DEPARTMENT OF PUBLIC HEALTH MEDICINE

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ACADEMIC PROGRAMME: JOURNAL CLUB

2022

Safety and perception: What are the greatest enemies of HPV vaccination programmes?

21 June 2022

Introduction

• Vaccines act at both individual and population levels (herd immunity) and can modify the immune status and the epidemiology of an infectious disease also reducing the circulation of an infectious agent.
• Herd immunity is achieved when the vaccine coverage in the population is sufficient to prevent the circulation of the infectious agent among those who remain susceptible.
• At present, 3 prophylactic vaccines for HPV; Bivalent HPV 16/18, quadrivalent HPV 16/11/16/18, nonovalent 6/11/16/18/31/33/45/52/58 administered to females and males 9-14 years in two doses.

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Introduction continued

• WHO recommends that the introduction of HPV vaccines into national immunization programs be made into a public health priority, however, a great number of women remain vulnerable to HPV related cancers due to vaccine hesitancy – the delay in acceptance or refusal of vaccines despite availability of vaccination services.
• South Africa’s target of administering vaccines is the school health system, however this study is not limited to that population.
• The main determinant categories to vaccine hesitancy include; complacency, convenience and confidence.

Determinants of HPV vaccine hesitancy and poor involvement in vaccination programmes

• Complacency

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• Public concerns about adverse events

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• Low confidence in safety findings by health authorities

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• Cultural, religious or social aspects

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• Wrong information collected from websites

Complacency

• Immunization programmes have successfully reduced the incidence of vaccine-preventable diseases, leading to an increasing proportion of healthcare providers and parents with little or no experience about vaccine preventable diseases.
• The public is no longer used to seeing these diseases and may think that vaccines are no longer needed, therefore there is the perception that an infectious disease may not be harmful.
• Denial about the possibility of contracting a disease and the severity thereof.

Wrong information collected from websites

• Parents searching for information about vaccines on the internet are likely to encounter websites that encourage vaccine refusal or emphasize the risk of vaccines.
• The media may sensationalise vaccine safety issues and fail to provide perspective.
• Before the addition of the HPV vaccine to the national immunization programme between 2010 and 2013 local media channels reported cases of girls complaining of CRPS, chronic pain, absenteeism from school, videos of girls suffering from walking problems and seizures were shown by a “victim group” during a press conference.
• Even though there was no proven causal relationship between the reported facts and the vaccination, incorrect information has lead to poor confidence in vaccine safety despite healthcare provider reassurance.

Public concerns about adverse events

• Pre- and post-licensure studies confirm that HPV vaccines are generally safe and well tolerated. Site injection symptoms are the most common adverse events and pain is the most frequent local symptom.
• Serious adverse events are rare and not associated with severe sequelae and no vaccine related deaths have occurred.
• Fear of possible adverse events among the people has raised the idea that vaccination can lead to increase in multiple sclerosis, optic neuritis, transverse myelitis, acute disseminated encephalomyelitis and neuromyelitis optica.

Cultural, religious or social aspects

• The aim of vaccines is to prevent sexual transmission of HPV evoking moral judgement in regard to sexual behaviour.
• Parents are worried about the possibility that their daughters may become sexually active too early.
• Events are often psychological reactions that can spread quickly among the young community that are vaccinated in groups at schools and observe the reactions of one another.
• The various sectors of culture and religion needs to be addressed.

Overcoming HPV-vaccination hesitancy – good communication strategy

• Multicomponent and dialogue-based interventions are the most effective plans and should be directed at unvaccinated or under-vaccinated populations or at specific target groups as local community or healthcare workers
• Multiple studies show that healthcare providers are identified as the most important and reliable source of information on prevention of vaccine preventable diseases playing an important role for parents who have many questions or doubts.

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Overcoming HPV vaccination hesitancy – the role of healthcare workers

• Health authorities should invest in training healthcare workers.
• Health organisations like ECDC and WHO have published guidelines in order to provide useful advice based on scientific evidences to all healthcare provides.
• Reference to immunisation in wider terms e.g.; “Let’s talk about protection enhancing childhood vaccination uptake communication guide for healthcare providers.”
• Involve PHC workers in appropriate sectors e.g. family planning to provide education.

Overcoming HPV vaccination hesitancy – publishing web-based information

• More frequently people are searching for news about health by themselves, therefore it is necessary to provide scientific information, written in adequate language to all citizens.
• WHO, CDC and national health institutions periodically publish informative material; dedicated web pages available to users or booklets describe HPV infection.
• Language has to be most suitable for the specific audience; parents should receive reassuring words from healthcare providers, teenagers should understand the value of vaccination through simple examples that may use also a graphic approach.
• Videos, written testimonies, or short video clips of survivors of cervical cancer have a positive impact on the public and promote the importance of vaccination.

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Overcoming HPV vaccine hesitancy - Dialogue based communication

• Engagement of religious and influential leaders in community for dialogue based communication.

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Overcoming HPV vaccine hesitancy – Increase knowledge and awareness

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• Improvement of access to vaccination service
• Low costs of immunisation
• Social and mass media intervention

Conclusion

• A great number of women remain vulnerable to HPV related cancers due to vaccine hesitancy
• Many factors influence people’s opinion about vaccines; cultural, social, religious aspects, spreading of unverified information by media and fear about possible adverse events.
• In order to resolve all issues around HPV vaccine acceptance it is necessary to;
• include good communication strategies
• publish accurate web-based information and social media information on a level that appeals to the target group
• recruit primary healthcare workers for patient education
• address various cultural and religious sectors.
• Ensure accessibility and involve schools in vaccination programs.

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Closing thought

Given the context in South Africa, are these the type of strategies we should employ?

Safety and perception: What are the greatest enemies of HPV vaccination programmes? 21 June 2022

Thank You