Electronic health records and clinical decision support

EHRs, digital systems that store and share patients’ health information, are essential for improving vaccine uptake. During COVID-19, EHRs, mobile apps, and analytics expanded coverage and enabled real-time monitoring [15]. These systems store up-to-date patient data and, when paired with CDS, which provides patient-specific recommendations, prompt providers to recommend the HPV vaccine at the right time. EHRs also track vaccination history, flag missed doses, and send automated reminders via portals, text, or email [16]. Randomized controlled trials confirm that EHR-based interventions improve HPV vaccination initiation, completion, and follow-up [6].

Emerging ambient AI tools that “listen” to provider-patient encounters could extend CDS by generating real-time prompts and adapting messaging to patient demographics. Early studies show promise, but validation and large-scale deployment remain limited [17]. Scaling these tools requires interoperability standards such as Health Level Seven International (HL7) and Fast Healthcare Interoperability Resources (FHIR). These enable data exchange across platforms and support population-level tracking.

Lenert et al. [18] showed how extending Bulk FHIR improved access to state immunization registries for coordinated outreach, yet integration remains uneven in under-resourced systems, particularly in low- and middle-income countries (LMICs) and rural areas where infrastructure and workforce capacity are limited. Ensuring compliance with established privacy regulations like the Health Insurance Portability and Accountability Act (HIPAA) in the United States and the General Data Protection Regulation (GDPR) in Europe remains essential, as these frameworks protect patient confidentiality while allowing data exchange for public health purposes [19–21].

EHR-based CDS reminders are highly scalable, as they integrate across health systems and adapt to local HPV vaccination guidelines. A New York City trial showed EHR reminders improved immunization opportunities, demonstrating feasibility for wider implementation [16]. When enhanced with analytics, these systems can also monitor HPV vaccine efficacy by linking records with later diagnoses of HPV-related disease. This strengthens confidence in its cancer-preventing benefits and helps identify gaps in coverage and patient behavior. Together, EHR/CDS interventions, augmented by ambient AI and supported by interoperability, function as infrastructure-level enablers of equitable HPV vaccine delivery.

Mobile health applications and telehealth access

Mobile health (mHealth) applications are accessible tools for delivering accurate vaccine information. They offer schedules, education, and links to trusted providers, helping patients navigate HPV vaccination decisions [22]. Evidence consistently links these tools with improved HPV awareness and vaccine adoption [23].

When paired with telehealth services, mHealth extends reach through real-time provider-patient engagement. Telehealth, the remote delivery of care through digital platforms, is especially valuable in underserved regions where healthcare access is limited [24]. Virtual consultations allow providers to address misinformation, discuss HPV vaccine safety, and deliver tailored recommendations that sustain engagement and reduce stigma [25].

The COVID-19 pandemic demonstrated scalability: Both mHealth and telehealth sustained immunization campaigns when in-person visits collapsed, proving feasibility for HPV vaccination in constrained settings [15]. HPV-specific digital tools, such as a culturally U.S.-Mexico border program, improved provider communication and uptake in Hispanic communities, where uptake is historically lower [26]. While promising, outcomes vary by population due to differences in digital literacy and access [27].

Together, these tools function as more than communication channels; they operate as equity-focused infrastructure, reducing barriers, expanding reach, and building continuity of care, while laying the groundwork for advanced AI and natural language processing (NLP) systems to further optimize delivery and misinformation surveillance.

Artificial intelligence and misinformation surveillance

AI, which enables computers to perform tasks requiring human intelligence, and NLP, which allows computers to understand and analyze human language, can be applied to monitor vaccine-related discourse online. For HPV, AI-driven tools are especially valuable for identifying persistent myths, such as the misconception that the vaccine is only relevant for women, and detecting emerging narratives that discourage uptake. These systems can flag misinformation and trigger timely responses from public health authorities [28, 29].

Practical applications are already visible: Platforms such as X (formerly Twitter) have introduced community-driven fact-checking [30]. Beyond detection, AI can perform sentiment analysis, helping public health organizations understand vaccine-related perceptions and tailor outreach to HPV-specific concerns. HPV studies using NLP on X (2008–2017) tracked sentiment shifts and false versus verified claims, showing misinformation spreads faster and engages more users; Instagram analyses found similar patterns, highlighting surveillance challenges [31, 32].

