Physicians report high refusal rates for the HPV vaccine and need for improvement

Health care providers must also learn to deal with parents hesitant to get their children vaccinated with HPV vaccine.

The study, published today in Pediatrics, is the first to examine pediatricians and family physicians' delivery practices for the vaccine since the new 2-dose schedule came out for adolescents 11 or 12-years-old.

"A physician recommendation is one of the most important factors in vaccine acceptance by parents," said Allison Kempe, MD, MPH, lead author and professor of pediatrics at the University of Colorado School of Medicine. "However, we're seeing a lack of understanding from healthcare providers about the need for vaccination early in adolescence and high rates of refusal on the part of parents. The vaccine is underutilized, with less than half of American adolescents completing the vaccination. We need to maximize methods of introducing the vaccine that we know to be more effective, as well as the use of reminder and delivery methods at the practice in order to improve this rate."

Every year, HPV causes over 33,500 cases of cancer in women and men in the United States, according to the Centers for Disease Control and Prevention.

"The earlier someone is vaccinated, the better the immune system responds. It also increases the chances of being vaccinated before having exposure to HPV strains," Kempe said. "If we can increase the rate of vaccination in early adolescence, then we can prevent cancers that develop in later years."

The study surveyed 588 pediatricians and family physicians and found that refusal rates from parents remain high, especially for 11 to 12-year-olds, the target population for vaccination.

But physicians who use a `presumptive style' approach have higher acceptance rates. Presumptive style means physicians introduce the HPV vaccine and recommend it in the same manner and as strongly as the other recommended adolescent vaccines for meningitis and Tdap.

For example, a doctor could say, "We've got three vaccines today: Tdap, HPV and Meningitis," rather than isolating HPV as an option that is not as important.

Still, the survey found some encouraging signs:

• Despite a high refusal rate, pediatricians who strongly recommend the vaccine increased from 60% in 2013 to 85% in 2018 for 11 or 12-year-old females and from 52% to 83% for 11 to 12-year-old males.
• Some 89% of pediatricians and 79% of family pediatricians reported more adolescents under age 15 are completing the HPV series now that only 2 doses are recommended.

Along with improving physician communication styles, HPV delivery could also be optimized by increased use of standing orders and alert systems in the medical record to remind providers of the need for vaccination at the point of care.

The study was supported by a grant from the Centers for Disease Control and Prevention.