Accelerating Our Impact: Introducing Revised Priority Actions to Improve Rural HPV Vaccination Coverage

People living in rural areas have higher rates of HPV cancers and lower rates of HPV vaccination compared to people living in urban areas. There is a critical opportunity for impact in making sure those living in rural communities across the United States (U.S.) are protected from HPV cancers. One size will not fit all, and approaches to addressing this disparity will require flexibility to accommodate the diversity of people living in rural communities. Opportunities for action exist, such as improving health care provider recommendations and addressing vaccine hesitancy. Thus, rural U.S. populations are a priority population for the St. Jude HPV Cancer Prevention Program.

Beginning in January 2023, the St. Jude HPV Cancer Prevention Program initiated strategic planning focused on preventing HPV cancers with rural communities in the U.S., with the goal of addressing differences in outcomes in rural HPV vaccination coverage while accounting for and embracing differences within and across these populations. To identify priority actions, a Rural HPV Cancer Prevention Think Tank was established to bring together diverse expertise and lived experience to identify priority actions and guide a unified strategy to prevent HPV cancers with rural communities. The think tank was established and, from March to August 2023, met to inform actions to improve HPV vaccination rates in rural U.S. communities. These priority actions were released in fall 2023 and widely promoted thereafter to guide efforts to increase HPV vaccination coverage with rural communities.

Nearly two years later, a lot has changed in the rural health landscape, yet HPV cancer prevention opportunities remain. Beginning in April through October 2025, the St. Jude HPV Cancer Prevention Program assessed the progress of each original priority action and engaged a group of national rural HPV cancer subject matter experts to revisit the original priority actions. After thoughtful consideration of progress, new opportunities, and the current conditions, we are pleased to share the revised priority actions to improve HPV vaccination coverage with rural communities. 

Implement Best Practices: Use best practices and evidence-based interventions to increase HPV vaccination
Promote and integrate best practices and evidence-based interventions (e.g., starting at age 9, health care provider training, rural-focused communication) to increase HPV vaccination with rural communities and share existing resources from partners to maximize impact.

Build Capacity: Strengthen health care providers’ and professionals’ training and support systems change
Provide focused training, support, and workflow improvements for rural health professionals to address unique rural challenges to enhance HPV vaccination delivery and increase HPV vaccination. Train and empower trusted messengers in rural communities to prioritize HPV vaccination for cancer prevention.

Preserve and Expand Data Resources: Leverage existing data and bolster data assets to guide informed actions
Protect, strengthen, and expand rural-specific HPV data systems to inform action, support advocacy, and empower communities with accessible, actionable data. Support immunization information systems and data analysis to inform policy and programming and increase public access to understandable data.

Foster Partnerships for Progress: Build alliances and cultivate collaborations for collective impact
Build and strengthen cross-sector collaborations—engaging non-traditional vaccinators and local organizations like schools, faith groups, and farmworker coalitions – to support HPV vaccination. Amplify successful rural efforts, support community-led programming, and provide tools and training for sustainable, community-driven solutions.

Monitor Context: Scan the rural health landscape for new challenges and opportunities
Track changes in the rural health landscape, including policies, funding, and misinformation. Translate these changes into actionable insights for rural partners, leveraging communication channels and strategic dissemination to ensure communities and those serving them are informed and empowered.

We believe these revised priority actions will catalyze efforts and optimize impact because our delays mean fewer people protected against HPV cancers in rural communities. These revised priorities offer insight into the most impactful actions to increase HPV vaccination coverage and decrease the burden of HPV cancers among people living in rural areas of the U.S. They recognize that individuals act based on their environment, resources, history, and motivation—as well as what they know, think, and feel. Systems-level changes aim to make HPV vaccination the default action; while addressing challenges related to access and emphasizing the vital role of providers, whose strong recommendations remain the single greatest predictor of vaccination.

The St. Jude HPV Cancer Prevention Program is committed to working with those who share our goal of preventing HPV cancers with rural communities to directly and indirectly implement activities aligned with each of these five revised priority actions. We know our work together affords greater potential for reach and impact with more people protected against HPV cancers in rural communities. 

About the Authors

The St. Jude HPV Cancer Prevention Program collaborated with subject matter experts to revisit the original priority actions for improving rural HPV vaccination and revise the priority actions to accelerate impact. Special thanks to contributing subject matter experts Trisha Amboree, PhD, Natoshia Askelson, PhD, Gabriel Benavidez, PhD, Deanna Kepka, PhD, Ashley Lach, Jason Semprini, PhD, Christina Turpin, and Whitney Zahnd, PhD in addition to St. Jude team members Heather Brandt, PhD, Julia Brown, and Nicole Williams. 

Learn more about preventing HPV cancers with rural communities