To ensure reliability, AI and NLP models are evaluated with metrics such as accuracy, precision, recall, F1-score, and area under the receiver operating characteristic curve (AUC). Transformer models like BERT and RoBERTa have been applied to HPV misinformation detection, with RoBERTa embeddings and logistic regression achieving AUC 0.958 and F1 0.88. Large-scale analyses of 650,000 HPV-related tweets achieved 71.4% recall and 31.2% precision when classifying concerns [33]. These benchmarks are vital for reducing misinformation and misclassification of marginalized voices, showing that HPV surveillance has moved from concept proposals to measurable, real-world applications.

Ultimately, AI’s impact lies not in detection alone but in integration: Misinformation insights can feed into public health dashboards, guide provider scripts, and inform school-based campaigns, transforming raw surveillance into coordinated HPV-focused responses.

Reducing structural barriers and promoting equity

Addressing HPV vaccine hesitancy also requires strong policy action. Financial constraints remain a significant barrier. Sustained vaccination requires coordination across governments, providers, schools, and civil groups to ensure scalable, culturally relevant interventions [34]. A rural U.S. study found that public health and education leaders identified school-based promotion programs and cross-sector collaboration as key opportunities to increase HPV vaccination uptake and overcome systemic barriers [35]. Free or subsidized vaccinations in schools and clinics, supported by national programs and Gavi, are critical for access and sustainability [36, 37].

Gavi’s co-financing model promotes gradual country ownership while maintaining support until programs are self-sustaining, a feature especially vital for LMICs with weak insurance systems and limited resources [37]. Gavi-supported countries have demonstrated notable increases in HPV coverage through program introduction into national schedules [38].

Legislative measures like school-entry HPV vaccination and insurance mandates for preventive vaccines can further reduce inequities and institutionalize access [39]. However, mandates often face political resistance, and financing mechanisms are shaped by broader political economies, which can affect implementation. Linguistic and cultural barriers require attention; multimedia materials and interpreter services can improve outreach to immigrant and minority communities [40]. School-based delivery with sustainable financing and community partnerships is often the most practical starting point, especially in resource-limited settings.

Structural reforms lay the foundation for equity, but policy must also address the digital influences on vaccine perceptions.

Holding social media platforms accountable

Social media is a powerful vehicle for misinformation [29]. Regulatory bodies such as the Federal Trade Commission (FTC) have issued enforcement orders requiring transparency in how platforms filter health-related ads and deceptive content [41]. The FDA has proposed draft guidance allowing “tailored responsive communications” to address third-party misinformation on medical products [42]. These steps show that voluntary measures are inadequate; binding standards like content labeling, algorithm transparency, and user education tools are needed to counter false narratives. Yet, policy reforms alone are insufficient if communities carry deep-seated mistrust shaped by historical and cultural experiences.

Historical and cultural sensitivities

Mistrust in the medical system, particularly among communities of color, cannot be ignored. Historical injustices like the Tuskegee experiment have left lasting scars [43]. Digital health interventions must therefore be coupled with culturally tailored communication and meaningful community engagement to rebuild trust. This also means ensuring that emerging surveillance tools are deployed ethically, with safeguards that protect privacy and equity.

Ethical considerations in digital surveillance

While monitoring misinformation online is an essential component of modern vaccine policy, the privacy of users must be carefully protected [44]. Clear data-use guidelines are needed to limit intrusion and prevent misuse, and algorithmic bias, such as marginalized communities being unfairly flagged, must be addressed because these disparities can reinforce existing inequities in vaccine access and trust [45]. Real-world cases, such as healthcare prediction tools underestimating Black patients’ needs, show how bias can perpetuate inequities unless systems are designed with equity and auditability from the start [46]. If similar biases emerge in digital surveillance tools, they risk undermining trust in HPV vaccination efforts, particularly among marginalized communities. Implementing safeguards such as transparency in AI decision-making, independent audits of surveillance tools, and mechanisms for community oversight are key strategies for addressing these challenges [47]. Balancing surveillance with human rights ensures that digital interventions remain trustworthy and equitable. Governance mechanisms such as algorithmic audits and community advisory boards can help ensure transparency, equity, and accountability in digital surveillance tools.

Global policy context

Global commitments are already underway to improve HPV vaccine uptake and eliminate cervical cancer through the World Health Organization’s (WHO) 90-70-90 strategy: By 2030, 90% of girls under 15 years old should be fully vaccinated, 70% of women screened by ages 35 and 45 using high-performance tests, and 90% of women diagnosed with cervical disease should receive appropriate treatment [48]. Achieving these targets will require leveraging digital health implementation frameworks, as the WHO has emphasized that robust health information systems are essential for tracking coverage, sending reminders, and enabling population-level data analytics to ensure accountability and equitable progress [49].

