A young woman receives a HPV vaccine.
The HPV vaccine prevents many cancers caused by human papillomavirus if given early enough. Credit: Flickr / Art Writ

Providing health care to underserved areas of San Antonio is one of the primary missions for the University of the Incarnate Word School of Osteopathic Medicine (UIWSOM). In 2017, the school conducted a risk assessment showing three major disparities in District 3 compared to other City districts: severely limited access to care, wellness support, and food. When it came to health care access, parents said they were unable to vaccinate their kids because it took time and resources they did not have to travel to health facilities for shots and medical attention.

This is an especially critical concern because vaccines save lives. Prevention is our greatest defense against disease, and as of 2019, the CDC has approved vaccines for 16 preventable diseases among children. Additionally, these vaccinations have significant savings. For example, in the case of diphtheria, a single vaccine costs $1.87, whereas treatment costs $16,982.

Based on this impact and assessment, the UIWSOM has sought to help by bringing vaccinations directly to the community, partnering with multiple activists and organizations to set up biannual immunization drives for children on the South Side. Through this outreach, UIWSOM students and faculty help provide information and vaccinations to the community for diseases such as meningococcal meningitis, tetanus, diphtheria, pertussis (whooping cough), and human papillomavirus (HPV) at a sliding scale cost.

The HPV vaccine is particularly significant because it prevents many cancers caused by human papillomavirus if given early enough.  The newest guidelines from 2019 for the 9-valent HPV vaccine expanded from ages 9 to 26 to include vaccinating individuals up to 45 years old, allowing more adults to take charge of their health and reduce their risk of infection and these cancers.

Based on data from 2012 to 2016, about 44,000 HPV-associated cancers occur in the United States each year – about 25,000 among women and about 19,000 among men. But despite guideline changes and the continued efficacy of the HPV vaccine in preventing cancer, only 51.1 percent of adolescents in the US received both required doses in 2018. That same year, Texas was one of the states with the lowest vaccination rates.

In 2017, recognizing the need for change, District 3 Councilwoman Rebecca Viagran, Dr. Anil T. Mangla from UIWSOM, Dr. Linda Hook from the UIW School of Nursing, Randy Escamilla from Southside ISD, Valerie G. Maldonado from Southwest ISD, Elizabeth Manrique and Katherine Diaz from University Health System, and Dr. Ricardo Gonzalez from UIW’s Ettling Center for Civic Leadership and Sustainability coordinated four vaccine drives for Southside Independent School District and Southwest Independent School District. 

That year, we provided 544 vaccine doses, including 161 HPV doses, with an acceptance rate of 96.3 percent compared to the national average of 73 percent. By 2019, the total number of vaccines administered increased to 873, a 60 percent increase, including 169 HPV doses. The acceptance rate, already quite high at 96.3 percent, increases to 97.9 percent in 2019.

So how do we get such low refusal rates?

One way is focusing the conversation on cancer prevention.  The team implements a four-tier system to increase acceptance rates and decision-making. 

  1. At registration, medical students and staff trained to emphasize open communication with the parents explain the cancer prevention benefits their children could gain by receiving the HPV vaccine. 
  2. At the consent table, students discuss the importance of the HPV vaccine with parents that have doubts, and the parents can talk to multiple faculty members to answer any remaining questions they may have. 
  3. While waiting for the vaccine delivery, the next set of students continue to advocate the importance of the HPV vaccine.
  4. At this stage, if the parents are still uneasy with the HPV vaccine, Dr. Mangla and Dr. Vince Fonseca – former state epidemiologists – can discuss the medical benefits and clinical literature, and share the most current data on cancer prevention.  So far at this tier, the team has changed 85 percent of parents’ perceptions on the HPV vaccine.

Another key contributor to parents accepting the HPV vaccine is its accessibility and affordability at our drives. Parents appreciate the convenience of having the events within distance of their children’s school districts and that the immunizations are at little to no cost to them, compared to what they would pay if they went to another medical office.

It takes the constant vigilance of an inter-professional team to raise overall immunization rates and ensure the good health of a community. In South Side San Antonio, we are lucky to have such steadfast allies in this effort in Councilwoman Viagran (District 3); the University of the Incarnate Word (UIW) Schools of Nursing, Pharmacy, and Osteopathic Medicine; the University Health System; Southside Independent School District; and South West Independent School District. 

By taking time with our families, discussing the benefits of vaccination, and focusing on primary prevention on a one-on-one basis, these vaccine drives have shown significant progress over the past three years, and their continued success is attributed to the participation of our community, word-of-mouth recommendations, and the supporters of the local school districts.

Data collected and reported from this project was funded by the Hogg Foundation for Mental Health.

Kaylyn Snook is a third-year medical student at the University of the Incarnate Word School of Osteopathic Medicine. She has an interest in preventative and community health and was part of a major drive...

Mia K. Vento is a public health research and administrative assistant at the UIWSOM. Her focus on health equity comes from 8 years of experience in education and scientific research throughout the U.S....

Dr. Emma Santa Maria is the Director of Professional Development and an Assistant Professor at the University of the Incarnate Word School of Osteopathic Medicine. Her areas of expertise include policy...

Dr. Anil Mangla is the director of public health and research at University of the Incarnate Word School of Osteopathic Medicine. He brings 15 years of international, state, and local government experience...