Recommendations for Optimizing HPV Vaccine Uptake

Increasing Healthcare Provider (HCP) Recommendation

Healthcare providers are considered the most trusted source of information about vaccination, with their recommendation serving as a key predictor of vaccine uptake.6,28 However, many HCPs fail to provide effective recommendations for routine vaccination with their patients. 28 Specifically, HCPs are challenged by the high cost of HPV vaccination for individuals not eligible for publicly-funded programs, and limited evidence-based guidelines for vaccinating high-risk and targeted populations (e.g., MSM, transgender peoples). 29 For example, in a study exploring communication practices as a barrier to HPV vaccine uptake amongst MSM, approximately 70% of primary care practitioners were aware of existing vaccine recommendations, but only 13% routinely discussed sexual orientation and HPV vaccination. 30 Since disclosure of sexual orientation/practices serves as a key determinant of vaccine recommendation, uptake is profoundly influenced by evidence suggesting that only 38% of MSM disclose this information to their HCPs. 31 Similarly, disclosure of sexual orientation/practices pose unique challenges for transgender individuals, leading to missed opportunities to receive evidence-based preventative care (e.g., HPV vaccination). 32 From this perspective, it is imperative that HCPs strive to create inclusive, trauma-informed and culturally-competent care environments, which are essential to fostering positive patient-provider relationships, trust in healthcare systems, and improving the uptake of recommended health interventions amongst underserved populations.31,33 Increasing efforts to mitigate the barriers influencing HCPs’ recommendation of inclusive HPV vaccination can bridge gaps in vaccine uptake and mitigate the persistence of HPV-related disparities in Canada.

Accessing HPV Vaccination: Implications for Community-Based Programs

Despite the implementation of publicly funded school-based vaccination programs, HPV vaccine uptake amongst adolescents and young adults remains inconsistent, further reinforcing the need for robust community-based interventions.6,17 For example, inconsistent HPV vaccination coverage amongst adolescents has been attributed to concerns with parental consent, vaccine hesitancy and the exclusion of high-risk youth populations (e.g., unhoused youth).34,35 Additionally, newcomers to Canada represent another particularly underserved population, with approximately 70% reporting no prior awareness of HPV, and only 46% being aware of vaccination. 36 Although HPV vaccination is widely available in medical clinics, pharmacies, community health centres and public health departments, access remains a significant barrier. 37 A systematic review found that 38% of studies identified access as a primary obstacle to adult vaccination, highlighting an opportunity for stakeholders (e.g., researchers, community members, clinicians, policymakers) to develop tailored, community-centric solutions aimed at increasing HPV vaccine uptake amongst targeted, underserved populations (e.g., transgender peoples, MSM). 37

Enhancing HPV Vaccine Communication/Messaging

Given the complex landscape of HPV vaccination in Canada, multi-level communication strategies targeting HCPs, parents and eligible individuals are essential to addressing disparities in vaccine uptake. 38 Evidence-based messaging- inclusive of public health vaccine campaigns- has been shown to increase vaccine acceptance, dispel misconceptions (e.g., safety concerns) and address hesitancy. 38 However, operationalizing effective communication strategies remains a significant public health challenge. 38 Community-based participatory research (CBPR) is an effective approach for integrating diverse perspectives into the design and implementation of health interventions, including vaccine promotion. 38 By identifying beliefs, values and barriers to HPV vaccination amongst under-vaccinated populations, CBPR can ensure interventions are culturally and contextually appropriate. 38 A one-size-fits-all approach to HPV vaccination fails to acknowledge the multi-level, intersectional factors influencing uptake, which continues to exacerbate vaccine-related disparities in Canada. 38 By designing communication strategies that extend beyond the binary, gender-neutral approach, public health initiatives can effectively address disparities, making equitable vaccine uptake a tangible public health objective.