Changes in HPV Vaccine Uptake after the COVID Vaccine

Historically, the human papillomavirus (HPV) vaccine has been the subject of vaccine hesitancy. In 2020, the introduction of the COVID-19 vaccine incited a new wave of vaccine hesitancy. We investigated whether introducing the COVID vaccine correlated with changes in HPV vaccine initiation compared with Tdap in a large New England health system.

Initial doses only of HPV, as well as first recorded doses of the Tdap vaccine, administered to individuals ages 9-18 between March 2019 and May 2023 were analyzed. Linear trends and per-day rates of each vaccine were assessed in 3 periods: before the pandemic (3/19-2/20), during the pandemic (3/20-5/21), and post-COVID vaccine (5/21-5/23), with a secondary analysis performed to account for seasonality. Daily vaccination rates were stratified by sex and population density (urban vs rural).

Records from 15,696 patients who received 10,502 HPV initiation vaccines and 10,282 Tdap vaccines were analyzed. No difference was noted in HPV initiation rates during the pandemic (7.05 vs 7.30, P = .203), though a significant decrease was noted post-vaccine compared with pre-pandemic (7.05 vs 6.63, P = .011). This post-vaccine decrease was driven primarily by the male (3.68 vs 3.43, P = .035) and urban (3.48 vs 2.73, P < .001) populations. Tdap rates were unchanged during the pandemic (6.60 vs 6.34, P = .148) but increased post-vaccine (6.60 vs 7.11, P = .003).

HPV initiation rates declined after the introduction of the COVID vaccine in a large health system in New England, driven mostly by a decline among males and the urban population.