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Commentary: Only we can turn around epic failure to provide HPV vaccine :

January 13, 2016

A couple of years ago, my teenage son used the phrase “epic fail” as I unsuccessfully attempted to beat him in a game. I thought it was a harsh but accurate assessment of my performance. And I certainly was motivated to practice, so the next time things would be different.

The same phrase came to mind as I read through an article titled “Quality of Physician Communication about Human Papillomavirus Vaccine: Findings from a National Survey” published in the November 2015 issue of Cancer Epidemiology, Biomarkers & Prevention ( The article describes the poor performance of the medical community (primarily pediatricians and family physicians) in providing this vaccine.

The National Immunization Survey-Teen 2014 reports another alarming trend: HPV vaccine series initiation and completion continue to lag far behind what they should be.

HPV vaccine series initiation and completion continue to lag far behind what they should be. AAP News photo by Jeff Knox
HPV vaccine series initiation and completion continue to lag far behind what they should be. AAP News photo by Jeff Knox

The Cancer Epidemiology, Biomarkers & Prevention article clearly showed what I have suspected for some time and what has been hinted at by previous studies. The epic failure in providing what essentially is a cancer-prevention vaccine to the recommended population of 11- to 12-year-old boys and girls lies not at the feet of the anti-vaccine movement or hesitant parents. Rather, the failure belongs to us.

The article describes findings from an online survey sent to 2,368 pediatricians and family physicians in 2014. The 776 respondents self-reported their own performance on strength of endorsement (saying the vaccine is important), timeliness (recommending it at ages 11 and 12), consistency (recommending it routinely vs. using a risk-based approach) and urgency (recommending same-day vaccination).

More than one-quarter stated they did not strongly endorse the HPV vaccine, and a similar number reported they did not recommend it be given at 11 to 12 years of age. Amazingly, 59% stated they used a risk-based approach vs. a routine approach to recommending the HPV vaccine, and only half of the respondents recommended giving the vaccine at the encounter when discussing the HPV vaccine.

Since these are self-reported data, the results represent a best-case scenario because respondents would be unlikely to paint an unflattering picture of their own performance.

Clearly, we have a major problem with physicians struggling with their own discomfort in talking about the HPV vaccine and who erroneously believe parents do not value it. The physician's lack of competency in communicating effectively overtly and covertly leads to a lack of an affirmative recommendation that is so important in any preventive intervention.

We are at risk of being the generation of pediatricians and family physicians who collectively failed to protect our patients from a preventable cause of cancer. Only we can fix what it wrong with us. Only we can turn around this epic failure.

Dr. Terk is a member of the AAP Section on Administration and Practice Management and immediate past president of the Texas Pediatric Society.

Originally published by the Texas Medical Association, Nov. 9, 2015. Reprinted with permission.

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