WHO has also endorsed a single-dose HPV vaccine schedule, which substantially reduces logistical and financial barriers to vaccination [50]. This shift is especially critical in LMICs where resource constraints and weak follow-up systems make multi-dose schedules difficult. LMICs, which bear nearly 90% of the global cervical cancer burden, stand to benefit most from simplified regimens, digital tracking tools, and community-based delivery approaches that improve completion rates and reduce inequities [49, 51]. However, implementation remains uneven, particularly in LMICs and rural areas where digital infrastructure and provider capacity are limited. Together, these efforts show how technology, paired with global policy, can drive sustainable and equitable HPV elimination [51].

Building on these insights, the proposed Digital Vaccine Advocacy Toolkit operationalizes these technological, policy, and equity strategies into a coordinated framework to maximize HPV vaccine uptake.

Proposed integrated intervention

To maximize impact, a Digital Vaccine Advocacy Toolkit is proposed. This framework integrates technical infrastructure, policy, equity-focused implementation, and ethical safeguards to strengthen HPV vaccine confidence and uptake.

Technical features

CDS alerts embedded in EHRs prompt timely HPV vaccine recommendations at the point of care. For scale, these alerts must be interoperable across health systems, leveraging exchange standards such as HL7 and FHIR. Personalized reminders delivered through SMS, email, or mobile applications extend this reach by tailoring notifications to patients’ vaccine schedules, including both multi-dose and single-dose regimens.

Population dashboards aggregate vaccination data to track coverage and identify gaps, with cloud-based infrastructures enabling population-level analytics while maintaining compliance with privacy regulations. Complementing these tools, AI-powered misinformation surveillance employs NLP to detect emerging narratives online. Reliability requires validation metrics (accuracy, precision, recall, F1-score, and AUC), and fairness safeguards reduce risks of algorithmic bias. Finally, multilingual and culturally tailored education delivered through mHealth platforms ensures inclusivity.

Policy integration

Sustained impact requires policy support. Financing models such as national immunization budgets, Gavi co-financing mechanisms, and public-private partnerships with telecoms provide long-term sustainability. Legislative measures, including school-entry vaccination mandates, insurance coverage for preventive vaccines, and platform accountability for misinformation, reinforce equitable access. Ministries of Health embed interventions into national immunization schedules, while non-governmental organizations (NGOs) and community groups support cultural tailoring and last-mile delivery.

Implementation pathways

Adaptation to context is central. In LMICs, low-bandwidth SMS systems, simplified single-dose tracking, and community health worker dashboards are emphasized. In high-income countries, advanced features such as interoperable EHR/CDS integration and app-based reminders can be prioritized, illustrating adaptability across health systems. Workflow integration creates synergy. Provider prompts trigger reminders that feed into dashboards, misinformation surveillance informs campaigns, and monitoring data guides policy decisions.

Future pilots should incorporate stakeholder feedback and cost modeling, apply implementation science methods to optimize workflow integration.

Evaluation metrics

Effectiveness should be assessed using clearly defined equity-sensitive indicators with baseline comparators and data sources specified, including vaccine initiation and completion rates across demographic groups; provider adoption of CDS alerts; reductions in inequities; and shifts in digital sentiment around HPV vaccination. Using validated tools such as standardized immunization registries and NLP sentiment analysis models can anchor these indicators in measurable outcomes.

Ethical safeguards

Finally, ethical guardrails are essential. Patient data must be managed under HIPAA, GDPR, or equivalent standards. AI tools should undergo independent audits to detect and mitigate algorithmic bias, with transparency in decision-making to ensure accountability. Community oversight mechanisms can further align digital strategies with public expectations, sustaining trust and preventing unintended harms.

Together, these elements form a scalable, ethically grounded framework that positions digital health as a catalyst for sustained HPV vaccine confidence and equity. Figure 1 illustrates the workflow of the Digital Advocacy Toolkit for HPV vaccination, showing how clinical, data, and communication interventions are integrated with ethical safeguards across all components.

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Figure 1. Workflow of the Digital Vaccine Advocacy Toolkit for HPV vaccination. The framework integrates provider prompts, patient reminders, and dashboards (clinical/data flow) with AI surveillance and inclusive education (communication/education flow). Ethical safeguards, including privacy protection, bias audits, and community oversight, apply across all components to ensure equity and trust. CDS: clinical decision support; EHR: electronic health record; AI: artificial intelligence; HPV: human papillomavirus.