Vaccine skepticism is proving infectious. As refusing a COVID-19 shot becomes a badge of honor for some, lawmakers are beginning to revisit existing vaccine mandates, with politicians from Florida to Montana questioning long accepted immunization requirements against diseases like polio and measles. Coupled with a precipitous drop in childhood vaccination rates during the pandemic-which first plummeted as locked-down kids skipped healthcare visits, according to the Centers for Disease Control and Prevention (CDC)-vaccine skepticism could allow previously well-managed viruses and diseases to start reappearing.
Among the viruses most at risk of coming back may be human papillomavirus, or HPV. The most common sexually transmitted infection in the United States, according to the Population Reference Bureau, HPV can cause genital warts and a range of cancers. Although there are 5.5 million new cases of HPV and more than 30,000 cases of HPV-related cancers every year in the US, vaccination with a series of shots has proven a highly effective defense: A major study in the United Kingdom recently found rates of cervical cancer were 87 percent lower in women who'd received the vaccine in their early teens.
So why the concern? The number of teens receiving an HPV shot in the US fell by 70 percent in 2020, according to the CDC-a plunge the agency says hasn't reversed.
A new study from Boston University School of Medicine may show a way to help those numbers bounce back-and perhaps lift up vaccination rates against other viruses and diseases. A team of researchers tested a program of multilevel interventions, which included improved health center staff training and an earlier start to vaccinations, and found it has the potential to push vaccine rates up by double digits.
Good Public Health Investment
The program, called Development of Systems and Education for HPV Vaccination, was initially rolled out at Boston Medical Center (BMC), BU's primary teaching hospital, and four practices in affiliated community health centers between 2016 and 2018. Training was given to all staff-from those on the front desk to doctors-and included sessions on how to recommend vaccines, as well as the basics on HPV. The researchers, who helped create tailored implementation plans for each site, continued following the program after the intervention was completed-including through the early stages of the pandemic-to see if it remained effective after they left.
"The data showed that the improvements were sustained for four years beyond the completion of the initial vaccination," says Rebecca Perkins, a BU School of Medicine associate professor of obstetrics and gynecology. "And the rates of adolescents completing the HPV vaccine series by their 13th birthday-the CDC definition of on-time completion-increased from 62 percent to 88 percent, nearly double the national rate of series completion among 13-year-olds."
According to Perkins, who is also a gynecologist at BMC, this is the first study to examine the effectiveness of interventions four years after implementation.
"The sustained improvement over time indicates that these types of programs may be a good public health investment," she says. "It also indicates that starting the HPV vaccine series before age 11 can improve on-time completion of the series by giving more chances for kids to be vaccinated."
Vaccine Success Without Mandates
Because the HPV vaccine series can start at age nine, Perkins encourages healthcare providers to use every wellness visit as an opportunity to recommend immunization.
"With the ongoing pandemic, you really don't know how often you will see a child for routine well-care. That means that every visit, whether for a checkup or a sprained ankle, is a chance to protect them against vaccine-preventable diseases."
As some states debate adding or removing vaccine mandates, Perkins says that programs like the one her team created can be more effective than enforced directives. "Our long-term data show that once the new practices become standard care, they are maintained," she says. "Data from our program, and also the state of Rhode Island, which did similar work through their Department of Public Health, show that very high rates [of vaccination] can be achieved without mandates."
COVID vaccines, however, present a different challenge. Perkins says that most viruses haven't evolved much for centuries, but the virus that causes COVID keeps mutating, leading to new variants. Although vaccines have proven to be effective against every current iteration of the virus, she says the frequent changes have taken away the clarity many used to have about vaccinations.
"Parents want to protect their kids, and doctors want to protect their patients. The vaccines we have available today are the best way to do this. The situation with COVID is a little more challenging and it's led to a lot of confusion. The simple message on vaccine effectiveness has gotten lost," she says. "But we have seen very clearly that, even with the changes from the original strain to alpha, then delta, and now omicron, COVID vaccines are the best way to keep you alive and out of the hospital."
This research was supported by the American Cancer Society.
