Public Reports and Testimonies

NEW YORK CITY COUNCIL
COMMITTEE ON HEALTH AND
COMMITTEE ON WOMEN’S ISSUES

OVERSIGHT HEARING: EXAMINING THE CITY’S EFFORT TO PREVENT THE HUMAN
PAPILLOMAVIRUS VIRUS AND DECREASE
RISK FOR CANCER

Good afternoon Speaker Mark-Viverito, Chairperson Cumbo, Chairperson Johnson and members of the Committees on Health and Women’s Issues. I am Dr. Ross Wilson, Senior Vice President and Chief Medical Officer for the New York City Health and Hospitals Corporation (HHC). I am joined by Dr. Machelle Allen, Deputy Chief Medical Officer, and we speak on behalf of HHC President Dr. Raju. Thank you for the opportunity to discuss HHC’s efforts to decrease cancer risks for New Yorkers through Human Papillomavirus (HPV) immunization and cervical cancer screening.

In the earlier testimony from Dr. Varma at DOHMH, the size and importance of the problem of HPV infection and increased cancer risk is well covered. HHC has worked extensively over the past several years on dual tracks to increase screenings for cancer and to expand effective treatment and prevention programs. HHC’s facilities offer cancer treatment services that are comprised of the latest therapeutic programs and appropriate support services.

Each year HHC facilities conduct more than 115,000 cervical cancer screenings, more than 68,000 mammograms for breast cancer screening and 12,000 colonoscopies for colon cancer screening. Through these aggressive efforts we aim to diagnose more cancers at earlier stages thus allowing for more effective treatment and a better prognosis. We are grateful to the City Council for supporting these efforts.

HHC’s focus on cancer prevention is part of our ongoing work to provide comprehensive care to all New Yorkers. We were aided in our prevention efforts as they relate to HPV, by the creation of the HPV vaccine several years ago. The HPV vaccine has been shown to prevent certain types of HPV infection, which account for 70% of cervical cancers and other diseases.

HHC was at the forefront of providers in New York City when we began to offer the vaccine in 2006. We embarked on a plan to increase access to the vaccine, educate and train our providers and increase awareness among our patients and the communities we serve. Our early efforts proved successful and these practices are now embedded into our workflow.

In the same manner that we offer children other vaccines, HHC offers the HPV vaccine to children when they are approximately between the ages of 11 and 12. We also offer it to older children, adolescents and young adults who have not previously received the vaccine. Early adolescence through young adulthood is the best time for children to be vaccinated.

It’s important to be vaccinated before sexual activity begins, since that’s how HPV is usually transmitted. Although only women can get cervical cancer, both boys and girls should be vaccinated for HPV, since the virus can cause other forms of cancer and warts in the genital and throat areas of both boys and girls. The vaccine is administered in a series of three injections over a 6 month period.

For calendar year 2013, 77.5% of HHC patients age 13 – 17 have initiated the HPV vaccination series, and 47% have completed the series: 44.5% boys and 50.1% girls. The national completion rates for the same time period are 13.9% for boys and 37.9% for girls. For 2014, the HHC overall completion rate has increased to 52.5%: 52.5% for boys and 52.4% for girls. Initiation rates are 83.2% for boys and 80.0% for girls. The continued improvement in these rates reflects the importance HHC places on this aspect of health care.

The enhanced acceptance rate within HHC as compared to national and New York City rates is attributed to two major factors: the HHC providers were early adopters and promoters of the HPV vaccine. In addition, the federal Vaccines for Children (VFC) program, along with insurance coverage and HHC Options, have eliminated any financial/cost barriers. I will briefly return to this later in my testimony.

Facility interventions to enhance vaccination rates include utilizing every provider encounter (annual school physical, sports clearance, summer camp physicals, etc.) as an opportunity to initiate or resume the vaccine series. In addition, once the series is begun, the subsequent doses can be given during a nurse visit, not requiring a doctor’s appointment/visit.

Outreach efforts include working with local community based organizations, houses of worship as well as the school based health clinics. Utilization of the Citywide Immunization Registry allows our physicians to readily identify missed opportunities.

For those patients whose primary language is not English, printed materials with information about the HPV vaccine are currently available in multiple other languages. We also have educational materials on cervical cancer in all clinical sites for parents of children and young women to review prior to their clinic visit. HHC encourages all parents to talk to their doctor about protecting their child with an HPV vaccination.

To ensure that our clinicians stay up to date, a continuing medical education program on cervical cancer, HPV, and HPV vaccines is available for relevant clinical providers including materials on the efficacy, safety, and administration of HPV vaccine. Patients rely heavily on the advice of their clinician so the more up to date and knowledgeable our clinicians are, the better it is for our patients.

In New York, health insurance plans that are regulated by the State are required to cover the cost of the HPV vaccine for patients through the age of 18. If patients lack health insurance coverage, HHC offers the vaccine at no charge. Children are eligible to receive this vaccine, and others, at no charge through the federally funded Vaccine for Children program.

Uninsured patients will receive assistance from HHC staff to enroll them where eligible onto public health insurance programs. We also help patients seek subsidized coverage through New York’s Health Care Marketplace - The New York State of Health. For those who are ineligible for public health insurance coverage, we offer patients our HHC Options program. This financial assistance program provides affordable, comprehensive healthcare services to New Yorkers on a sliding fee scale system.

Thank you for the opportunity to briefly review HHC’s efforts to prevent HPV. We look forward to working with the City Council and others to increase awareness of the HPV vaccine and - more broadly - to the comprehensive healthcare servicesthat HHC offers to all New Yorkers. This concludes my written testimony. I now look forward to answering any questions you may have.