Promising alternative settings for HPV vaccination of US adolescents

Abstract

Vaccination in alternative settings, defined here as being outside of traditional primary care, can help address the pressing public health problem of low human papillomavirus vaccine coverage among adolescents in the United States. Pharmacies are promising because they are highly accessible and have well established immunization practices. However, pharmacies currently face policy and reimbursement challenges. School-located mass vaccination programs are also promising because of their high reach and demonstrated success in providing other vaccines, but control by local policymakers and challenges in establishing community partnerships complicate widespread implementation. Health centers in schools are currently too few to greatly increase access to human papillomavirus vaccine. Specialty clinics have experience with vaccination, but the older age of their patient populations limits their reach. Future steps to making alternative settings a success include expanding their use of statewide vaccine registries and improving their coordination with primary care providers.

Keywords::

• adolescent vaccines
• alternative vaccination settings
• human papillomavirus
• pharmacists
• school vaccination

Financial & competing interests disclosure

PD Shah and MB Gilkey drafted the manuscript. PD Shah, MB Gilkey, JK Pepper, SL Gottlieb and NT Brewer critically reviewed and revised the manuscript. The authors received no honorarium, grant or other form of payment to produce the manuscript. The secondary analyses of publicly available data reported in this manuscript did not require institutional review board approval. NT Brewer received grants and/or honoraria from Merk Sharp & Dohme and from GlaxoSmithKline, unrelated to this manuscript. MB Gilkey received funding from the Cancer Control Education Program at UNC Lineberger Comprehensive Cancer Center (R25 CA57726). The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

The authors did not receive any writing assistance in the production of this manuscript.

Key issues

• Human papillomavirus (HPV) vaccine coverage among adolescents remains low as initial increases in coverage have stagnated, despite national recommendations.

• Causes of low HPV vaccination include missed opportunities in traditional primary care settings to vaccinate and inadequate primary care provider recommendations to adolescents and their parents.

• Pharmacies and voluntary mass vaccination programs in schools are already effectively providing vaccines in the USA.

• The most promising alternative settings are pharmacies and voluntary mass vaccination programs in schools, in part because they have the greatest potential reach to adolescents aged 11–12.

• Specialty clinics are less promising alternative sites as they have more limited access to adolescents, have low acceptability as providers of HPV vaccine or face substantial challenges to feasibility.

• Emergency departments and dental practices do not prioritize HPV vaccination because of scope of practice and may not play a large role in HPV vaccine provision without revision to practice.

• Expanding access to immunization registries, developing reimbursement mechanisms and maximizing care coordination will help make alternative settings more acceptable and sustainable for HPV vaccination.