Question

On Cervical cancer policy issue in US , give recommenations and limitations of the policy on Cervical cancer prevention by using HPV VACCINE

and lay out argument why the policy is better than each of the others

Answer 1

The worldwide incidence of cervical cancer cases is approximately more than half a million women. Researchers supported by the National Cancer Institute (NCI) identified that the human papillomavirus (HPV) is the major cause of cervical cancer.

In the early 1990s, two large epidemiological studies were conducted: one by NCI intramural researcher Mark Schiffman, M.D., and another by a group at the NCI-designated Albert Einstein Cancer Center using a new DNA technology, these studies showed that a select group of HPV types is responsible for premalignant abnormalities found in Pap smear screening and for the development of most cervical cancers. Later many studies proved that nearly all cervical cancers are caused by HPV.

The assumed costs of management of cervical cancer are not acceptable when HPV vaccination is cost-effective in the United States compared with cervical cancer screening by Pap test.

HPV vaccine policy issues and implementation in the United States

There are two approved vaccines and routine HPV vaccination is recommended for females aged 11 to 12 years and can be started as early as age 9 or 10 with catch-up vaccination for females aged 13 to 26 years in the US. The initial HPV vaccine approved by the US Food and Drug Administration (FDA) in 2006, and the latest monovalent vaccine was approved in 2015. The HPV vaccine is added to the immunization schedule for adolescent girls aged 11–12 years in 2006 by the Advisory Committee on Immunization Practices (ACIP) and the recommendation was extended to males in 2010. The uptake and completion of the HPV vaccine’s three-vaccination series have very much lagged behind anticipated rates, the increased immunization coverage remains a public health priority and Healthy People 2020 goal.

In the U.S the vast majority of states introduced legislation in the year following initial FDA approval of the HPV vaccine except for six states. Two opportunities have been made available – 1) the Vaccine for Children program, which provides the vaccine series at no cost to certain families, and 2) the Affordable Care Act (ACA) from a federal funding standpoint.

The states must develop and enact evidence-based vaccination policy. The current trend in declining interest in HPV vaccination will hinder the goal of Healthy people 2020.

These newly approved vaccines represent a major advance in our armamentarium for the reduction of cervical cancer. The extension of the HPV vaccination schedule to men should serve to further interrupt the chain of HPV transmission to girls and women. The recommended vaccine schedule is made difficult by the non-adherence of adolescents and rare physician visits.

To improve the vaccination rate there are many recommended strategies:

Gynaecologists: The care relationships developed by the gynaecologist with the mother of an adolescent girl give unique access and professional standing to deliver education regarding cervical cancer prevention through HPV vaccination. Education can be passive or active like brochures, videos, or kiosks in the office setting or active education within the gynecologic visit itself.

The teachable moment: It refers to a naturally occurring life or health events that can be utilized to motivate one to adopt risk-reducing health behaviours spontaneously. They include office visits related to reproductive health and pediatric good care, notification of abnormal test results. HPV vaccination importance can be conveyed to the people through teachable moments.

Maternal adherence: The women who adhere to recommended cancer-screening behaviours for themselves are more likely to adhere to health recommendations for their children. Thus targeting women can improve the HPV adherence.

Cost concerns: The unaffordability of the health care is the potential reason for declining vaccination. By increasing the coverage under the federal Medicaid program and State Children’s Health Insurance Programs can improve vaccination rates.

The health system issues like System Financing, State Level Coordination and the Socio-Organizational Cultural Elements must be addressed effectively to improve vaccine acceptance and vaccination rates.