Comparatively low attendance during Human Papillomavirus catch-up vaccination among teenage girls in the Netherlands: Insights from a behavioral survey among parents

Abstract

BackgroundThe Dutch Human Papillomavirus (HPV) catch-up vaccination program in 2009 appeared less successful than expected. We aimed to identify the most important determinants of refusing the vaccination.MethodsTwo thousand parents of girls born in 1996 targeted for HPV vaccination received an invitation letter to participate in a questionnaire study. Two study groups were defined: the first group consisted of parents of girls who had accepted the vaccine and already received the first dose of HPV vaccination. The second group consisted of parents whose daughters were not vaccinated. The questionnaire consisted of a broad spectrum of possible determinants that were revealed after literature search and discussions with the stakeholders.ResultsFour hundred sixty nine questionnaires (24%) were returned, 307 (31%) from those who accepted and 162 (16%) from those who declined the vaccine. The decision not to accept the vaccine was largely determined by: (i) perception that the information provided by the government about the vaccine was limited or biased (OR 13.27); (ii) limited trust, that the government would stop the vaccination program if there were serious side effects (OR 9.95); (iii) lack of knowledge about the effectiveness of the vaccine (OR 7.67); (iv) concerns about the side effects of the vaccine (OR 4.94); (v) lack of conviction that HPV can be extremely harmful (OR 3.78); (vi) perception that the government is strongly influenced by vaccine producers (OR 3.54); and (vii) religious convictions (OR 2.18).ConclusionsThis study revealed several determinants for HPV vaccination uptake after implementation of the HPV vaccine for adolescent girls. These determinants should be taken into consideration in order to successfully implement HPV vaccination into National Immunization Programs.

HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

“…Insufficient knowledge or information, and beliefs that the information available is unclear, biased and/or inadequate were identified in almost all articles reviewed. An average of 44% of hesitant participants from quantitative studies reported that there was insufficient information available about HPV vaccination, and/or that their own knowledge was insufficient, [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] particularly in studies in Romania (2015, 81%), 30 the Netherlands (2009-2011, 67%), 26,28 and Denmark (2010, 70%). 35 This was also reported by 53% of general study participants [42][43][44][45][46][47][48][49][50][51] and 11% of favourable study participants.…”

Immunogenicity and safety of human papillomavirus (HPV) vaccination in Asian populations from six countries: a meta-analysis

“…Notably, as shown here, vaccine immunogenicity and safety studies from Asian countries show comparable outcomes to studies in other regions, including those in developed countries. For overcoming potential barriers in the area of socioeconomics, including acceptance, adherence (62,63), education and promotion of HPV-related cancer prevention should be further substantiated. Direct promotion by health-care professionals is considered as the optimal strategy (63).…”

The benefit of the doubt or doubts over benefits? A systematic literature review of perceived risks of vaccines in European populations

“…In the 29 articles that studied HPV vaccination , the most common concerns identified were about safety, and particularly unknown adverse reactions that might develop long after vaccination [104][105][106][107][108][109][110]112,113,[115][116][117][118][119][120][123][124][125][126][127][129][130][131][132]. These concerns often came with discussion around the newness of the vaccine [104,107,112,113,117,126,129], and claims that it has not been tested long enough [104,105,107,115,122,[129][130][131].…”

“…Mistrust was common, especially of pharmaceutical companies [105,106,118,130], government [104,109,123], research [112,130], and health authorities [118,130]. Two studies reported conspiracy theories about vaccines causing sterilisation [118,130] and others expressed concerns about the vaccine not being natural [ 104,130], and a preference for homeopathy, screening or sexual abstinence [105,117,130].…”