Executive Summary

Human papillomaviruses (HPV) cause six types of cancer—cervical, oropharyngeal, anal, penile, vulvar, and vaginal—and several other diseases. HPV vaccination provides a compelling opportunity to protect against infection with HPV and prevent cancers and other diseases. The President’s Cancer Panel concluded in its 2012-2013 report to the White House, Accelerating HPV Vaccine Uptake: Urgency for Action to Prevent Cancer, that underuse of HPV vaccines was a serious but correctable threat to progress against cancer. That report identified several goals and objectives to increase HPV vaccine uptake in the United States and globally.

Substantial progress in HPV vaccine uptake has been achieved in recent years—the percentage of adolescents who started the HPV vaccine series increased an average of 5 points each year between 2013 and 2017. However, HPV vaccine coverage is still too low to achieve its cancer prevention potential. As of 2017, less than half of U.S. adolescents were fully vaccinated, far below the Healthy People 2020 goal—full vaccination of 80 percent of adolescents aged 13-15 years. In addition, HPV vaccines are not included in the national vaccine programs of many low- and middle-income countries, where the vast majority of cervical cancer cases and deaths occur.

In this report, the Panel Chair provides an overview of progress made over the past five years and presents priorities and strategies to speed progress toward goals identified in the previous report. Several research priorities also are highlighted.

Goals and Opportunities to Increase HPV Vaccine Uptake

The Panel’s 2012-2013 report identified three goals to increase HPV vaccine uptake in the United States. A fourth goal was to promote global HPV vaccine uptake. Research and discussions with key stakeholders on the current landscape of HPV cancers and HPV vaccination led the Panel Chair to conclude that the goals outlined in the previous report are still relevant. Priorities and strategies that will help achieve these goals are outlined below.

Goal 1: Reduce Missed Clinical Opportunities to Recommend and Administer the HPV Vaccine.

Communication strategies and systems changes are essential to ensure that all eligible adolescents and young adults are offered the HPV vaccine when they visit their healthcare providers. Provider- and systems-level changes hold the greatest potential for eliminating missed clinical opportunities, normalizing HPV vaccination, and ensuring that U.S. adolescents and future generations are optimally protected from HPV cancers. As such, the Panel Chair urges healthcare providers to strongly recommend HPV vaccination for all eligible adolescents. In addition, health system leaders should make HPV vaccination a high, measurable priority.

Goal 2: Increase Parents’ Acceptance of HPV Vaccination.

Communication campaigns and promotion of the HPV vaccine by a growing number of healthcare providers have contributed to recent progress in vaccination rates. However, more must be done to ensure that parents have access to clear, accurate information about the HPV vaccine. The Panel Chair encourages the Centers for Disease Control and Prevention, American Cancer Society, and other trusted organizations to continue to develop and deploy evidence-based communication campaigns to increase parents’ acceptance of HPV vaccination.

Goal 3: Maximize Access to HPV Vaccination Services.

Ensuring that HPV vaccination is affordable and convenient for all U.S. adolescents will support optimal vaccine uptake. National, regional, and local efforts are needed to understand and address existing and potential barriers to access. While sources of private and public financing currently ensure that the vaccine’s cost is covered for most adolescents, the Panel Chair asserts that insurance coverage for preventive services must be maintained to ensure that cost does not limit U.S. adolescents’ access to HPV vaccination.

Goal 4: Promote Global HPV Vaccine Uptake.

The potential impact of HPV vaccination is greatest in less developed countries, where the vast majority of cervical cancer cases and deaths occur and HPV vaccination rates are disproportionately low. The Panel Chair urges the United States to continue to support implementation and sustainability of HPV vaccination programs around the world, particularly in low- and middle-income countries.

A Renewed Call to Action

Progress and momentum built over the past half decade have created a compelling opportunity to further increase HPV vaccine uptake and dramatically reduce—and perhaps eventually largely eliminate—the preventable burden of HPV cancers. Cancer and immunization stakeholders worldwide must renew their collective commitment to achieving HPV vaccination targets. All should rally without hesitation around the ultimate goal of cancer prevention.

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