Goal 2: Increase Parents’ Acceptance of HPV Vaccination
Parents and legal guardians are the primary decision makers about adolescent vaccination, particularly at the recommended ages for routine vaccination (11 to 12 years old).1 HPV vaccination increasingly is a standard part of care for U.S. adolescents. The majority of parents have their children vaccinated against HPV. In 2017, more than 65 percent of 13- to 17-year-old adolescents had received at least one dose of the HPV vaccine.2 Surveys of parents of unvaccinated teens indicate that a growing proportion are accepting of their children receiving the vaccine,3 and many parents who initially decline the vaccine eventually accept it.4
This progress is likely due, in part, to communication campaigns—such as those carried out by the Centers for Disease Control and Prevention (CDC),5 American Cancer Society (ACS)6 (see Sharing Survivors’ Stories), and Merck & Co.7—and promotion of the vaccine by a growing number of healthcare providers. However, more must be done to increase acceptance of the HPV vaccine. A 2015 survey found that about half of parents of unvaccinated teens did not intend to have their children vaccinated against HPV.3 No single reason predominated, but common reasons cited by parents included:3,8
- Vaccination not needed
- Vaccination not recommended by healthcare provider
- Lack of knowledge about the vaccine or diseases caused by HPV
- Concerns about safety and side effects
- Son or daughter not sexually active
The Panel Chair encourages CDC, ACS, and other trusted organizations to continue to develop and deploy evidence-based communication campaigns to increase parents’ acceptance of HPV vaccination. It is important that parents have access to clear, accurate information about HPV vaccination, particularly if they have questions or concerns. Key messages may include:
- The HPV vaccine prevents six cancers and other diseases.
- The HPV vaccine prevents cancers and other diseases in both girls and boys.
- The HPV vaccine is safe.
- The HPV vaccine is most effective when administered to young adolescents, well before they are exposed to HPV.
Campaigns should build on current knowledge and use existing materials whenever possible. Use of multiple tools and modes of communication will reach as many parents as possible. Strategies are needed to directly reach older adolescents and young adults who may make their own decisions about vaccination. Targeted campaigns may be needed in some cases to counteract widely circulated misinformation (see Addressing Misinformation).
While communication campaigns play an important role in multipronged approaches to increase HPV vaccine uptake, evidence suggests that interventions designed to influence parents’ knowledge, thoughts, and feelings are likely to only modestly affect vaccination rates and may be most effective when a vaccine is new.9,10 Ensuring that providers make strong recommendations and address parents’ questions and concerns likely will be the most effective way to increase parents’ acceptance of HPV vaccination and boost vaccine uptake (see Goal 1). Systems- and community-level interventions also may facilitate access to the vaccine so that parents with positive or neutral views of HPV vaccination have their children initiate and complete the series (see Goal 1 and Goal 3).
Sharing Survivors’ Stories
Videos that feature the stories of HPV cancer survivors—like this one created by the National HPV Vaccination Roundtable—help parents understand the risks of not having their children vaccinated against HPV.
Source: National HPV Vaccination Roundtable. Tamika Felder, HPV Cancer Survivor [Internet]. Atlanta (GA): American Cancer Society; 2018 Oct 8 [cited 2018 Oct 15]. Available from: https://www.youtube.com/watch?v=z4Quat3lJlY&feature=youtu.be
Misinformation about the HPV vaccine can be spread widely and quickly through social media and traditional media outlets, often with dire effects. Widespread dissemination of misinformation about safety has resulted in dramatic decreases in HPV vaccination in several countries, including Japan, Ireland, Colombia, Denmark, Romania, and India, leaving thousands of young people vulnerable to HPV cancers. In some cases, vaccination programs have even been terminated. Effective communication campaigns before and during vaccine rollout may make the general public less susceptible to misinformation. Effective crisis communication and leadership by policymakers are essential to prevent misinformation from having dramatic negative effects on coverage.
Once misinformation about vaccines takes hold, it can be exceedingly difficult to debunk. Contrasting myths with facts is often ineffective, and, in some cases, even reinforces false beliefs. There have been some success stories. Multipronged campaigns in both Ireland and Denmark have begun to reverse dramatic drops in HPV vaccine coverage precipitated by spread of misinformation about safety through the media. In both countries, coverage fell from around 90 percent to 50 percent or less. Both campaigns have involved multiple stakeholders, including policymakers, and have disseminated accurate information through multiple outlets. More research is needed to better understand how and why misinformation spreads, examine the role of media and policymakers in fostering or halting HPV vaccine coverage collapse, and develop better ways to effectively combat it.
Strategies that have been recommended to help overcome misinformation include:
- Keep key messages simple.
- Emphasize core facts, not the myth.
- Give explicit warnings before mentioning a myth.
- Provide an alternative explanation to fill gaps left by debunking the myth.
- Emphasize scientific consensus about the benefits of HPV vaccination.
