President’s Cancer Panel: Accelerating HPV Vaccine Uptake – Urgency for Action to Prevent Cancer

Report: Accelerating HPV Vaccine Uptake – Urgency for Action to Prevent Cancer
[U.S.] President’s Cancer Panel (PCP):  February 2014

Human papillomaviruses (HPV) cause most cases of cervical cancer and large proportions of vaginal, vulvar, anal, penile, and oropharyngeal cancers. HPV also causes genital warts and recurrent respiratory papillomatosis. HPV vaccines could dramatically reduce the incidence of HPV-associated cancers and other conditions among both females and males, but uptake of the vaccines has fallen short of target levels. The President’s Cancer Panel finds underuse of HPV vaccines a serious but correctable threat to progress against cancer. In this report, the Panel presents four goals to increase HPV vaccine uptake: three of these focus on the United States and the fourth addresses ways the United States can help to increase global uptake of the vaccines. Several high-priority research questions related to HPV and HPV vaccines also are identified .

Excerpts from Executive Summary
HPV vaccine uptake has not kept pace with that of other adolescent vaccines and has stalled in the past few years. In 2012, only about one-third of 13- to 17-year-old girls received all three recommended doses. These levels fall considerably short of the U.S. Department of Health and Human Services Healthy People 2020 goal of having 80 percent of 13- to 15-year-old girls fully vaccinated against HPV. Immunization rates for U.S. boys are even lower than for girls. Less than 7 percent of boys ages 13 to 17 completed the series in 2012. This low rate is in large part because the ACIP recommendation for routine vaccination of boys was not made until 2011. However, it is even lower than what was observed for girls in 2007—the first year following the recommendation for females—suggesting that concerted efforts are needed to promote HPV vaccination of males.

The Centers for Disease Control and Prevention (CDC) estimates that increasing HPV vaccination rates from current levels to 80 percent would prevent an additional 53,000 future cervical cancer cases in the United States among girls who now are 12 years old or younger over the course of their lifetimes. Thousands of cases of other HPV-associated cancers in the U.S. also likely would be prevented within the same timeframe. A growing proportion of these cancers—most notably, oropharyngeal cancers—will occur in males, who currently are vaccinated at very low rates.

The President’s Cancer Panel finds underuse of HPV vaccines a serious but correctable threat to progress against cancer. Organized, mutually reinforcing efforts could have synergistic impact on HPV vaccine uptake. The Panel presents four goals to increase HPV vaccine uptake; three goals focus on increasing uptake in the United States (Part 3), and the fourth addresses ways the United States can help increase global uptake of the vaccines (Part 4). Several high-priority research areas also are identified (Part 5). All recommendations and some of the stakeholders responsible for implementing them are summarized in Appendix B.

The Panel urges all stakeholders—including federal and state governments, healthcare professionals, nongovernment organizations with a focus on public health, and parents, caregivers, adolescents, and other members of the public—to contribute to efforts to achieve this goal and protect millions of men and women around the world from the burden of avoidable cancers and other diseases and conditions in the coming years…

The burden of HPV-associated cancers extends beyond the borders of the United States, affecting populations in every country. Patterns of HPV-associated cancers differ by region. Cervical cancer is the most common HPV-associated cancer globally. In less developed regions, the large majority of HPV-attributed cancers are cervical cancers. In the United States and other more developed regions, other sites account for a significant proportion of HPV-associated cancers.

While the prevalence of HPV infections and distribution of HPV types vary by region, research has found consistently that HPV16 and HPV18, the cancer-causing strains HPV vaccines protect against, are responsible for at least two-thirds of cervical cancer cases in populations around the world. This provides a strong indication that HPV vaccines will be effective virtually everywhere.

As with cervical cancer screening programs, HPV vaccination programs have been implemented primarily in high-resource areas. Some of the most successful vaccination programs are in Australia, the United Kingdom, and parts of Canada. The U.S. can learn from successful HPV vaccination programs in these and other countries that in some cases have already led to measurable public health benefits.

Addressing the global burden of HPV-associated cancers requires implementation of HPV vaccination programs in low- and middle-income countries, where the majority of HPV-associated cancer cases occur.

The World Health Organization recommends that HPV vaccines be introduced into national immunization programs where prevention of cervical cancer is a public health priority and vaccine introduction is feasible and sustainable. The Panel recommends that the United States collaborate with global partners to support HPV vaccine uptake and other cancer prevention and control activities worldwide.

Objective 4.1: The United States should continue its collaboration with and support of GAVI to facilitate HPV vaccine introduction and uptake in low-income countries.
Objective 4.2: The United States should continue to support global efforts to develop comprehensive cancer control plans and cancer registries in low- and middle-income countries.


     Four U.S.-based national medical associations — the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), the American College of Physicians (ACP), and American College of Obstetricians and Gynecologists (ACOG) — together with the Immunization Action Coalition and the CDC “issued a call urging physicians across the U.S. to educate their patients about the human papillomavirus (HPV) vaccine, and to strongly recommend HPV vaccination.” In the “Dear Colleague” letter issued today, medical and public health organizations “emphasize to physicians that strong health provider recommendations are critical to increasing the HPV vaccination rate and preventing HPV-associated cancers. Despite more than seven years of vaccine monitoring showing overwhelming evidence of HPV vaccine safety and effectiveness, vaccination rates are not improving while rates for other adolescent vaccines are…”

Feb. 12, 2014