Parallel with these scientific efforts to estimate the impact of HPV in Puerto Rico, grassroots movements have promoted educational campaigns and outreach activities to increase HPV vaccine uptake and awareness at the community level, as well as developed training opportunities among health care professionals. These efforts from multiple sectors (eg, coalitions, government agencies, health providers, scientists) led Puerto Rico to have among the highest HPV initiation rates since 2014. These sectors have been pioneers in developing policies that support HPV vaccination access in Puerto Rico. Among the more meaningful is Law No. 9 (passed December 20, 2010), which provided HPV vaccine access to girls aged 11 to 18 years. The law was amended in 2012 to also include boys aged 11 to 18 years (4). Implementation of this public policy was essential because the Vaccine for Children Program, which is available for Puerto Rican families with no health insurance, provides limited access to the vaccine for children from families with private insurance. In 2015, after the implementation of this law, the Vaccination Coalition of Puerto Rico (VOCES, by its acronym in Spanish) led the first discussion about having an HPV vaccine requirement for school entrance, as part of the HPV Advisory Panel report (5).
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