New Zealand school children missing out on human papillomavirus vaccine

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New Zealand school children missing out on human papillomavirus vaccine

2 March 2022

By Cathy Stephenson and Robyn Kooperberg

Wednesday 2 March 2022, 12:35 AM

5 minutes to Read

Nurses from Panmure Medical Centre have been active in recalling patients for vaccinations. From left, Vibha Mistry, Robyn Kooperberg and Sara Newbury [Image: Supplied]

Human papillomavirus vaccinations have dropped as the COVID-19 pandemic has disrupted the school-based immunisation programme. Here are some ways you can help ensure children and young people don’t miss out

Key points

Over the last two years, more than 30,000 young New Zealanders have missed out on the human papillomavirus vaccine due to COVID-related disruptions in the school-based immunisation programme.
Primary care practices can be part of the solution by implementing proactive processes for recalling and vaccinating those who have missed out.
All vaccines on the National Immunisation Schedule (except shingles vaccine) can now be given at the same time, or immediately before or after, the COVID-19 vaccine.

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There is no debating the fact that the human papillomavirus (HPV) vaccine reduces the risk of developing certain cancers later in life, particularly cervical cancer.^1–5

So, having a significant proportion of our children missing out on this health prevention opportunity, due to the disruption brought by COVID-19, is of great concern.

In August 2021, members of Pharmac’s Immunisation Subcommittee of the Pharmacology and Therapeutics Advisory Committee considered that the failure of the HPV school-based immunisation programme may contravene the United Nations Convention on the Rights of the Child.⁶

The vaccine is usually offered to students in year eight, with the first dose at the start of the year and the second at least six months later.^1,7The vaccination protects against specific HPV-related diseases associated with nine HPV types.^1,4This includes certain types of cancer, such as cervical and anal cancer, as well as genital warts.^1,4,8–10

In 2021, 53,000 fewer vaccines were delivered than in 2019, and the total reduction in doses over two years has been approximately 78,000 – that’s more than 30,000 young New Zealanders who have missed out (Seqirus, data on file, 2021).

Cathy Stephenson, a GP at Mauri Ora Student Health and Counselling, Victoria University of Wellington, says, “COVID-19 has wrought havoc on the HPV vaccination programme, as it has on many other aspects of healthcare delivery.

“The good news is that any children and young people who have missed out on their free immunisations at school can still be vaccinated in general practice, as Gardasil is fully funded up to age 26 for both males and females.

“The issue will be enabling general practices, which are currently stretched to capacity managing COVID-19 in the community, on top of their business as usual, to prioritise identifying, recalling and then vaccinating those who have missed out.”

Possible solutions

Ideally, local health authorities should be informing primary health organisations which children missed out on a vaccine at school so GPs and healthcare providers can reach out to them. Regions that have managed to put this into practice are already seeing very positive results and can provide an exemplar for others to follow, so they too can start recalling these patients.

Other practices have initiated their own proactive processes in recalling those young people who have missed out (see case study).

Dr Stephenson is hopeful that despite the current stressors on the health system, practices can be part of the solution. “We can now co-administer the COVID-19 vaccine alongside other vaccines, so hopefully practices can check in on HPV immunisation status when seeing children and young people for their COVID-19 vaccination and take the opportunity to offer Gardasil simultaneously to those who have missed out.

“It is crucial that public uptake of HPV and other vaccination programmes remains high during the ongoing COVID-19 pandemic, to protect New Zealand’s long-term health outcomes and burden of disease,” she adds.

Initiated by Seqirus (NZ) Ltd, the Gardasil 9 catch-up programme objective is to identify and work with practices that have capacity to recall their share of the children now in year nine and 10 who missed out on the school-based programme in 2020 and 2021. It also aims to help identify any unvaccinated young adults about to turn 27, who will then no longer be eligible for free vaccine.

Healthcare professionals, Family Planning and sexual health clinics are also encouraged to recommend HPV vaccination to their patients by providing educational materials about the importance of the vaccine and its benefits to the health of New Zealanders.

Case study

The Panmure Medical Centre has been, and continues to be, very proactive with recalling HPV vaccine patients. Here’s how they do it.

When HPV vaccine funding was extended to include males in 2017, they had a list of about 740 people, both male and female, who were in the 15–26 age range and eligible for the vaccine. All eligible patients were texted or contacted by mail to encourage them to make an appointment for a vaccination. They now have approximately 240 people who remain unvaccinated in that age group.

Alongside this, the practice opportunistically advises any person under age 27 that they are eligible for the vaccination when they come in for an appointment.

Additionally, each month, the list from their patient management system is printed off, and clinic staff manually check everyone from that list has been contacted at least three times.

The clinic administered many overdue vaccinations during COVID-19 lockdown periods. During the last lockdown, a student nurse was engaged to phone all overdue patients and make appointments for the vaccine. Most appointments were kept.

Further, the clinic proactively seeks to educate its patients and has an information board on the HPV vaccine and sexually transmitted infections, which rotates through the four waiting rooms, where there is a captive audience of patients.

The clinic actively targets 25 and 26-year-olds at the beginning of each year to remind them of the vaccine.

Every opportunity to have a conversation about the vaccine is taken, and it has been noted that if a patient has had an STI, they seem to be more receptive to the benefits.

This proactive approach can easily be woven into patient consultations if the clinic does not have the resources to do an outreach campaign.

This article was written with assistance from Seqirus (NZ) Ltd. Further information is available from Jill Desborough, associate director commercial, Seqirus (NZ) Ltd

Cathy Stephenson is a GP at Mauri Ora Student Health and Counselling, Victoria University of Wellington; Robyn Kooperberg is a registered nurse at Panmure Medical Centre

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References

1. Medsafe. New Zealand Data Sheet: Gardasil 9. March 2020. www.medsafe.govt.nz/profs/Datasheet/g/gardasil9inj.pdf

2. Patel C, Brotherton JM, Pillsbury A, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Euro Surveill 2018;23(41):1700737.

3. Canepa P, Orsi A, Martini M, et al. HPV related diseases in males: a heavy vaccine-preventable burden. J Prev Med Hyg 2013;54(2):61–70.

4. Huh WK, Joura EA, Giuliano AR, et al. Final efficacy, immunogenicity, and safety analyses of a nine-valent human papillomavirus vaccine in women aged 16-26 years: a randomised, double-blind trial. Lancet 2017;390(10108):2143–59.

5. Giuliano AR, Joura EA, Garland SM, et al. Nine-valent HPV vaccine efficacy against related diseases and definitive therapy: comparison with historic placebo population. Gynecol Oncol 2019;154(1):110–17.

6. Pharmac. Record of the Immunisation Subcommittee of PTAC Meeting held on 10 August 2021. https://pharmac.govt.nz/about/expert-advice/specialist-advisory-committees/

7. Ministry of Health. HPV immunisation programme. https://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/hpv-immunisation-programme.

8. Forman D, de Martel C, Lacey CJ, et al. Global burden of human papillomavirus and related diseases. Vaccine 2012;30 Suppl 5:F12–23.

9. Garland SM, Steben M, Sings HL, et al. Natural history of genital warts: analysis of the placebo arm of 2 randomized phase III trials of a quadrivalent human papillomavirus (types 6, 11, 16, and 18) vaccine. J Infect Dis 2009;199(6):805–14.

10. Greer CE, Wheeler CM, Ladner MB, et al. Human papillomavirus (HPV) type distribution and serological response to HPV type 6 virus-like particles in patients with genital warts. J Clin Microbiol 1995;33(8):2058–63.

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