Derek van Amerongen, MD, MS: Let’s turn our discussion now to racial disparities in cervical and breast cancer. We all know the HPV [human papillomavirus] vaccination is perhaps the most effective way to prevent infection of HPV, which of course is associated with many HPV cancers, most notably cervical cancer. According to the NCHS [National Center for Health Statistics] data brief from 2020, HPV vaccination rates are good, but well below what the optimal rate should be. Dr Wells, what do you believe are some of the barriers preventing us from achieving those improved vaccination rates?

Roxie Cannon Wells, MD: I think that’s a very timely question and I think coming out of the past 3 years and getting people vaccinated during the pandemic and all of the barriers associated with getting people vaccinated during the pandemic, I think all of those things were there anyway. Certainly, the pandemic highlighted the issues of vaccinations and people not getting vaccinated. But I think some of the things are, as we’ve talked about and as we’ve seen in the pandemic, medical mistrust for many reasons that we’ve already discussed. Exposure to incorrect or erroneous information about safety concerns. And it really is overexposure now that people have access to the internet and Twitter and Facebook and what have you. They are just inundated with inaccurate, erroneous information. And then people are concerned about the safety of vaccines. Even though studies have been done to prove that these vaccines are safe, people still have concerns. When you think about things like the HPV vaccine, it’s really been around since 2006. I think the first one was released in 2006. And here we are over a decade later and people are still asking questions, although tons of studies have been done proving the safety of it, proving why it’s necessary, and the outcomes associated with it if people get the vaccine. I think we’re starting to see some of the outcomes from studies where there is a decrease in cervical cancer associated with HPV. I think really it’s medical mistrust. It’s misinformation. It’s lack of education regarding the safety of vaccines and why they’re necessary. Several things.

Derek van Amerongen, MD, MS: Now, increasing vaccination rates has always been a top priority for health plans. What has your experience been, Dr Deans?

Sharon Deans, MD, MPH, MBA: This is a tough one to track. We have a push every year around HPV. I agree with Dr Wells on her comments regarding knowledge and increasing the knowledge base. But I think what’s unique to HPV, and what I found in my practice when I was practicing OB-GYN, is the implication around this vaccine being used to prevent a sexually transmitted infection. It’s like having a young woman, a young teenager who needs to be on birth control pills, which is a medicine to help with abnormal menses. But the implication that it’s birth control is almost like, well, parents are worried we’re giving children a license to be sexually active, or they by consenting to this vaccine are given a license to be sexually active. So, I think the knowledge and understanding of why the vaccine is necessary, there are 36,500 cases of cancer in men and women, and it’s not just cervical cancer. It became real for me when I had a closet done and a guy came to the door quite debilitated post-treatment for throat cancer and had never smoked, and it was from HPV. So, it’s very, very real. I think the concern about whether or not there’s a cost for the vaccine to them. And I think the series can sometimes be a challenge. You’re talking about a population that already has trouble getting to the doctor; 1 in 5 with transportation issues, and there’s a series of 3 [shots]. Getting to the doctor 3 times to do that can be a bit of a challenge as well. We have a lot of incomplete treatments and when it first came out in 2006, there was a lot of controversy around it going to be enough treatment. Do they have to start the series over? There are a lot of questions but I think those are the primary things that we’re seeing. We advocate for it. We have campaigns around it. It’s one of our quality measures to get HPV vaccines done in our adolescent members as well.

Derek van Amerongen, MD, MS: Dr Hawkins, as an active practitioner, how are you addressing this among your patients?

Soyini Hawkins, MD, MPH, FACOG: Two parts. I think that we’re making more of an emphasis on getting the vaccinations younger in our teenagers and not just our little girls but our little boys as well. Some of the barriers we see are when we talk to parents about vaccinating our young patients, they do feel like, is that saying that I’m OK with them being sexually active since it’s associated with a sexually transmitted disease and they don’t necessarily see the long picture unless you give them that vision of this is going to protect them when they’re in college and not telling you what they may be doing or when they’re in their 30s or 40s and they’re getting their annual screenings. This is the long game for getting them vaccinated younger. And it speaks even to the series. The numbers are different. I even had to tell my own child, “You get fewer shots, son, if we do it now rather than later in your life.” So the education piece is extremely important, and the fact that we have the support connected to a hospital system that is able to supply the vaccinations as a part of our contract with them, so we have the ability to take that burden away from us, as a small office staff, in receiving the supply. And, as you said, when we talk to them about what the payer support is, we let patients know this is included as a part of their preventive care. Because for a lot of patients, it is down to the bottom dollar. How much do I have to pay for this? They’ll say no simply because of that concern. It’s definitely made progress, I think, over the years. Of course, like everything else we’ve discussed today, we still have some work to do, and a lot of that work is in the trust.

Derek van Amerongen, MD, MS: Now under the ACA [Affordable Care Act], the cost share for vaccines has been reduced to $0. Has that had a positive impact on the vaccination rates?

Soyini Hawkins, MD, MPH, FACOG: Absolutely. Absolutely, for all the reasons that we just spoke of, because some of the barriers are specific around, not just access to some of these preventative measures, but the cost. That’s definitely a concern for many, many patients.

Transcript edited for clarity.