Factors contributing to the low completion rate of the HPV vaccine series and potential strategies to increase uptake among adolescents in the United States

The human papillomavirus (HPV) is a very common sexually transmitted infection that affects an estimated 14 million people each year in the United States. There are two licensed prophylactic HPV vaccines currently available for use: a quadrivalent vaccine that protects against HPV types 6, 11, 16, and 18 and a bivalent vaccine that protects against HPV types 16 and 18. Less than half of American adolescents are getting vaccinated against HPV, which is responsible for close to 26,000 incidence cases of cancer in men and women every year in the United States. Cancer prevention through vaccination is a significant public health achievement, although the benefit is only realized with uptake of the vaccine. Challenges including cost and delivery of the vaccine are prevalent, but the social challenges, including the misconceptions regarding safety and efficacy, perception of risk, and consequences of vaccination, are among the most difficult to overcome. However, a strong collaborative effort among health care providers, public health professionals, and legislators has the potential to overcome these challenges, increase uptake of the HPV vaccine, and ultimately prevent future cancers. An analysis of several HPV vaccination mandate scenarios indicate that 4,190 estimated cases of cervical cancer could be prevented by increasing vaccine coverage to 80% among girls entering public school for 6th grade (11-12 years old) in 2015. In addition to the decrease in estimated HPV-associated disease outcomes, health care costs decrease with a greater proportion of the population vaccinated. Compared to the current vaccination rate, vaccinating 90% of the population has the potential to save 219 million 2015 U.S.$ in health care costs associated with oropharyngeal cancer and 212 million 2015 U.S.$ in health case costs associated with cervical cancer. Information regarding the health and economic burden of HPV-associated disease may be useful to policymakers and public health professionals for informed decisions about investments in future HPV prevention programs