HPV Vaccination Strategies: Comparing Jurisdictions with and without School-Entry Requirements

Introduction: HPV is the most common sexually transmitted infection in the United States (U.S.) and the leading cause of cervical and other HPV-related cancers. Despite an FDA-approved HPV vaccine available for over two decades, vaccination rates remain suboptimal, varying by state and ethnicity. While some jurisdictions require HPV vaccination for school entry, most rely on non-mandatory approaches. This study explored how policy contexts, specifically the presence or absence of school-entry requirements, shape strategies, barriers, and facilitators to HPV vaccination. Methods: We conducted semi-structured interviews with nine key informants (KIs) from six U.S. jurisdictions between May and August 2024. KIs had at least three years of experience in health or vaccination policy and knowledge of HPV vaccination strategies. Seven participants represented jurisdictions with HPV school-entry requirements, and two represented jurisdictions without. Interviews were audio-recorded, transcribed, and coded using a mixed deductive-inductive approach. Verbal data were compared by theme in Dedoose. Results: KIs from jurisdictions with school-entry requirements emphasized provider recommendation and reframing HPV vaccination as cancer prevention as effective strategies. Those without school-entry requirements highlighted starting vaccination at age nine and using educational materials. Participants from jurisdictions with school-entry requirements reported that the policy increased vaccination rates, improved access, and convinced hesitant parents. KIs from jurisdictions without this policy described resistance that has prevented its adoption, noting that opposition was often aimed at requirements themselves rather than the vaccine, reflecting opposition to government involvement in health decisions. In both policy contexts, misinformation fueled by social media was a major barrier. KIs described the COVID-19 pandemic as a setback that contributed to ongoing vaccine fatigue and skepticism. They noted general exhaustion with vaccine discussions, while some observed that the pandemic polarized attitudes. All KIs emphasized community engagement through trusted messengers and culturally appropriate outreach in building vaccine confidence. Conclusions: Policy context shapes HPV vaccination framing, delivery, and accessibility. Jurisdictions with school-entry requirements reported better uptake, attitudes, and access, while those without requirements relied on non-mandatory approaches to navigate cultural and political sensitivities. Comparative insights can guide context-specific implementation approaches to enhance HPV vaccination and reduce cancer outcomes. Funding: NCI grant #R01CA232743. Declaration of Generative AI: The authors used AI for editing suggestions. Citation Format: Erika Escabí-Wojna, Natalie M. Alamo, Mariola Acosta-Rullán, Grace Vélez-Crespo, Pamela C. Hull, Maria E. Fernandez, Vivian Colón López. Comparing perspectives on HPV vaccination strategies across jurisdictions with and without school-entry requirements: A qualitative study of key informants in the U.S. and territories [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2026; Part 1 (Regular Abstracts); 2026 Apr 17-22; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2026;86(7 Suppl):Abstract nr 3691.