School-located vaccination programs, centralized reminder systems, and quality improvement (QI) visits with primary care physicians are three state-level outreach tactics lawmakers could use to improve HPV vaccination rates, according to the results of a recently published analysis.1

HPV causes more than 30,000 cancer cases in the United States annually, but more than 90% of those cases could be prevented with the HPV vaccine.2 However, just 51% of Americans age 13 to 17 years are up to date on all their shots; 68% percent have received just one dose.3

State-level policy on HPV vaccination is heavily fragmented. Forty-eight states, the District of Columbia, and Puerto Rico allow pharmacists to provide the vaccine. But only a few states, like New Hampshire and Illinois, have enacted legislation that allows eligible patients to receive the vaccine for free. Just five states require this vaccine for school attendance.4

“With limited and shrinking budgets for state-based government programs in preventive care and increasing centralization of primary care in cost-conscious healthcare systems, it is important to identify not just effective but high-value [tactics] for improving HPV vaccine uptake,” the authors of the recent study wrote.

Investigators created a simulation model of HPV transmission and progression for a theoretical population of 5 million people. The simulation considered 50 years of outcomes if there were no interventions or QI visits, school-based vaccine programs, or a centralized reminder system. Each intervention was cost-effective to some degree. The QI option seemed to be most effective if budgets were tight; the school-based program appeared to be most successful. When scaled to the rest of the U.S. population, the authors estimated these interventions could prevent between 3,000 and 14,000 cancer cases.

“Three interventions for increasing HPV vaccine coverage were cost-effective and offered substantial health benefits,” the authors concluded. “Policymakers seeking to increase HPV vaccination should, at minimum, dedicate additional funding for QI visits, which are consistently effective at low cost and may additionally consider more resource-intensive interventions (reminder and recall or school-located vaccination).”

The National HPV Vaccination Roundtable, a group formed by the American Cancer Society and which receives funding from the Centers for Disease Control and Prevention, created a toolkit to help nurses improve HPV vaccination rates where they work.5


  1. Spencer JC, Brewer NT, Trogdon JG, et al. Cost-effectiveness of interventions to increase HPV vaccine uptake. Pediatrics 2020;146:e20200395.
  2. Senkomago V, Henley SJ, Thomas CC, et al. Human papillomavirus-attributable cancers — United States, 2012-2016. MMWR Morb Mortal Wkly Rep 2019;68:724-728.
  3. Walker TY, Elam-Evans LD, Yankey D, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years — United States, 2018. MMWR Morb Mortal Wkly Rep 2019;68:718-723.
  4. National Conference of State Legislatures. HPV vaccine: State legislation and regulation.
  5. Stone A. Nurses lead charge for HPV prevention. ONS Voice. Feb. 24, 2020.