Clemson University’s HPV Vaccination Approach Becomes Part of National EXCITE Curriculum

By Kathleen Cartmell, MPH, PhD

As a researcher, I started my career working on a study with head and neck cancer patients. Many of the patients had human papillomavirus (HPV) cancers. My job was to interview these patients, and a recurring theme I heard was how devastating HPV cancers were to them, often affecting their appearance, as well as their ability to swallow, eat, and speak.

I was so thankful in 2006 when the HPV vaccine was approved to prevent six HPV cancers, including head and neck cancer. I had seen first-hand how much this vaccine could help prevent these cancers. The HPV vaccine protects against 90% of HPV cancers, has an excellent safety profile, and provides long-lasting prevention.

As part of a grant from the Extension Collaborative on Immunization Teaching and Engagement (EXCITE), a nationwide initiative led by U.S. Cooperative Extension in partnership with the United States Department of Agriculture – National Institute of Food and Agriculture (USDA-NIFA) and CDC to boost adult vaccination confidence and access, particularly in rural and underserved communities, I worked with our team at Clemson University to carry out a project to provide education about vaccines and help people in the community find resources for getting vaccinated. Through this work, I discovered only 54% of SC adolescents were up-to-date on HPV vaccination, compared to 63% in the U.S. So, we started thinking – maybe there is an opportunity to provide education about HPV vaccination and navigate our students to opportunities for HPV vaccination on campus. This could help to protect our own students from getting HPV cancers.

Several barriers contribute to low HPV vaccination rates in South Carolina, including lack of knowledge about vaccine requirements; limited number of primary care visits among adolescents; vaccine hesitancy for routine childhood vaccination; lack of providers who administer vaccines (especially in rural communities); barriers related to work, travel and poverty; and, perceptions that an adolescent is not at risk for HPV, which is a sexually transmitted disease. One additional barrier has been a lack of vaccination campaigns.

College provides a great opportunity for students to get vaccinated against HPV cancers if they did not get vaccinated when younger. Most college students have pharmacy benefits that will cover HPV vaccination. Additionally, risk for exposure to HPV increases during college and college students have more autonomy to choose to protect themselves from HPV cancers. Most student health centers also have electronic health records, which provide an easy way to provide vaccine reminders to students. 

We reached out to our student health center director to see if there might be opportunities to increase awareness about HPV vaccination and navigate interested students to get vaccinated. The health center loved the idea, so we brainstormed with the student health team, including their student health communications director, pharmacy manager, health services manager, along with the university’s communications office that does digital media promotions on campus. 

We developed a simple protocol to routinely recommend vaccination and navigate students to get vaccinated. As a first step, we trained the student health service health care providers about HPV cancers and HPV vaccination. The presentation also included information about the safety, effectiveness and long-lasting protection of the vaccine, and why it is important for college students to get vaccinated. We also shared the HPV vaccination project protocol with the clinical team and provided lots of time for questions answered about the vaccination campaign. Response to the campaign was incredibly positive.

We also worked with the student health communications director to develop exam room signs and flyers that we could use in the student health center and digital ads and social media that we could share across campus. Exam signage was posted in all our student health exam rooms and throughout student health. We worked with the communications team to also disseminate messages across campus to provide students with information about HPV vaccination and direct them to student health for vaccination if interested. Once these educational and communication logistics were in place, we got started with 2024-2025 HPV vaccination campaign.

When students came to student health services for any visit, HPV vaccination was recommended for those who were not vaccinated against HPV. Students who wanted to get vaccinated were navigated to the student pharmacy down the hall for vaccination. Students were also given a flyer with a QR code to sign up for vaccination later if they did not have time during that visit to get the vaccine.

Vaccination is a covered pharmacy benefit for about 90% of students, which was helpful for our campaign. Once students signed up for HPV vaccination appointments, they would automatically get reminders from the electronic health record. This also helped to make the campaign easy to implement.

In addition to offering the vaccine in student health, digital messaging was disseminated across campus in high traffic areas such as football and basketball stadium kiosks, library bridge and most educational buildings across campus. Additionally, a brief article was placed in the student newsletter that gets emailed to all students, and digital media ads were disseminated. 

We also focused our campaign messaging to connect with HPV Vaccine Awareness Day and Cervical Cancer Awareness Month in January and HPV Cancer Awareness Day in March.

To summarize, our campaign included the following strategies:

• Health care provider training
• Strong provider recommendation, with option for point of care vaccination, or to schedule in EHR
• Visual cues (exam signs, flyers) in student health office to encourage vaccination
• Used EHR to schedule subsequent vaccine doses and send vax reminders
• Digital and social media disseminated across campus
• Multidisciplinary team (leadership, clinicians, pharmacists, process improvement, media experts, vaccine researcher)

The campaign was successful, and it was also relatively easy to implement. Campaign messages received over two million views across campus, all students received information about HPV vaccination in their student newsletter, and a 273% increase in HPV vaccine administration was achieved during the 2024-25 campaign, compared to the previous academic year. The student health team also continues to recommend HPV vaccination as part of standard clinical operations. 

This project curriculum was recently added to the national EXCITE Immunization Education Curriculum. EXCITE’s goals are to help rural and other key audiences make informed decisions around vaccinations, strengthen connections between communities and healthcare systems, and support local community partners in implementing programs that increase health outcomes. Explore the curriculum for details on the project protocol and implementation.

About the author

Kathleen Cartmell, MPH, PhD is a health services researcher and Associate Research Professor in the Department of Public Health Sciences at Clemson University. She earned an MPH from Emory University’s Rollins School of Public Health and a PhD from the Medical University’s Health and Rehabilitation Sciences Program. Most of Cartmell’s work focuses on finding ways to broadly disseminate evidence-based approaches for improving health, and her projects have focused on HPV vaccination, vaccine confidence, tobacco cessation and home-based palliative care. In carrying out her work, Cartmell works closely with stakeholders to determine the simple and streamlined strategies for integrating evidence-based programs into routine clinical care and community programs.