal

HPV (3 doses, females)

HPV (3 doses, males)

Adolescent vaccine coverageUS adolescents ages13-17

HCPs think…

Conversation will be uncomfortable (34%)

Parents don’t want HPV vaccine (even though

patents do want it)

Think discussion will take a long time

Discuss HPV vax last,

or not at all

0

1

2

3

4

5

HPV Meningococcal Tdap

Me

an

len

gth

(m

inu

tes)

Recommendation quality

61%

74%

73%

61%

60%

39%

26%

27%

39%

40%

0% 20% 40% 60% 80% 100%

Timeliness for males

Timeliness for females

Endorsement

Consistency

Urgency

Strong Weak

Gilkey, et al., 2015

HPV vaccine initiation rates

73% - high-quality recommendation

53% - low-quality recommendation

23% - no recommendation

Impact of rec quality

Gilkey, et al., 2015

Announce

Note child’s age.

Announce the child is due for 3 vaccines

recommended for children this age, placing HPV

vaccine in middle of list.

Say you will vaccinate today.

Move on with the visit.

Announce

Announce

“I see here that Michael just turned 11. Because he’s

11, Michael is due for meningitis, HPV, and Tdap

vaccines. We’ll give those at the end of the visit.”

“Now that Michael is 12, there are three vaccines we

give to kids his age. Today, he’ll get meningitis, HPV,

and Tdap vaccines.”

Announce

0

50

100

150

200

250

300

350

400

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Stan

dar

diz

ed H

PV

vac

cin

e u

pta

ke

Summer peaks

NIS-Teen 2007-2012 Moss, Reiter, Rimer, Ribisl & Brewer, in press

Sources of HPV vaccine communication

30%

9%

28%

42%

47%

15%

18%

9%

33%

60%

1%

62%

0% 10% 20% 30% 40% 50% 60% 70%

None of These

Insurance companies

CDC

Drug companies

AAFP

AAP

Received information about HPV vaccine

Pediatricians

Family Physicians

Hswen, Gilkey, et al., under review

Communications and recommendation quality

16

0%

20%

40%

60%

80%

Boys Girls Boys Girls

Had heard from AAFP/AAP to deliver strong HPV vaccine

recommendations for…

Knew AAFP/AAP position on HPV vaccination for…

% w

ith

hig

h r

eco

mm

en

da

tio

n q

ua

lity

No

Yes

17

www.cdc.gov/hpv/hcp/

AAP HPV Champion Toolkit

The National HPV Vaccination Roundtable is a national coalition of organizations working together to prevent HPV-associated cancers and pre-cancers by increasing and sustaining U.S. HPV vaccination. Supported by grant #1H23IP000931-01, funded by the Centers for Disease Control and Prevention (Saslow, PI)

Mission

Roundtable Members

Academic Institutions/Cancer Centers

Advocacy and Survivors

Cancer Prevention

Communication

Government Agencies

Immunization

Insurance

Providers/Professional Societies

Public Health

State-based Organizations

Quality Improvement

Research

Special Populations

Training

Vaccine Manufacturing

Roundtable Task Groups

Topic Chair

Provider training Sharon Humiston, AAP

National campaign Marsha Wilson, FWC

Pharmacy-located vaccination Bruce Gellin, NVPO

School-based parent education Nichole Bobo, NASN

Electronic health records Paul Throne, WA DOH

Survivor involvement Rebecca Perkins, ACOG

Contact information

Noel Brewer, ntb@unc.edu

@noelTbrewer

HPV research: www.unc.edu/~ntbrewer/hpv.htm