Why are HPV vaccination rates so low?

National leaders and cancer center representatives recently met in Houston to review strategies for improving human papillomavirus (HPV) vaccination rates during a gathering titled Increasing HPV Vaccination in the U.S.: a Collaboration of NCI-designated Cancer Centers Summit.

The summit brought together experts from the National Cancer Institute (NCI), the American Cancer Society (ACS), the CDC and more than 35 of the nations’ NCI-designated cancer centers. Bruce Gellin, M.D., Deputy Assistant Secretary for Health and Director of the National Vaccine Program Office, delivered the keynote address.

Seventy-five to 80% of the American population will acquire an HPV infection in their lifetimes. The virus is responsible for more than 90% of cervical and anal cancers, approximately 70% of vaginal, vulvar and oropharyngeal cancers, and more than 60% of penile cancers. Oropharyngeal cancers disproportionately affect men and new cases are expected to eclipse that of cervical cancers by the year 2020.

The good news is any of three FDA-approved vaccines are available to prevent most of these cancers. The bad news is vaccination coverage in American adolescents remains extremely low. It’s recommended that all boys and girls get the three-dose vaccine between the ages 11 and 12.

Prevention of HPV-related diseases is a major priority of MD Anderson’s newly unveiled HPV-related Cancers Moon Shot. Accomplishing this goal is a two-fold approach that includes increased access to appropriate screening for early diagnosis of cancers and dramatically increasing HPV vaccination rates through education and policy.

There remains a stigma related to this virus being sexually transmitted, and parents may not be appropriately educated about the vaccine's safety, efficacy or necessity. Further, evidence suggests physicians may not be adequately recommending vaccination at appropriate ages.

Earlier this year, the Centers for Disease Control and Prevention (CDC) reported only 40% of girls and 21% of boys in the U.S. are receiving the recommended three doses of the vaccine. These rates represent a slight increase from previous years but remain significantly lower than rates reported in many other countries such as Australia (75%), the United Kingdom (84-92%) and Rwanda (93%). Health leaders cite this is as an enormous missed opportunity to prevent many “preventable” cancers.

A goal of the Healthy People 2020 initiative is to increase HPV vaccination in the U.S. to 80% over the next five years. Lois Ramondetta, M.D., professor of Gynecologic Oncology and Reproductive Medicine and co-leader of the HPV-Related Cancers Moon Shot, explained that the conversation must emphasize this being an anti-cancer vaccine rather than the focus being on HPV as a sexually transmitted disease.

“Although we have this excellent vaccine, there is still a lot of resistance and lack of uptake,” said Ramondetta. “It’s our goal to find out whether anyone has discovered useful interventions to promote vaccination that others could share and learn from.”

Several national partners were similarly enthusiastic about combining forces to change the conversation about the HPV vaccine.

A highlight of the summit was the presentation of findings from recently completed environmental scans focused on HPV immunization. Funded by NCI supplemental awards to 18 NCI-designated cancer centers, the results of these scans revealed barriers to increasing vaccination rates in pediatric settings as well as successful strategies that might be adapted by others across the country.

Another objective of the summit was to develop a shared endorsement for HPV vaccination from cancer centers, highlighting it as a safe and effective cancer prevention vaccine for both boys and girls. Additionally, initial conversations focused on developing a series of collaborative actions that can be taken across cancer centers to advance vaccination rates in the U.S.

“We feel that a strong statement from multiple cancer centers would be helpful in order to make people recognize that this is much more about fighting cancer than it being a sexually transmitted disease,” Ramondetta said.

A working group was established at this summit to finalize a consensus statement to be made public at a later date. Future summits will bring additional parties to the conversation, including industrial and health care reimbursement partners, to continue making progress in this effort.

“It is exciting to see cancer centers working collaboratively to advance cancer prevention as a leading priority,” says Ernest Hawk, M.D., vice president and head of MD Anderson’s Division of Cancer Prevention and Population Sciences. “In 2015, we have an amazing chance to make HPV-related cancers a thing of the past through HPV vaccination. We should never fail to take hold of such an exciting opportunity.”