Innovative strategies raising state's HPV vaccination rates

June 19, 2019
Kathleen Cartmell
Researcher Kathleen Cartmell, Ph.D., looks for ways to increase HPV vaccination rates and improve access to the vaccine. Photos by Emma Vought

Picture the average South Carolina public high school, which has about 600 students. That’s close to the number of people in the state who get a cancer related to the human papillomavirus (HPV) each year.

To Hollings Cancer Center researcher Kathleen Cartmell, Ph.D., who knows there’s a vaccine that can prevent those cancers, that’s not OK. 

The public health researcher spends a lot of time working with state partners and conducting research to optimize strategies in the state to get adolescents and young adults vaccinated against HPV-related cancers. The HPV vaccine is extremely safe and effective, and it can dramatically help lower the number of HPV-related cancers, she says. There is an urgency right now to let parents and pediatricians know about their critical role in protecting children with the vaccine at an age when children’s immune systems offer the best protection.

Spearheading those efforts led by Dr. Cartmell is the Hollings Cancer Center, which has launched a $700,000, three-year HPV initiative. Working in conjunction with numerous statewide partners including, the South Carolina Cancer Alliance and the American Cancer Society, the cancer center has prioritized this as one its top cancer prevention outreach projects.

Hollings Cancer Center Director Gustavo Leone, Ph.D., says this is low-hanging fruit in cancer prevention. “I didn’t want us to look back and realize we could have done something, that we could have worked harder. This isn’t rocket science. This is something that is reachable. We can save lives with this vaccine.”

In 2016, South Carolina had the lowest rate of HPV vaccine completion among adolescent girls in the United States (30.8%) and second-to-last for up-to-date vaccination among adolescent boys (27.4%), according to the 2017 National Immunization Survey Teen report from the Centers of Disease Control and Prevention, an annual survey that estimates vaccination coverage among adolescents aged 13 to 17 years.

The good news is that efforts already are paying off. South Carolina had the third largest increase in HPV up-to-date vaccination status from 2016 to 2017, making substantial gains to 59.6% for 1 dose and 42.7%, up-to-date vaccination.

Those are numbers Leone and Cartmell are thrilled to see.

Cartmell says the best cure for cancer always is prevention and many people fail to realize a cure in the form of prevention already exists for six HPV-related cancers, including cancers of the cervix and oropharynx (back of the throat, including the base of the tongue and tonsils). It’s an important message to get out in a state that ranks in the highest category in the nation as far as the prevalence of HPV.

When Cartmell speaks at community events to raise awareness, what she finds is most people, sometime even physicians, just aren’t aware of the need and availability of the vaccine. Two doses of the HPV vaccine are recommended for all boys and girls at ages 11 to 12. The vaccine can be given as early as age 9. Adolescents who start the vaccine series on or after their 15th birthday still need to get three doses instead of two, she says.

Kathleen Cartmell speaking to a group of nurses 
Dr. Cartmell speaks to school nurses at a recent educational event to raise awareness about the HPV vaccine.

Collaborative Effort

Cartmell and collaborators conducted an environmental scan study in 2016 to find out why the state ranked so low in its vaccination rate, particularly given that a neighboring state, Georgia, had one of the highest vaccination rates. Using these findings, Hollings Cancer Center set goals for its HPV Initiative that includes three parts.

  • Engaging health care organizations across the state in addressing HPV vaccination through educational efforts and awareness events.
  • Carrying out a social and digital media campaign to educate parents and adolescents about HPV vaccination.
  • Fostering a partnership with four health systems in the state, providing funding for customized, targeted work within their health systems to dramatically increase HPV vaccination through clinical and administrative strategies.

The health systems partnership, which had its kickoff last month, went over overwhelmingly well, Cartmell says. The four health system partners are PRISMA Health (formerly Greenville Health System), McLeod Regional, MUSC Health Department of Pediatrics and Spartanburg Regional. Each health system will receive $50,000 grants to develop and implement clinical strategies to improve HPV vaccination rates.

“It's really unprecedented because this is systemwide, so we're not talking about change in a few practices. We're talking about change in some of the largest health systems in the state,” she says.

Cartmell says this is a deep dive into providing education as well as support to change delivery methods, such as adding vaccination prompts to electronic health systems or improving administrative workflows in health systems to make it easier on patients and health care providers.

“By working with four large health systems in the state, there is an unprecedented opportunity to dramatically increase HPV vaccination rates in all of the health system-affiliated practices. Provider recommendation is the most influential factor in whether adolescents and young adults will get the HPV vaccine,” she says. “By working to make sure providers routinely offer HPV vaccination to adolescents and young adults, the yield of doing this work is likely to be substantial.”

HPV vaccination ad 
One of the goals of the HPV Vaccination NOW campaign is to increase awareness of HPV vaccination among parents and health care providers. Image provided

Parent Power

The other area seeing traction is a social media campaign targeted to parents. Cartmell is working with Beth L. Sundstrom, Ph.D., who is associate professor in Communications and Public Health at the College of Charleston and an affiliate member in the Cancer Control Program at Hollings Cancer Center, to use a social media digital campaign to raise awareness.

Sundstrom says the work by a dedicated group of stakeholders to make significant improvements in HPV vaccination rates is starting to pay off.

“Nationally, we had the third largest increase in HPV vaccine up-to-date status from 2016 to 2017,” she says. “I believe this is a transformative moment to build on our success and protect a generation of girls and boys from six HPV-related cancers. It is an exciting time to work toward eliminating HPV-related cancers in South Carolina.”

The statewide, social digital campaign,HPV Vaccination NOW: This is our Moment, is based on Sundstrom’s formative audience research and a successful pilot campaign initiated last year by the South Carolina Cancer Alliance. The goals of the campaign include increasing awareness of and positive attitudes toward HPV vaccination among parents and health care providers.

“We aim to increase provider recommendations and parents’ intention to start and complete the HPV vaccination series for their children,” she says. “We want to raise the voices and stories of parents in South Carolina.”

To do that, Sundstrom is starting an HPV Vaccination Influencers project as a way to connect with parents throughout the state. The goal of the project is to develop a collaborative learning and advocacy environment to increase HPV vaccination by training and supporting parents to serve as HPV vaccination proponents in order to overcome barriers to HPV vaccination.

Starting this fall, participants will join a private Facebook group, receive bi-weekly emails with facts about HPV vaccination and attend online webinars about HPV vaccination. “We still have places available for parents who are committed to increasing HPV vaccination and dedicated to starting conversations, online and in-person, about HPV vaccination in their social networks.”

One thing Sundstrom says she knows as a researcher who has talked with hundreds of women and parents in South Carolina is how compassionate and thoughtful they are. “They want to do what is best for their children and families.”

Most parents in South Carolina already choose the HPV vaccine for their children. Almost 60% of teens in the state receive the first dose. The goal is to reach 80% of young adults to protect the next generation of girls and boys from 6 HPV-related cancers. 

“Parents have the power to shape the future — they can prevent cancer by choosing HPV vaccination. That is why our campaign is focused on listening to parents and raising the voices and stories of parents in South Carolina,” she says. “Please join us in making South Carolina HPV cancer-free. We hope that everyone will follow our social media campaign on Facebook @HPVvaxSC and Twitter @HPVvaxSC and check out our new website.”

(For more information on being a parent ambassador, contact: