During the last decade, extensive efforts have focused on establishing completion of the HPV vaccine series as a standard of adolescent health care. Evidence shows the vaccine is safe and effective in preventing cervical cancer and other HPV-associated diseases. Yet, HPV vaccination rates lag behind those of other childhood vaccines.

Public health and professional organizations, researchers and clinicians worked together to increase HPV vaccinations among 13- to 17-year-olds. The rate rose from 30% in 2014 to 54% in 2019. While this gain shows progress, vaccination rates remain below the national goal.

Pandemic and reductions in HPV vaccinations

The COVID-19 pandemic’s effect on preventive health care and in-person educational programs threatens this progress. Ordering and billing for HPV vaccination is below pre-pandemic levels. There has been little recovery over time, unlike other childhood vaccinations.

Reduced office visits limit vaccination opportunities. Some offices postponed adolescent visits and vaccination programs to reduce capacity and maintain social distancing. Remote online educational programs and restrictions on athletic programs precluded many “back-to-school” check-ups. In the past, these were a key way to address adolescent vaccination.

The current focus is on urgent care, with a lower priority assigned to adolescent vaccinations. This could increase vaccine disparities in adolescent health and threaten our hard-won gains.

These issues call for coordination between health care providers and public health officials. They must address vaccinations missed during stay-at-home periods. They must also consider the reduced capacity of many practices imposed by the pandemic. Previous barriers to HPV vaccination reported by providers may further threaten gains in improving vaccination rates.

We don’t know how much the pandemic influenced parental anxiety about the vaccine. Some parents may be more willing to accept it after a provider’s recommendation. Others may hesitate due to the pandemic and the COVID-19 vaccine.

HPV vaccinations low in Tennessee and the southeast

Data from the Tennessee Department of Health shows that HPV vaccinations given between January and September of 2020 were at least 20% lower among children 9-18. Tennessee and other states in the Mid-South and Southeast already have the lowest rates of HPV vaccination in the U.S., while also having the highest rates of HPV-associated cancers.

Stressing preventive care for children

The pandemic’s effects may also change a willingness to seek preventive care. Some families weigh the benefits of vaccination versus the risks of COVID-19 exposure. We also don’t know how the economy has affected a family’s ability to pay for the HPV vaccine.

We must use evidence-based interventions that help providers recommend vaccination of adolescents age 9 years or older at every visit. It is also crucial to create a reminder/recall system that assures series completion.

Telehealth is likely to continue to play a role in health care. Other methods (e.g., drive-through appointments) and settings (e.g., pharmacies, school health centers) for HPV vaccination may be long-lasting solutions. If we increase public awareness about programs that cover the cost of HPV vaccinations, access may rise for uninsured or underinsured families.

The pandemic will continue to affect health care for many years. We must act fast to increase HPV vaccinations and achieve the national goal to fully vaccinate 80% of adolescents.

HPV vaccination is safe, effective and long-lasting. Our priority should be to get back on track with HPV vaccination. If you have a child age 9–12 who is due for the vaccine, call your health care provider to learn your options.