In the JournalsPerspective

Fewer than 40% of adults support mandatory HPV vaccination

Findings published in Vaccine demonstrated that fewer than 40% of surveyed adults supported a policy requiring HPV vaccination for school entry.

Loren Saulsberry, PhD, instructor of public health sciences at the University of Chicago, and colleagues wrote that the vaccine has been “politically charged” since its approval in 2006 because the disease it prevents is sexually transmitted, and also because of several controversial legislative mandates.

The vaccine against HPV is a safe and proven cancer prevention method, so it is one that could have many benefits for public health,” Saulsberry said in a press release. “The better we can understand the public’s appetite for policies regarding HPV vaccination, the better we can implement approaches that are the most likely to be successful.”

Between May and June 2016, the researchers conducted a survey of 1,519 adults aged 18 to 59 years. Of these respondents, 290 were aware of the HPV vaccine.

More than half (59%) of the 290 adults who were aware of the vaccine supported a policy requiring pediatricians to offer it to children aged 11 to 18 years, but only 39% supported the vaccine being added to school requirements. Adults who believed that the science behind HPV vaccination was uncertain were less likely to support either policy (P < .0001). The researchers found that more women were supportive of physician requirements to offer the vaccine compared with men (65% vs. 50%; P < .05).

Among adults with some knowledge of the vaccine, only 44% of females aged 18 to 36 years and only 15% of males aged 18 to 33 years had been vaccinated against HPV.

“After more than 10 years of HPV vaccine use, school entry requirements remain underutilized as a tool to raise HPV vaccination uptake,” Saulsberry and colleagues wrote. “The observed lower public support for a school vaccination mandate in comparison with a requirement for physicians to offer the vaccine reiterates that the political will to pursue HPV vaccine school entry requirements may not be strong. Furthermore, the design of school entry requirements for the HPV vaccine may impact vaccine uptake as the inclusion of opt-out provisions have been shown to increase support while simultaneously limiting their effectiveness.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

Findings published in Vaccine demonstrated that fewer than 40% of surveyed adults supported a policy requiring HPV vaccination for school entry.

Loren Saulsberry, PhD, instructor of public health sciences at the University of Chicago, and colleagues wrote that the vaccine has been “politically charged” since its approval in 2006 because the disease it prevents is sexually transmitted, and also because of several controversial legislative mandates.

The vaccine against HPV is a safe and proven cancer prevention method, so it is one that could have many benefits for public health,” Saulsberry said in a press release. “The better we can understand the public’s appetite for policies regarding HPV vaccination, the better we can implement approaches that are the most likely to be successful.”

Between May and June 2016, the researchers conducted a survey of 1,519 adults aged 18 to 59 years. Of these respondents, 290 were aware of the HPV vaccine.

More than half (59%) of the 290 adults who were aware of the vaccine supported a policy requiring pediatricians to offer it to children aged 11 to 18 years, but only 39% supported the vaccine being added to school requirements. Adults who believed that the science behind HPV vaccination was uncertain were less likely to support either policy (P < .0001). The researchers found that more women were supportive of physician requirements to offer the vaccine compared with men (65% vs. 50%; P < .05).

Among adults with some knowledge of the vaccine, only 44% of females aged 18 to 36 years and only 15% of males aged 18 to 33 years had been vaccinated against HPV.

“After more than 10 years of HPV vaccine use, school entry requirements remain underutilized as a tool to raise HPV vaccination uptake,” Saulsberry and colleagues wrote. “The observed lower public support for a school vaccination mandate in comparison with a requirement for physicians to offer the vaccine reiterates that the political will to pursue HPV vaccine school entry requirements may not be strong. Furthermore, the design of school entry requirements for the HPV vaccine may impact vaccine uptake as the inclusion of opt-out provisions have been shown to increase support while simultaneously limiting their effectiveness.” – by Katherine Bortz

Disclosures: The authors report no relevant financial disclosures.

    Perspective
    Neal D. Goldstein

    Neal D. Goldstein

    Mandatory vaccination for school entry is overwhelmingly supported in the United States. The public health benefits of these policies are quite clear and have been for some time.

    A main force behind present day vaccination controversy is a small but vocal group of individuals and organizations who are susceptible to misinformation and lacking trust in established institutions. These “vaccine-hesitant” groups are connected politically and thus can garner support for anti-vaccination legislation. Fortunately, such proposed measures rarely become law.

    Along with the MMR vaccination, HPV vaccination has historically been one of the more controversial vaccines for a variety of reasons. Because only sexually active individuals are at risk for exposure to HPV, the vaccine unfortunately became conflated with sexual promiscuity. This has been repeatedly debunked, and the conversation has rightly shifted to it being a cancer-preventing vaccine. Nevertheless, the unfortunate association persists, as does the unfortunate and fallacious association between MMR vaccination and autism spectrum disorder, and this is one reason HPV vaccination is a politically controversial issue.

    As we have seen with other vaccination policies, this does not have to be an “all or none” approach. Offering the vaccination at the doctor’s office is a very low bar, and all states should do this immediately. Mandating the HPV vaccine as part of school entry will require more political capital and will be addressed on a state-by-state basis. As we have recently seen, though, with other vaccine-preventable diseases — notably measles — widespread outbreaks can be a tipping point for legislative action: mandating the vaccine and removing nonmedical reasons to opt out. Given the high rates of HPV infection, certain cancers of the head, neck, anal and genital areas will continue to be a source of preventable morbidity and mortality. Although this may spur legislators to take action for future generations, for the current generation, it may be too late.

    • Neal D. Goldstein, PhD
    • Assistant research professor
      Drexel University Dornsife School of Public Health

    Disclosures: Goldstein reports consulting for Merck.