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October 06, 2021

Hesitancy to the HPV vaccine remains high despite its safety and effectiveness

Some parents feel the vaccine is unnecessary because their children are not sexually active; others have concerns about side effects

When the human papillomavirus vaccine was approved by the U.S. Food and Drug Administration in 2006, federal health officials sought to have 80% of eligible adolescents vaccinated by 2020. However, that goal has not been met.

Just over half of U.S. adolescents have received two or more doses of the HPV vaccine.

A new study that tracked parental attitudes toward the HPV vaccine found that vaccine hesitancy initially declined from 2010 to 2012. But since then hesitancy has stabilized, remaining high overall. 

Almost two-thirds of parents most recently surveyed in the study said they were unlikely to have their child vaccinated against HPV. And in certain ethnic and age groups, vaccine hesitancy has increased.

"More work needs to be done so that we can achieve the 80% completion goal now set by Healthy People 2030," said lead author Eric Adjei Boakye, assistant professor in the Department of Population Science and Policy at Southern Illinois University.

Overall, HPV vaccine hesitancy decreased from approximately 69% in 2010 to 63% in 2019, the study found. However, in certain groups it increased or improved for a while and then stalled.

For mothers of boys, vaccine hesitancy decreased 6.17% annually from 2010 to 2012, but then it remained stable until 2019.

Vaccine hesitancy among mothers with Hispanic children decreased 6.24% annually from 2010 to 2013. But then an increase of 1.19% was observed from 2013 to 2019.

The researchers also explored whether a mother's age influenced how she felt about the vaccine. They found that for mothers ages 35-44, average vaccine hesitancy decreased 5.88% from 2010 to 2012 and then remained stable.

Hesitancy among mothers ages 45 or older decreased 3.92% from 2010 to 2013 before remaining stable. Women with a high school diploma saw a slightly bigger decrease in hesitancy than mothers with a college degree from 2010 to 2012, but hesitancy stabilized in both groups after 2012.

In the Philadelphia region, vaccine hesitancy is a concern as well. A Blue Cross Blue Shield report released earlier this year found that only 55% of commercially-insured adolescents ages 10-13 received their first doses of the HPV vaccine during a recent three-year period. Only 29% came back for their second doses.

In the city, the percentages were slightly better, with nearly 57% having received the first dose and 31% having received the second.

The latest study included National Immunization Survey data on 16,383 adolescents who had not received any dose of the HPV vaccine. Their parents were asked how likely it is that their teen will receive the vaccine in the next year. All parents who said "not too likely," "not likely at all," or "not sure/don't know" were defined as vaccine hesitant.

Parental concern over the vaccine's effectiveness and side effects is a big driver of the vaccine hesitancy, the study found. Some parents feel that the vaccine is unnecessary, especially because their children are not sexually active.

Not having enough information about the vaccine was another reason cited by parents surveyed. 

Boakye said their findings suggest that public information campaigns should target parental hesitancy more. He also recommends culturally tailored messages for Hispanic parents and more direct conversations about the safety and efficacy of the vaccine.

"The HPV vaccine is very safe, and it is effective at preventing HPV-associated cancers," he said. "Over 135 million doses have been administered in the United States alone with very few reported adverse effects."

He added that anti-vaccine sentiment in American society and social media disinformation also plays a role. 

"Do not trust everything you read on the internet or social media platforms. If you are in doubt or have a question, please talk to your doctor," he said.

What the research shows

The Children's Hospital of Philadelphia reports that there have been no cause-effect links between HPV vaccines and adverse events such as blood clots, allergic reactions, strokes, seizures, Guillain-Barré Syndrome, birth defects, miscarriages, infertility or premature ovarial failure, or infant/fetal death.

Though three HPV vaccines have been approved by the FDA, only one – Gardasil 9 – has been available in the U.S. since 2016. It was found to be safe and effective in clinical trials involving more than 15,000 females and males, according to the U.S. Centers for Disease Control and Prevention.

HPV is a common sexually transmitted infection that has been linked to an increased risk for cervical, vaginal, vulvar, penile, anal and throat cancers. The virus is responsible for 70 to 90% of these cancers in the U.S., the CDC reports.

The HPV vaccine must be administered as two doses to provide full immunity. The CDC recommends that children receive their two doses between ages 9-14. Anyone who receives the first dose after their 15th birthday should receive three doses.

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