In 2020, the world experienced an unprecedented event in the COVID-19 pandemic. In the United States, initial social distancing measures impacted rates of all vaccine administration as well as healthcare delivery at large, with a sharp decrease in vaccination rates noted in March 2020.1 While routine vaccination rates gradually trended back to pre-pandemic rates in the following months, a new barrier to vaccination arose in 2021: a prominent cultural wave of antivaccination sentiment.2, 3, 4, 5 This increase in vaccine hesitancy was attributed to a lack of public trust in the medical establishment and skepticism about the novel COVID-19 vaccine.2 Social media discourse around the COVID-19 vaccine, in particular, was noted to be a powerful force, with individuals who relied primarily on social media for news and information being less likely to receive the vaccine.4

Historically, the Human Papillomavirus (HPV) vaccine has been the subject of significant skepticism and hesitancy. This trend predates the COVID-19 pandemic and disproportionately affects HPV over other routine adolescent vaccines. 6, 7, 8 When compared to Tetanus, Diphtheria, and Acellular Pertussis (Tdap), for example, HPV uptake in the United States has lagged, with Tdap vaccination rates of 85-90%, compared to 70-75% rate of initiation and 45-60% rate of series completion for HPV, despite both vaccines being recommended as part of routine vaccination for 11-12 year olds.9,10 Myriad reasons for the hesitancy around the HPV vaccine exist, with a few more prominent being parental concerns around the safety of the vaccine as well as concern for its promotion of adolescent promiscuity.11 In addition, rates of HPV vaccine uptake have historically displayed a geospatial divide, with decreased uptake in rural as compared to urban counties.12 Moreover, in the United States, HPV vaccine uptake in males is typically lower than that of their female peers. 10

In our study, our primary aim was to investigate a temporal correlation between the introduction of the COVID-19 vaccine and the rates of HPV vaccine series initiation as compared to rates of adolescent Tdap administration in our single, large, academic health system. Secondary aims included evaluating for a correlation between demographic factors and rates of HPV initiation versus Tdap uptake, including patient sex and urban versus rural residence. We hypothesized, given the historical skepticism around the human papillomavirus vaccine, that the introduction of the COVID-19 vaccine and its associated wave of vaccine hesitancy would correlate with decreased initiation of the HPV vaccine series as compared to pre-pandemic and post-pandemic, pre-COVID-19 vaccine periods. Additionally, we hypothesized this decline in HPV vaccine initiation would be more pronounced in the rural population and more pronounced among males than females, given historical trends in HPV vaccination.