Supporting HPV Vaccination with Rural Communities
In this article, Casey L. Daniel, PhD, MPH, director of epidemiology and public health and associate professor of family medicine at the University of South Alabama, shares why improving HPV vaccination with rural communities is important.
Despite an estimated 1 in 5 Americans living in a rural area, rural dwellers in the United States experience numerous health disparities compared to their urban dwelling counterparts. This is due, in large part, to many gaps related to social determinants of health. Disparities between rural and urban areas continue to grow, which translates to rural children and adolescents being less likely to receive appropriate health care—including preventive care such as vaccinations.
Many rural areas lack local health care providers such as full-time practicing pediatric or family medicine clinicians. Additionally, high demand, budget constraints, and immense strain on the health care system, which have only increased in the era of COVID-19, have forced many state health departments to reduce their availability in rural areas where their help is most needed for services such as vaccination. In the economically straining times of COVID-19, we have also seen more small, rural practices forced to close due to financial and/or staffing issues, taking away other local options. If there is not a provider locally, parents must travel to a clinician for their child to receive the vaccine—sometimes over 100 miles to the nearest pediatric facility (in parts of rural Alabama, for example). This scenario comes with its own obstacles, such as transportation barriers, employment/working constraints, and lack of social support services. Thus, people with the fewest resources are often those with the most limited options. They also likely lack awareness of the importance of the HPV vaccine when they are told it is “optional” or not highly encouraged to seek it out to begin with.
“When increasing access to vaccination providers, thoughtfulness and creativity should abound. We are not limited to pediatricians and family physicians (though we treasure and appreciate them). To increase rural HPV vaccination, we must explore multiple options such as pharmacists (particularly community pharmacists who have established trust and relationships with community members), mobile vaccination units, vaccine clinics, sports physical clinics, and school-based vaccination programs.”
– Casey L. Daniel, PhD, MPH, University of South Alabama Mitchell Cancer Institute
Even for rural areas where provider access to HPV vaccination exists, access must fit the needs of the population. Given the consistently high rates of Medicaid-enrolled individuals in rural settings, children who receive vaccines through the national Vaccines for Children (VFC) program are required to be vaccinated only by a currently enrolled VFC provider. These children will be turned away from a provider who is not a VFC provider because of regulations involved with enrollment and reimbursement. The number of VFC providers ranges widely by state, from a few dozen to over 1,000. It can be a confusing program for both patients and providers to navigate. However, it could open the door to vaccinating tens of thousands more children and adolescents if these problems can be overcome.
Improving HPV vaccination in rural communities is important because the disparities we see can and must be mitigated. People living in rural areas must not be overlooked because of the challenges in providing them the same opportunities for health care and prevention as anyone else. Preventive services are arguably even more important for those in rural settings, as they are less likely to engage in timely screenings, which translates into higher morbidity and mortality from cancers that could have been prevented. Rural communities need just as much, and likely more, awareness and education about HPV cancers. And these messages must be targeted to the needs of the communities to increase their impact and effectiveness.
The disparities between urban and rural populations have persisted for far too long. We have a responsibility to go where the need is greatest. Ultimately, facing more barriers means that rural communities need and deserve more help to overcome them. It is our role to do just that.