Multifaceted HPV Vaccination Strategies in California Achieving the Promise Avoiding the Pitfalls Heidi M. Bauer, MD MS MPH California Department of Public Health STD Control Branch ISSTDR Seattle July 2007

Acknowledgements  Eileen Yamada  Terri Thorfinnson  Kurt Snipes  Tammy Pilisuk  Joyce Lisbin  Gail Bolan  And the many California stakeholders!

Overview  The rationale  The process: keys to success  Challenges and accomplishments  Future efforts

What are the benefits of the HPV vaccine in the US?  Cervical cancer is still a problem: 11,150 new cases and 3,670 deaths projected in 2007  Pap screening is secondary prevention  Vaccine affords primary prevention: > 10,000 cervical and anogenital cancers ~ 4,000 head and neck cancers 160,000 abnormal Pap tests > 300,000 cases of genital warts

Rationale for Workgroup  Intervention crosses multiple agencies  Pool resources and expertise  Create and promote consistent messages  Opportunity to create partnerships between state government and advocacy, professional, and healthcare organizations

The Process: Keys to Success

California HPV Vaccine Workgroup  Lead agencies: Immunization STD Control Cancer Detection  State government partners: Office of Women’s Health Dept of Education Maternal Child Adolescent Health Office of Family Planning Office of AIDS

Workgroup Process  Strategic planning  Sharing resources  Stakeholder involvement External stakeholder interviews Statewide HPV Vaccine Summit Meaningful partnerships

Controversies  Framing of the vaccine: Cancer vs. STD prevention?  Rationing of resources for target populations  Minor consent  School mandates  Unanswered questions

Challenges and Accomplishments

Challenge #1: Lack of public awareness of HPV, the connection with cervical cancer, and the availability of an effective vaccine

* 9/06-6/07: > 2,000 hits; 2,600 page views

Platform:  MCV4  Tdap  Varicella  HPV  Influenza * 4,000 providers, local PH programs, partner organizations * 26,000 print brochures in English; 15,000 brochures in Spanish

Challenge #2: Lack of knowledge about HPV vaccine among health care provider and public health professionals

* 1/07-6/07: ~ 350 downloads

* > 35,000 copies to 4,500 VFC providers, local IZ coordinators, etc

* > 1,700 hits to index page and > 7,500 page views

Challenge #3: Ensuring access to the vaccine among those who will benefit most

California VFC Program  As of June 15: 221,000 doses distributed to 2,400 VFC providers  Estimated 250,000 doses distributed within private sector

Challenge #4: Lack of surveillance data to assess the public health impact of the vaccine

Cervical Disease Surveillance Collaboration with California Emerging Infection Program:  Demonstration project to monitor CIN 2/3 within one county  Feasibility study for expansion and continuation

Future Efforts  Conduct surveys to assess knowledge of HPV and vaccine uptake  Provider surveys to understand barriers  Promote immunization registry for preteen vaccines  Provide technical assistance on policy issues  Develop and distribute materials for high-risk populations

Conclusions  The unique challenges of implementing an HPV vaccination program require an ongoing statewide collaborative effort to engage and coordinate a wide variety of stakeholders  Our work reinforces the effective role that state health departments have in supporting the introduction of HPV vaccines

Thank You!  Visit us! California HPV Vaccine Workgroup:  Or write: