States Seek to Increase HPV Vaccine Coverage Through School Immunization Requirements

December 04, 2019|2:53 p.m.| ASTHO Staff

Human papillomavirus, or HPV, is a common virus that can lead to certain types of cancer later in life. The virus is spread through intimate skin-to-skin contact and can be transmitted by having sex with someone who has HPV. Almost 80 million Americans are currently infected with HPV and about 14 million become infected each year. While 90 percent of HPV infections go away within a couple of years, they sometimes last longer and can cause 6 types of cancer. Each year, approximately 20,700 cancer cases in women and 14,100 cancer cases in men are caused by HPV. In 2006, the FDA approved a vaccine to prevent HPV infection. The CDC currently recommends that all children at ages 11-12 receive the HPV vaccine and that anyone through the age of 26 who is not vaccinated also be vaccinated. Giving the vaccine at an early age can protect a person long before he or she is ever exposed to the virus.

Nathaniel Smith, MD, secretary of health for the Arkansas Department of Health and ASTHO president, spoke last year about the importance of the HPV vaccine as a cancer prevention tool. Smith also highlighted the importance of coalition building, partnering with healthcare systems, and addressing rural provider needs as ways of improving HPV vaccine coverage.

Some policymakers are also working to include the HPV vaccine in school entry immunization requirements to boost vaccination rates. Three states and the District of Columbia have added the HPV vaccine to their school vaccination requirements, with Virginia leading the pack. Virginia requires all female students entering sixth grade to receive the vaccine. A parent or guardian may choose to not vaccinate their child against HPV but only after reviewing informational materials about HPV and the vaccine. The District of Columbia also requires female students who are entering the sixth grade to receive the HPV vaccine. In Rhode Island, all students entering seventh grade must show they have received the HPV vaccine and in Hawaii new rules adopted earlier this year added HPV vaccine as a requirement for all students entering the seventh grade.

During the 2019 legislative year, several other states considered bills to require the HPV vaccine before school attendance. While none of these bills became law, they do show the various ways legislatures continue to deliberate the issue. Florida (HB 245 and SB 356) and Massachusetts (S 1264) introduced bills that would add HPV to the list of diseases students are required to be vaccinated against before attending school. A bill in Illinois (SB 1659) directed the state health agency to adopt rules requiring children entering sixth grade to receive the HPV vaccine and a bill in New Jersey (A 1847) required children enrolling in grades six through twelve to have the vaccine. In New York, companion bills (A 2912 and S 298) were introduced to require children entering the seventh grade to receive the HPV vaccine and in Connecticut there was a bill (HB 7199) setting the vaccine requirement for ninth grade.

In addition to school immunization requirements, states are also seeking to improve HPV vaccine coverage by expanding the pharmacist scope of practice to administer the vaccine. For example, earlier this year North Carolina added the HPV vaccine to the list of vaccinations a pharmacist may administer to anyone over the age of 18 (HB 388). In 2017, Hawaii enacted a law (SB 514) allowing trained pharmacists to prescribe and administer the vaccine to anyone between the ages of 11-17. Other examples of state efforts to improve HPV vaccine coverage, such as requiring health insurance to cover the vaccine, and informing families about HPV and the vaccine, can be found at NCSL’s HPV Vaccine: State Legislation and Statutes page.

The HPV vaccine is a safe and effective way of preventing HPV-related cancers later in life. Increasing HPV vaccine coverage rates and increasing access to the vaccine by informing the public and expanding the providers authorized to administer the vaccine often requires legislative and regulatory action. State and territorial health agencies are well positioned to utilize their expertise and partnerships to educate policymakers and pursue appropriate policies that will increase vaccine coverage. ASTHO will continue to monitor legislative activity and trends on this important public health issue.