Local Health Department Perspectives on HPV Vaccine Implementation Poki Stewart Namkung, MD, MPH President National Association of County & City Health Officials (NACCHO) Health Officer Santa Cruz County Health Services Agency Santa Cruz County Health Services Agency NVAC Meeting Washington, DC 26 September 2006

NACCHO Overview National voice of local public health National voice of local public health Nonprofit membership organization serving the ~3000 city/county/district/tribal public health agencies Nonprofit membership organization serving the ~3000 city/county/district/tribal public health agencies Formed in 1994 Formed in 1994 Focus on providing education, research, information, and technical assistance to our members Focus on providing education, research, information, and technical assistance to our members

NACCHO HPV Activities Hosted 2 partner meetings this year Hosted 2 partner meetings this year Developed Web page dedicated to these vaccines and the diseases they can help prevent Developed Web page dedicated to these vaccines and the diseases they can help prevent A special issue of NACCHO Exchange dedicated to HPV vaccines, cervical cancer, and associated issues A special issue of NACCHO Exchange dedicated to HPV vaccines, cervical cancer, and associated issues Working with C-CHANGE Working with C-CHANGE Working with Partnership to End Cervical Cancer Working with Partnership to End Cervical Cancer Surveyed a sample of our membership re: key issues/concerns around implementing HPV vaccines Surveyed a sample of our membership re: key issues/concerns around implementing HPV vaccines

NACCHO Activities HPV Partners Meeting #1 March 16 – communications Representatives: vaccine manufacturers, academia, provider groups, professional organizations, faith-based organizations, and governmental public health Representatives: vaccine manufacturers, academia, provider groups, professional organizations, faith-based organizations, and governmental public health Goal Goal Collaborate to examine steps that can be taken as individual organizations and collectively to promote consistent messages to the general public, providers, parents, and others to increase awareness of the vaccines, cervical cancer, and the various associated issues Collaborate to examine steps that can be taken as individual organizations and collectively to promote consistent messages to the general public, providers, parents, and others to increase awareness of the vaccines, cervical cancer, and the various associated issues Outcomes Outcomes Communications checklist, reference notes Communications checklist, reference notes Helped make all our partners aware of the spectrum of issues, across areas of practice, to share with their constituents Helped make all our partners aware of the spectrum of issues, across areas of practice, to share with their constituents Active participation and follow-up Active participation and follow-up

NACCHO Activities HPV Partners Meeting #2 September 14 - implementation September 14 - implementation Follow-up meeting with a wider array of partners focusing on HPV and the implementation of the vaccines. Follow-up meeting with a wider array of partners focusing on HPV and the implementation of the vaccines. Goals Goals Costs/financing Costs/financing School mandates School mandates share information, updates, and strategies on collaborative activities among stakeholders to address many of the opportunities and challenges discussed at the March 2006 meeting. share information, updates, and strategies on collaborative activities among stakeholders to address many of the opportunities and challenges discussed at the March 2006 meeting. Outcomes Outcomes Clearly articulated and identified barriers Clearly articulated and identified barriers Brainstormed strategies to address barriers Brainstormed strategies to address barriers

Key LHD Issues Costs – how do providers cover this expensive vaccine, given the limitations of VFC and 317 funding? Costs – how do providers cover this expensive vaccine, given the limitations of VFC and 317 funding? Costs – how do we vaccinate those girls and women who fall outside of public assistance coverage? Costs – how do we vaccinate those girls and women who fall outside of public assistance coverage? Costs – how does HPV vaccine “fit” into the spectrum of adolescent-focused recommended vaccines? Costs – how does HPV vaccine “fit” into the spectrum of adolescent-focused recommended vaccines?

Barriers/Issues Expense of the vaccines Expense of the vaccines Building a real adolescent health platform that includes these important vaccinations to assure universal access Building a real adolescent health platform that includes these important vaccinations to assure universal access LHDs: Cost of personnel (and lack of personnel in some cases) to implement and operationalize new immunization recommendations LHDs: Cost of personnel (and lack of personnel in some cases) to implement and operationalize new immunization recommendations LHD roles LHD roles Assess the need in the community Assess the need in the community Distribute the vaccines Distribute the vaccines Prioritization decisions and processes Prioritization decisions and processes Educate providers – all aspects of vaccine usage, storage, and handling Educate providers – all aspects of vaccine usage, storage, and handling Work with schools and other settings where adolescents are vaccinated Work with schools and other settings where adolescents are vaccinated Provide accountability by auditing our local providers Provide accountability by auditing our local providers Collecting all those data and reporting them up to our state and federal counterparts Collecting all those data and reporting them up to our state and federal counterparts

Key LHD Issues School mandates – state by state School mandates – state by state What is the spectrum of opinions on mandating HPV for school entry? What is the spectrum of opinions on mandating HPV for school entry? How do we stay off the slippery slope of “choice?” How do we stay off the slippery slope of “choice?” How do LHDs and others effectively address parental hesitancy within the issue of mandates? How do LHDs and others effectively address parental hesitancy within the issue of mandates? What is the reaction from school officials? What is the reaction from school officials?

Barriers/Issues Fluidity and difficulty of reaching higher-risk adolescents and dealing with the groups opposed to immunization mandates of any sort Fluidity and difficulty of reaching higher-risk adolescents and dealing with the groups opposed to immunization mandates of any sort Hepatitis B vaccine as a model for implementing HPV vaccine Hepatitis B vaccine as a model for implementing HPV vaccine We always want to keep some of missteps and failures in mind so that we learn from them We always want to keep some of missteps and failures in mind so that we learn from them Do we want to spend 20 years to get it right this time? Do we want to spend 20 years to get it right this time?

Action Items Actively continue to work and dialogue with our partners Actively continue to work and dialogue with our partners Develop, identify, disseminate, and warehouse tools and resource that our members can easily access and use, Be an active resource and partner in pilot demonstrations Develop, identify, disseminate, and warehouse tools and resource that our members can easily access and use, Be an active resource and partner in pilot demonstrations Advocate for public patient assistance programs that include vaccines Advocate for public patient assistance programs that include vaccines Provide advocacy tools for our members to work more effectively with their city/county councils and/or state legislatures regarding funding for delivery of immunization services Provide advocacy tools for our members to work more effectively with their city/county councils and/or state legislatures regarding funding for delivery of immunization services

Thank You NACCHO (202)