Reframing HPV shot as cancer vaccine improved uptake among 9-year-olds

Key takeaways:

• Some parents remain hesitant about HPV vaccination.
• Researchers suggested reframing discussions to focus on the vaccine’s ability to reduce the risk for cancer.

WASHINGTON — Experts at the Pediatric Academic Societies Meeting suggested reframing conversations about HPV to encourage parents to get children vaccinated starting at age 9 years.

Recently, researchers reported that moving HPV vaccine initiation to age 9 or 10 years could improve coverage. Although the rate of teenagers being vaccinated has improved in recent years, parents still remain hesitant about HPV vaccination.

Jonathan M. Miller, MD, chief of primary care for Nemours Children’s Heath in Wilmington, Delaware, presented findings at the meeting from a primary care network-wide initiative to increase HPV vaccine update.

“We really were interested in trying to increase the uptake in our population, because this is a vaccine that can prevent cancer,” Miller said. “The more patients in our population who get it, the more protected they'll be from cancers down the way.”

Miller and colleagues said uptake in HPV vaccination in their area has been below national benchmarks despite an effort to improve the Healthcare Effectiveness Data and Information Set (HEDIS) measure of getting patients vaccinated by age 13 years.

“Based on some other studies that we had seen nationally, some suggested that if you start the vaccine as early as 9 years old, you can improve that HEDIS metric,” Miller said. “We went about the process of trying to change our programming here, so that we were giving the vaccine starting at 9 and 10 years old, rather than starting at 11 years.”

Miller and colleagues created new educational materials for their network, from providing handouts and videos to families on the positive effects of the vaccine to changing their electronic medical record to prompt physicians to be aware that a child would be due for the vaccine starting at age 9 years.

As for direct discussions with parents, Miller and colleagues found that a new approach would be effective: namely, focusing on the possible negative effects of not receiving the vaccine.

“One thing that I was a little surprised about was how easy it was to begin to have this conversation with families [with] 9-year-olds and really just focus on cancer,” Miller said. “In the past, this was often a conversation about HPV being a sexually transmitted infection, and that really complicated the issue for a lot of families. When we started at 9 years, we just talked about it as a vaccine that prevents cancer, and the discussion became a lot easier, and we started to see a lot more uptake.”

Among the 20 practices in their primary care network, Miller and colleagues found that the “large majority” saw “significant improvements” in HPV vaccine intake among 9-year-old children with this method. In all, the system’s HPV HEDIS rate improved from 47.3% in 2019 to 60.5% in 2022 (P < .0001), and initiation before age 11 years improved from 12.4% in 2019 to 30.7% in 2020 to 42.48% in 2022 (P < .0001).

“We started this in 2020, with 9-year-olds, and some of them are just beginning to approach 13 now,” Miller said. “I fully expect that this will continue to increase in the next couple of years.”