Arkansas Health Official Offers Ideas for Improving Immunization Efforts

August 01, 2018|1:50 p.m.| ASTHO Staff

Nathaniel SmithEvery August, the National Public Health Information Coalition and CDC’s National Center for Immunization and Respiratory Diseases sponsor National Immunization Awareness Month to highlight the importance of vaccination in preventing diseases across the lifespan. To kick off this month’s observance, ASTHO spoke with Nathaniel Smith, director and state health officer of the Arkansas Department of Health, about his experience serving on several national advisory committees, how health officials can communicate about the benefits of vaccines, and opportunities for public health and healthcare partners to prioritize HPV vaccination as an effective cancer prevention measure.

Tell us about your involvement in national immunization groups. How have your experiences serving on these committees influenced your work as a state health official?

In June of this year, I completed a four-year term of service on the HHS National Vaccine Advisory Committee (NVAC). In addition, I currently serve as ASTHO liaison for the CDC Advisory Committee on Immunization Practices. Both opportunities have allowed me to help represent the voice of state public health in guiding national policy on immunizations. I have also had the chance to interact with leaders in this field and to dive deeper into some of the emerging issues affecting state immunization programs. These experiences have given me greater situational awareness and enabled me to more effectively support immunization efforts in Arkansas.

HPV vaccination coverage in the United States is currently 60 percent. What are three things health officials should consider in order to communicate effectively about the importance of HPV and other vaccinations?

Those of us in public health often take for granted that the public understands the benefits of immunizations. However, many of the messages available to the public question both the safety and efficacy of recommended childhood immunizations, such as the HPV vaccine. Health officials should continue to make the case that vaccinations are both safe and effective and that recommended childhood and adult immunizations are an important part of a healthy lifestyle. Second, health officials should appreciate the importance of healthcare providers in guiding patients toward recommended immunizations. Trusted healthcare providers can make a big difference in overcoming vaccine hesitancy and motivating parents to protect their children from vaccine-preventable diseases, including HPV-related cancers. Finally, improving HPV vaccine coverage will require effective partnerships and consistent messaging. Focusing on HPV vaccination as cancer prevention provides a more effective message for garnering public support than earlier messaging that emphasized HPV vaccination as prevention of a sexually transmitted infection. HPV vaccination messaging should also address the concerns of parents, who serve as the primary decisionmakers regarding childhood and adolescent vaccination.

What key strategies do you think health agencies could employ to help improve HPV vaccination coverage nationally?

One of my responsibilities on NVAC was to co-chair a working group on HPV vaccine implementation. The recommendations from that working group have been accepted for publication in Public Health Reports and address a number of issues that health agencies should consider. The NVAC report recommends ways to improve HPV vaccination coverage rates by focusing on four areas of activity: (1) identifying additional national partners, (2) guiding coalition-building for states, (3) engaging integrated healthcare delivery networks, and (4) addressing provider needs in rural areas. In 2014, the American Cancer Society and CDC established the National HPV Vaccination Roundtable, a national coalition of public, private, and volunteer organizations and individuals dedicated to reducing HPV cancers in the United States through coordinated leadership and strategic planning. Health agencies should use existing, publicly available resources for coalition building and partner coordination, including the State Coalitions and Roundtables Guide, and should encourage continued collaboration and active engagement between immunization and cancer advocacy groups to increase the availability of resources for HPV immunization.

What can public health and healthcare partners do to complement these efforts?

Public health should engage with healthcare systems to prioritize HPV vaccination as an effective means for cancer prevention and develop accountability mechanisms to track and incentivize performance, such as reporting requirements to the Healthcare Effectiveness Data and Information Set (HEDIS) and other quality reporting programs. Improved utilization of immunization information systems by public health and healthcare providers offers a significant but underutilized opportunity to improve HPV vaccination uptake. HPV vaccine uptake is lower in rural areas than in urban centers, so additional efforts to support vaccine providers in rural areas is needed. These efforts include overcoming barriers to accessing vaccination services, provider education on HPV vaccination, and more effective communication strategies, including the use of social media, to directly engage parents and adolescents in rural areas.

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