- Use visuals to convey core facts whenever possible.
Stakeholders, including national and local governments, advocacy groups, and others, should monitor the emergence of messages with potential to undermine confidence in the vaccine and quickly mobilize tailored responses. It is rarely possible to change the minds of people who strongly oppose vaccination; rather, the goal should be to provide the general public with accurate information from credible sources to make them more resilient to unsubstantiated anti-vaccine statements and stories.
Sources: Corcoran B, Clarke A, Barrett T. Rapid response to HPV vaccination crisis in Ireland. Lancet. 2018;391(10135):2103. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29856339; Cordoba V, Tovar-Aguirre OL, Franco S, et al. Barriers and facilitators of human papillomavirus (HPV) vaccination during the implementation of the school-based HPV vaccine program in Manizales, Colombia [poster]. Presented at: ASCO Annual Meeting; 2018; Chicago, IL: Journal of Global Oncology. Available from: http://ascopubs.org/doi/abs/10.1200/jgo.18.11000; World Health Organization. Denmark campaign rebuilds confidence in HPV vaccination [Internet]. Geneva (CH): WHO; 2018 Feb [cited 2018 Aug 28]. Available from: http://www.who.int/features/2018/hpv-vaccination-denmark/en/; Penta MA, Baban A. Mass media coverage of HPV vaccination in Romania: a content analysis. Health Educ Res. 2014;29(6):977-92. Available from: https://www.ncbi.nlm.nih.gov/pubmed/24890190; Sabeena S, Bhat PV, Kamath V, Arunkumar G. Global human papilloma virus vaccine implementation: an update. J Obstet Gynaecol Res. 2018;44(6):989-97. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29517117; Pluviano S, Watt C, Della Sala S. Misinformation lingers in memory: failure of three pro-vaccination strategies. PLoS One. 2017;12(7):e0181640. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28749996; World Health Organization Regional Office for Europe. Best practice guidance: how to respond to vocal vaccine deniers in public. Copenhagen (DK): WHO Regional Office for Europe; 2017. Available from: http://www.euro.who.int/__data/assets/pdf_file/0005/315761/Best-practice-guidance-respond-vocal-vaccine-deniers-public.pdf; Cook J, Lewandowsky S. The debunking handbook (version 2). St. Lucia (AT): University of Queensland; 2012 Jan. Available from: https://www.skepticalscience.com/docs/Debunking_Handbook.pdf
Research Priority: Harnessing Social Media
Social media use has grown dramatically over the past decade. Research is needed to identify ways to effectively use social media to spread research-tested messages about HPV and HPV vaccination.
- McRee AL, Reiter PL, Brewer NT. Vaccinating adolescent girls against human papillomavirus—who decides? Prev Med. 2010;50(4):213-4. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20153358
- Walker TY, Elam-Evans LD, Yankey D, et al. National, regional, state, and selected local area vaccination coverage among adolescents aged 13-17 years—United States, 2017. MMWR Morb Mortal Wkly Rep. 2018;67(33):909-17. Available from: https://www.ncbi.nlm.nih.gov/pubmed/30138305
- Hanson KE, Koch B, Bonner K, et al. National trends in parental HPV vaccination intentions and reasons for hesitancy, 2010-2015. Clin Infect Dis. [Epub 2018 Mar 27]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29596595
- Kornides ML, McRee AL, Gilkey MB. Parents who decline HPV vaccination: who later accepts and why? Acad Pediatr. 2018;18(2S):S37-S43. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29502636
- Centers for Disease Control and Prevention. Human papillomavirus (HPV): for parents and public [Internet]. Atlanta (GA): CDC; [updated 2015 Sep 30; cited 2018 Jun 1]. Available from: https://www.cdc.gov/hpv/parents/index.html
- American Cancer Society. Prevent cancer with the HPV vaccine [Internet]. Atlanta (GA): ACS; [cited 2018 Jun 11]. Available from: https://www.cancer.org/healthy/hpv-vaccine.html
- Merck. Know HPV [Internet]. Kenilworth (NJ): Merck Sharp & Dohme Corp.; [cited 2018 Sep 14]. Available from: https://www.hpv.com/
- Thompson EL, Rosen BL, Vamos CA, et al. Human papillomavirus vaccination: what are the reasons for nonvaccination among U.S. adolescents? J Adolesc Health. 2017;61(3):288-93. Available from: https://www.ncbi.nlm.nih.gov/pubmed/28842066
- Brewer NT, Chapman GB, Rothman AJ, et al. Increasing vaccination: putting psychological science into action. Psychol Sci Public Interest. 2017;18(3):149-207. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29611455
- Community Preventive Services Task Force. What works: increasing appropriate vaccination: evidence-based interventions for your community. Atlanta (GA): CPSTF; 2017 Nov. Available from: https://www.thecommunityguide.org/sites/default/files/assets/What-Works-Factsheet-Vaccination.pdf