States of health: Pharmacist vaccination laws and reaching CDC goals on HPV
Recent years have seen efforts to vaccinate young people against some of the most common types of human papillomavirus (HPV), a sexually transmitted infection linked to several types of cancer. To combat the spread of HPV, the Centers for Disease Control and Prevention (CDC) recommends that the two or three-dose vaccine series be given to males and females around age 11 or 12. One possible way to improve vaccination rates is through laws granting pharmacists the authority to administer vaccines. However, there has been little research looking at how such laws affect HPV vaccination rates specifically.
To help fill this gap, Cason Schmit, PhD, a research assistant professor at the Texas A&M School of Public Health, looked at the different types of vaccination regulations in the United States as they relate to HPV vaccines. In this study published in Public Health Reports, Schmit used data from the CDC Public Health Law Program database, which he helped create, to categorize vaccination laws in effect on or before January 1, 2016, in the 50 states and District of Columbia to build a more robust understanding of how laws might affect HPV vaccination rates.
To be most effective, HPV vaccines should be administered before patients become sexually active, as there is evidence showing that exposure to the virus makes the HPV vaccine less effective. This is why it is important to vaccinate young adolescents and a reason behind the United States Department of Health and Human Services’ Healthy People 2020 goal of an 80 percent HPV vaccination rate for youth between the ages of 13 and 15.
“Vaccination rates vary around the country, but no state currently has achieved the Healthy People 2020 goal,” Schmit said. “As of 2014, HPV vaccination coverage reached only as high as 56.9 percent for females and 42.9 percent for males, while rates were as low as 20.1 percent for females and 9 percent for males in some states.”
Allowing pharmacists to administer vaccines would improve access in states by greatly expanding the number of providers and giving busy patients and parents more convenient evening and weekend hours to get vaccines. Additionally, pharmacists could improve public awareness of the vaccine and its importance. However, efforts to expand pharmacist authority to vaccinate have sometimes been met with resistance. Concerns about disrupting regular care, inadequate training and a lack of communication with primary care providers are a few causes of concern, and there is political opposition from family and religious groups to the HPV vaccine itself.
Schmit and his team identified laws related to pharmacist administration of the HPV vaccine and categorized them as those giving pharmacists authority to vaccinate on their own, those requiring a standing order not specific to a patient and those that require a prescription from a physician.
“We found 22 states that allowed pharmacists to give HPV vaccines to patients between the ages of 11 and 12 like the CDC recommends, but nine of those states require a patient-specific prescription,” Schmit said. “If the goal is to improve convenience and access to HPV vaccination, then states that require a patient to first obtain a prescription from another provider before visiting their pharmacist would seem to miss the mark.”
“Only Idaho and California have laws that allow pharmacists to follow CDC recommendations for HPV vaccinations without a prescription or standing order,” Schmit added.
This study serves as a starting point for the use of publicly available legal databases and transparent methods to further understand the role that legal regulations affecting pharmacist vaccination authority play in health.
“State laws that do not allow pharmacists to dispense HPV vaccines at all or not in the recommended age range serve as a potential barrier to reaching the Healthy People 2020 80 percent vaccination rate goal,” Schmit said. “Strengthening the role that pharmacists play in administering the HPV vaccine could improve vaccination rates, leading to better health.”