Local Health Department Perspectives on HPV Vaccine Implementation

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Local Health Department Perspectives on HPV
Vaccine Implementation

• Poki Stewart Namkung, MD, MPH
• President
• National Association of County
• City Health Officials (NACCHO)
• Health Officer
• Santa Cruz County Health Services Agency
• NVAC Meeting
• Washington, DC
• 26 September 2006

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NACCHO Overview

• National voice of local public health
• Nonprofit membership organization serving the
  3000 city/county/district/tribal public health
  agencies
• Formed in 1994
• Focus on providing education, research,
  information, and technical assistance to our
  members

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NACCHO HPV Activities

• Hosted 2 partner meetings this year
• Developed Web page dedicated to these vaccines
  and the diseases they can help prevent
• A special issue of NACCHO Exchange dedicated to
  HPV vaccines, cervical cancer, and associated
  issues
• Working with C-CHANGE
• Working with Partnership to End Cervical Cancer
• Surveyed a sample of our membership re key
  issues/concerns around implementing HPV vaccines

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NACCHO Activities HPV Partners Meeting 1

• March 16 communications
• Representatives vaccine manufacturers, academia,
  provider groups, professional organizations,
  faith-based organizations, and governmental
  public health
• Goal
• Collaborate to examine steps that can be taken as
  individual organizations and collectively to
  promote consistent messages to the general
  public, providers, parents, and others to
  increase awareness of the vaccines, cervical
  cancer, and the various associated issues
• Outcomes
• Communications checklist, reference notes
• Helped make all our partners aware of the
  spectrum of issues, across areas of practice, to
  share with their constituents
• Active participation and follow-up

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NACCHO Activities HPV Partners Meeting 2

• September 14 - implementation
• Follow-up meeting with a wider array of partners
  focusing on HPV and the implementation of the
  vaccines. 
• Goals
• Costs/financing
• School mandates
• share information, updates, and strategies on
  collaborative activities among stakeholders to
  address many of the opportunities and challenges
  discussed at the March 2006 meeting.
• Outcomes
• Clearly articulated and identified barriers
• Brainstormed strategies to address barriers

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Key LHD Issues

• Costs how do providers cover this expensive
  vaccine, given the limitations of VFC and 317
  funding?
• Costs how do we vaccinate those girls and women
  who fall outside of public assistance coverage?
• Costs how does HPV vaccine fit into the
  spectrum of adolescent-focused recommended
  vaccines?

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Barriers/Issues

• Expense of the vaccines
• Building a real adolescent health platform that
  includes these important vaccinations to assure
  universal access
• LHDs Cost of personnel (and lack of personnel in
  some cases) to implement and operationalize new
  immunization recommendations
• LHD roles
• Assess the need in the community
• Distribute the vaccines
• Prioritization decisions and processes
• Educate providers all aspects of vaccine usage,
  storage, and handling
• Work with schools and other settings where
  adolescents are vaccinated
• Provide accountability by auditing our local
  providers
• Collecting all those data and reporting them up
  to our state and federal counterparts

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Key LHD Issues

• School mandates state by state
• What is the spectrum of opinions on mandating HPV
  for school entry?
• How do we stay off the slippery slope of
  choice?
• How do LHDs and others effectively address
  parental hesitancy within the issue of mandates?
• What is the reaction from school officials?

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Barriers/Issues

• Fluidity and difficulty of reaching higher-risk
  adolescents and dealing with the groups opposed
  to immunization mandates of any sort
• Hepatitis B vaccine as a model for implementing
  HPV vaccine
• We always want to keep some of missteps and
  failures in mind so that we learn from them
• Do we want to spend 20 years to get it right this
  time?

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Action Items

• Actively continue to work and dialogue with our
  partners
• Develop, identify, disseminate, and warehouse
  tools and resource that our members can easily
  access and use, Be an active resource and partner
  in pilot demonstrations
• Advocate for public patient assistance programs
  that include vaccines
• Provide advocacy tools for our members to work
  more effectively with their city/county councils
  and/or state legislatures regarding funding for
  delivery of immunization services

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Thank YouNACCHOwww.naccho.org(202) 783-5550