How Pediatricians Can Recommend HPV Vaccination to Parents and Caregivers

HPV vaccination is a safe, effective way to protect children and adolescents from HPV infection that can lead to six types of cancers (cervical, vaginal, vulvar, anal, penile and oropharyngeal) as well as hospitalization, disability and death. The AAP recommends starting the HPV vaccination series between 9 and 12 years, at an age that the provider deems optimal for acceptance and completion of the vaccination series.

HPV vaccination rates are low

Vaccination rates for HPV are lower than those for other routinely recommended adolescent vaccines. National CDC data shows that 62% of adolescents are up to date with HPV vaccines and there are clear disparities depending on insurance status, gender, race and ethnicity, poverty level and geography. These differences in vaccination rates could contribute to continuing disparities in HPV-related cancer incidence and outcomes. Explore immunization rates and learn about coverage gaps in your area with the AAP interactive child vaccination map.

Pediatricians have a crucial role

A strong presumptive recommendation from a pediatrician is the primary reason someone will get the HPV vaccine and be protected from HPV-related cancers.

You play a crucial role in immunizing children and are a trusted source for vaccine information. How you introduce the HPV vaccine when talking with patients and families leverages this trust and may lead to more conversation. HPV vaccination initiation rates depend on your high-quality recommendation to parents and caregivers.

What is a high-quality HPV vaccine recommendation?

A high-quality HPV vaccine recommendation:

• Is a clear and declarative statement
• Sends the message that the HPV vaccine is important
• Normalizes the vaccine as the standard of care

Examples of how to make the recommendation

Research shows that an effective communication strategy is to presume that parents and caregivers are ready to have their kids vaccinated. For example, “Now that Laura is 12, she’s due for three vaccines today that protect against meningitis, HPV cancers and pertussis.”

Theresa M. Fiorito, MD, MS, FAAP, a pediatric infectious disease specialist at NYU Langone Hospital, uses these conversation starters when recommending the HPV vaccine starting at age 9:

• “The CDC and AAP recommend this vaccine for all children.”
• "I got this vaccine for my children starting at age 9, and I recommend we give your child their vaccine today.”

Another strategy is to bring the cancer-preventing benefits of the vaccine into conversation.

Ashley Stephens, MD, FAAP, a pediatrician at New York-Presbyterian, has found focusing on cancer prevention an effective communication strategy since many parents may have family or friends who have been affected by HPV-related cancers. Dr. Stephens explains to parents and caregivers:

• “The vaccine prevents 90% of cancers caused by HPV in both boys and girls. It’s safe and effective, and I recommend that your child get it today to be protected from these cancers.”

Most families will accept vaccination after you give a clear, unambiguous recommendation that their child is due for HPV vaccine that day. Many of those who don’t immediately accept will have simple questions that you can easily address. Access the AAP digital adolescent immunization discussion guides for talking points to promote efficient, productive conversations about HPV and other adolescent vaccine recommendations.

Addressing vaccine hesitancy

A small percentage of parents will be more hesitant to vaccinate. There are various methods for talking with vaccine hesitant parents. In addition, using motivational interviewing techniques with these families may increase immunization rates and decrease provider frustration.

According to Dr. Fiorito, “Most parents want to feel heard and seen by their pediatrician. Acknowledging their concerns without judgment is crucial. I would say something like, ‘I can understand why you would be nervous about this vaccine, given all of the scary things on social media. This is your baby! I can guide you in separating fact from fiction.’”

Dr. Stephens adds, “Motivational interviewing is one proven technique that can help parents move towards vaccinating their child. The gist of it is that you ask what the parent’s concerns or questions are, validate that it’s ok to have questions, address their concerns and focus on the benefits of vaccinating and ask permission to give a strong personalized recommendation. Even if parents don’t want to vaccinate that day, they will be able to consider the information you have provided, and maybe next visit they will be ready to vaccinate their child.”

If a family declines the HPV vaccine

Every visit is an opportunity to vaccinate! If a parent declines, you can revisit the conversation at the next visit, or in as many visits as it takes. Many parents who initially refuse the HPV vaccine later agree to it.

To attempt to destigmatize HPV and look at the vaccine from an objective viewpoint, Dr Fiorito says to parents, “Say we had a vaccine that prevented lung cancer. It has very few side effects and it works extremely well. Would you then be interested? Why is this any different?”

“The majority of parents will vaccinate their child against HPV," says Dr. Stephens. “The protection against HPV-related cancers is better when the vaccine is given at younger ages, so that’s why it’s important to start the conversation about the vaccine at age 9 when children are eligible to be vaccinated. It gives you more opportunities to discuss the vaccine if the parents aren’t quite ready the first time you discuss it.”

HPV vaccination tools from AAP

Print and hang this free, colorful poster in exam rooms to introduce the subject. Also, the one-page HPV Vaccine Immunization Discussion Guide has speaking points for you to customize when you have those conversations.

AAP also has a toolkit of social media graphics, videos and other resources to share information with families about HPV and how the vaccine gets kids’ immune systems ready to resist the virus so they can live healthy lives.