A Multi-Pronged Approach to Implementing Multi-Dose Vaccines


More than a decade has passed since the Centers for Disease Control and Prevention (CDC) first recommended immunization against human papillomavirus (HPV), and yet despite significant promotion and awareness efforts, completion of the multi-dose series lags compared with other CDC-recommended vaccines.

In many ways, the HPV immunization series has been successful in both in protection against disease and in uptake among teens. Research cited by the CDC has proven the HPV vaccine to be highly effective. Additionally, the CDC reported recently that the number of teens, the primary audience for the vaccine, beginning the series has increased. However, the same report revealed that less than half of teens complete the recommended immunization series to protect against HPV. Completion rates for other CDC-recommended vaccines for teens, by comparison, typically fall within the 80% to 90% range.

Teens are not the only patients with incomplete immunizations. In fact, the American Academy of Pediatrics (AAP) reports that more than one-quarter of preschool children are missing at least one of their routine vaccinations. Effective implementation of any multi-dose vaccine program requires strong communication from providers to ensure that patients begin and complete their immunizations. Clinicians have the opportunity to:

  • Inform patients that immunity requires all doses of the vaccine
  • Send reminder messages via multiple channels, including email, text and mail to patients
  • Schedule a follow-up visit for the additional vaccine doses after the initial dose

In a study published in Human Vaccines & Immunotherapies, 90% of parents of children with an incomplete HPV immunization series say they intended to complete the series. The parents cited a lack of reminder from their provider and logistical barriers as the primary reasons for non-compliance. On the other side of the scenario, half of the providers in the study expected parents to reschedule the appointments on their own. There is an opportunity for providers to be more proactive in communication with parents to help ensure that children receive the proper vaccination schedule.

Both patients and providers expect the other to be proactive regarding preventive care with vaccines. Yet, the AAP recommends that providers take the onus of getting patients back in the door to complete their immunization series. The association recommends using reminder and recall communication systems, which reconcile with medical records to inform patients they are due for a vaccination and prompt those who have missed doses to get up-to-date. Additionally, research published in the Journal of Adolescent Health found that reminder and recall systems were more than twice as effective at improving vaccination rates when compared to no reminder. 

Many providers currently leverage reminder and recall systems, though the methods have changed as technology advances. Traditional communication methods such as postcards and phone calls remain effective, according to the Journal of Adolescent Health study, and are touted by the AAP as valid means of reaching patients and keeping them on track with the CDC-recommended immunization schedule. Additionally, electronic forms of communication, such as texts and emails, have emerged as effective at helping patients complete their immunizations. As technology improves and federal regulations require technology in care management, both traditional and modern means of communication will likely be the winning combination to reach and engage patients. 

While research may indicate one method outperforms another, ultimately, the most effective approach will be providers offering a multi-channel strategy that is customized and responsive to each family and patient’s needs and preferences. The more proactive providers can be about communicating with patients about their recommended vaccinations, the more patients we can keep on track with their preventive health.