The University of the Incarnate Word School of Osteopathic Medicine (UIWSOM) is leading a vaccine outreach effort that could become a model for more aggressive strategies to prevent deadly and disfiguring diseases.
In August, UIWSOM students and faculty provided 544 vaccinations to 255 children during four back-to-school vaccination clinics on San Antonio’s South and West sides.
Safe and effective vaccines against human papilloma virus (HPV) that prevent cervical, anogenital, and head and neck cancers in women and men have been available and recommended for more than a decade. Yet acceptance nationwide is low: only 63% of teen girls and 50% of teen boys have started the vaccination series.
Community outreach in San Antonio is having much better results.
The vaccines provided by UIWSOM were available to patients of all ages, but especially targeted were 11-12 year olds for meningococcal (required for college entrance in Texas), tetanus-diphtheria-acellular pertussis (tetanus booster plus the newly recommended pertussis booster for whooping cough), and HPV vaccines.
Acceptance for all vaccines was high. For the historically “hard to sell” HPV vaccine, only six out of 161 patients (3.7%) declined the immunization. That refusal rate is markedly better than what is achieved in many public and private clinic settings where misinformation and mistrust lead up to 50% of parents to decline having their children properly vaccinated again HPV-caused cancers.
Poor HPV vaccination acceptance over the past decade seems to be related to the high cost of vaccines, the need for three doses, the difficulty of providing medical care to adolescents in general, and the somewhat novel concept that children should be vaccinated to prevent diseases that will not strike them until adulthood. Parental discomfort over HPV’s link to sexual activity and the mistaken belief that vaccination may encourage sexual activity is another factor in low vaccination rates.
Some of these issues have been addressed. The Centers for Disease Control (CDC)’s Vaccine for Children program provides free vaccines, which are a covered benefit of Medicaid and private health insurance policies under the Affordable Care Act. Instead of three, the CDC now recommends only two HPV vaccine doses 6-12 months apart. Nonetheless, misinformation and mistrust persist.
Why then, was the UIWSOM school-based community outreach so successful?
For one, it was a collaborative effort. UIWSOM, led by Dr. Anil Mangla, devised the school-based strategy and provided the bulk of the man and womanpower necessary to staff the clinics. The UIW School of Nursing, UIW School of Pharmacy, University Health Systems (UHS), UT Teen Health, and the Southside and Southwest Independent School Districts also contributed staff and resources.
Furthermore, UIWSOM students who checked in patients, obtained histories, provided vaccine education, and offered the occasional hug to teary-eyed children created an atmosphere of warmth and respect.
Finally, school district endorsement and support, as well as organizing events in neighborhood schools, increased accessibility, safety, and trust. UIWSOM leaders are hopeful that this model of collaborative, community-based, culturally sensitive outreach may provide part of the answer to effective preventive care.
Working toward something important with other caring people in an inter-professional and inter-institutional setting was “just a lot of fun,” said Dr. Adam Ratner, UIWSOM professor of radiology, health policy, and medical humanities.
