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It was a no-brainer for New York City mom Jen L. when a pediatrician suggested that she vaccinate her two sons against human papillomavirus (HPV).
“Before my kids were eligible for the vaccine, I had read up on it to learn about the vaccine and its positives in general, and also to learn if there were any significant side effects," she said. “I have a good friend who had issues from HPV in her 20s, and I was excited to read a vaccine could now help prevent all the drama she had gone through.”
But not all parents feel this way about the cancer-preventing HPV shots, a new study suggests.
Parents of nearly 120,000 unvaccinated teens aged 13 to 17 were asked why they didn't plan to vaccinate their children against HPV, which is a sexually transmitted infection.
Overall, hesitancy about giving kids this vaccine decreased by almost 6% a year between 2010 and 2012, and remained stable from 2012 through 2020.
But the number of parents citing “safety or side effects” as a reason for vaccine hesitancy increased by nearly 16% annually from 2010 to 2018, the study findings showed.
“This would have been acceptable around 2006 when the vaccine was new, but now, it is shocking that people still think the vaccine may not be safe,” said study co-author Eric Adjei Boakye. He is an assistant scientist in the health sciences department at Henry Ford Health in Detroit.
HPV can cause a range of cancers, including anal, cervical, vaginal and penile cancers, and HPV vaccination during adolescence protects against around 90% of these cancers. The U.S. Centers for Disease Control and Prevention recommends that all boys and girls aged 11 or 12 get vaccinated against HPV (vaccination can start at age 9).
As of 2020, about 75% of U.S. teens had gotten at least one dose in the two or three-dose HPV series, and about 59% had completed the series. This rate falls short of the Healthy People 2030 goal of 80% completion among teens aged 13 to 15.
The main reasons parents were on the fence about the HPV shots in the new study? “They are not necessary,” “safety concerns,” “lack of recommendation,” “lack of knowledge” and “not sexually active.”
There are several other reasons for parents' HPV vaccine hesitancy, Boakye said. “At the beginning when the vaccine was recommended, there was a lot of attention placed on the sexually transmitted infections, and most people thought it was a sexually transmitted infection vaccine rather than cancer prevention vaccine,” he explained.
Some parents may think vaccinating their children gives kids the green light to become sexually active since they will think they are protected from sexually transmitted infection, he added.
There is also a lack of awareness that HPV causes several cancers, Boakye said.
“Another big one is mistrust in the medical system based on history, especially among minorities,” he noted. “The most contributing factor these days is misinformation about the safety of vaccines, especially on social media, which has gotten worse since the COVID-19 pandemic.”
Breaking down these barriers starts with addressing HPV vaccine misinformation, especially on social media, Boakye said.
What's more, health care providers and pharmacists should use every visit to educate eligible individuals about the cancer prevention benefit of the HPV vaccine.
“We should develop interventions tailored to parents' level of hesitancy and address the main reason(s) they are hesitant to vaccinate their children,” he said. That could mean addressing cultural issues, fears, and lack of knowledge and awareness, Boakye suggested.
The study was published online May 23 in Pediatrics.
Dr. Neal Hoffman is an attending physician at Children's Hospital at Montefiore and an associate professor of pediatrics at the Albert Einstein College of Medicine in New York City. He said the findings mirror what he has seen in his practice.
“Parents continue to be concerned about side effects of vaccinations, especially when they perceive them as new,” he said. The HPV vaccination was first recommended in 2006.
“The amount of information being put out by the anti-vaxxer movement, especially that HPV vaccine affects teens' future fertility, has been impactful, unfortunately,” Hoffman said.
To counteract reluctance, Hoffman reassures parents that this is not a new vaccine and that there is long-standing data that shows safety.
The proportion of parents reporting "child not sexually active" has decreased. Still, some studies suggest that parents remain uncomfortable about considering their teens as being sexually active, and this contributes to their hesitancy about the HPV vaccine, he noted.
Noting parents' concerns about vaccine safety, Dr. Jennifer Wu of New York City said, “We have a lot of good long-term data that the HPV shots are very safe.”
Public awareness campaigns about HPV and cancer may help convince parents of the benefits of this vaccine, said Wu, an obstetrician/gynecologist at Lenox Hill Hospital.
The shots are recommended, but not required, she said. “Some parents may feel that it is optional or unnecessary, but cervical cancer is one of the leading causes of cancer death in women," she said. “If you can prevent your child from getting cervical cancer, that is a huge gift.”
SOURCES: Jen L., New York City mom; Eric Adjei Boakye, PhD, assistant scientist, department of health sciences, Henry Ford Health, Detroit, Mich.; Neal Hoffman, MD, attending physician, Children's Hospital at Montefiore, and associate professor, pediatrics, Albert Einstein College of Medicine, New York City; Jennifer Wu, MD, obstetrician/gynecologist, Lenox Hill Hospital, New York City; Pediatrics, May 23, 2023, online
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