Immunisation program managers' experiences of implementing the change from a two dose to a single dose course of HPV...

In Australia, human papillomavirus (HPV) vaccination is routinely offered at age 12-13 years through school-based programs managed by eight states and territories. Coverage has declined since the onset of the COVID-19 pandemic, with widening equity gaps. In February 2023, Australia moved from a two-dose to a single-dose HPV course. While the move was expected to increase coverage, single-dose coverage declined in the school cohort offered vaccination in 2023. We aimed to document the experience of implementing single-dose HPV vaccination and understand the current challenges in school-based immunisation programs.

In September 2024, we interviewed 11 state and territory senior immunisation staff online about their experiences implementing single-dose HPV vaccination and about current challenges in their programs. We identified categories and themes using thematic analysis.

Factors that facilitated the shift to a single dose included clear and consistent communication once the change was announced, acceptance of the change by parents and providers and the increased flexibility in timing for school visits that a single-dose course provides. The main challenge related to the short timeline and a delayed ability to communicate the upcoming change due to government confidentiality requirements. This resulted in frustration, a need to retrospectively adapt consent forms and vaccine oversupply. Current challenges in the school-based immunisation programs include declining school attendance, staffing, competing priorities in schools, evolving consent processes in the digital era and increasing challenges in engaging parents and students in immunisation.

While implementing the change was straightforward, the shift to a single-dose occurred in a setting of increasing challenges to routinely providing immunisation in schools. Simplifying the HPV vaccination schedule may have inadvertently reduced in-school opportunities for vaccination by only requiring one annual visit. School-based vaccination programs should consider additional strategies to support catch-up vaccination and publicise options for vaccination outside of the school program.