Evaluating rural/urban HPV vaccine completion rates in Iowa after the COVID-19 pandemic

Abstract Adolescents face barriers, including stigma and hesitancy, to completing the HPV vaccine. These barriers contribute to lower HPV vaccination completion rates in rural communities. Although general vaccine hesitancy grew during the pandemic, whether rising vaccine hesitancy further widened rural HPV vaccination gaps remains unknown. With data from the Iowa Department of Health and Human Services (2017–2024), we analyzed annual, county-level sex-stratified HPV vaccination completion rates. Rates were reported as a proportion of the 13–15-year-old population. In addition to evaluating overall trends, we grouped counties by rural/urban status and above/below median COVID-19 vaccination rates. We then constructed population-weighted, panel regression model with county-level fixed effects testing if HPV vaccination completion rates changed after year 2020; and whether these changes varied by rurality and COVID-19 vaccination rates. Post-pandemic HPV vaccination completion rates increased 3.1-percentage-points in females (95% CI [2.2, 4.0]) and 4.3-percentage-points in males (95% CI [3.4, 5.2]). In the fully interacted model, the linear combination estimate found no post-pandemic change in completion rates for females in urban counties with below-median COVID-19 vaccine uptake (Est. = −0.2; 95% CI [−3.3, 3.0]). In males, the linear combination estimate found the post-pandemic change in completion rates was higher in urban counties below median COVID-19 vaccine uptake (Est. = 5.4; 95% CI [4.8, 6.0]) than rural counties below median COVID-19 vaccine uptake (Est. = 2.9; 95% CI [2.0, 3.9]). In Iowa, the dynamic post-pandemic HPV vaccination completion trends warrant interventions that address multiple factors driving unique contributors to incomplete HPV vaccination.