HPV (Human Papilloma Virus) is the most common sexually transmitted virus worldwide and causes virtually all cervical cancers. In England, the HPV vaccination is routinely offered in schools to girls in Year 8. Starting in September 2019, it will also be offered to boys aged 12-13 years for the prevention of other HPV-related cancers, such as cancer of the anus, penis, head, neck and genital warts.
However, vaccines are one of the few medical interventions that sometimes lack trust and acceptance among the general population. The WHO has specifically outlined vaccine hesitancy and refusal as one of the top ten global health threats (WHO, 2019). For example, the Wellcome Global Monitor 2018 study, which surveys attitudes to science, health and vaccines across the world, recently reported that in Western Europe, 41% of people did not agree that vaccines are safe and for Eastern Europe, the figure rose to 50%! Unfortunately, attitudes towards the HPC vaccine fall in line with this trend as it has been subject to opposition in Europe, including the UK, and the US (Gallup, 2019).
So what are some of the main reasons that some parents delay or refuse consent their children for the HPV vaccine?
David Robert Grimes, physicist and cancer researcher at Oxford University, elaborated on the public’s concerns surrounding HPV vaccine and its effectiveness in a cancer blog for Jo’s Cervical Cancer Trust in August 2016.
The scientist suggested that opposition to HPV vaccine is sometimes due to moral concerns or presumed safety issues. For example, religious conservatives (especially in America) suggest that the HPV vaccine might encourage young people to become promiscuous or initiate sexual activity too early on. However, studies on sexual activity in HPV vaccinated and unvaccinated teen cohorts suggest that sexual activity is not elevated in the vaccinated group (e.g. Bednarczyk et al., 2012). Moreover, young people receiving the HPV vaccine actually tended be more aware of sexual health compared to their non-vaccinated peers. Similarly, the safety fears appear to be rooted in emotive, false and easily debunked ‘vaccine-damage’ narratives which are portrayed by media. For example, anti-vaccine campaigners spread claims online that the HPV vaccine causes thrombosis and chronic fatigue. Unfortunately, these claims often remain publicly unchallenged.
David Robert Grimes pointed out that these ill-founded arguments do not withstand the scientific and statistical evidence against them, as around 200 million doses of the HPV vaccine have been given worldwide to date, without reported physical or psychosomatic illness after inoculation. Nevertheless, targeted communication strategies to address these types of HPV vaccination fears and myths must be developed in order to increase the acceptance of the vaccine and, in turn, adolescents' protection against future HPV-associated cancers.
As billions of people worldwide now actively use social media, digital platforms could serve as an engaging medium for delivering vaccination promotion interventions. A scoping review of the scientific literature on the use of online social media for sexual health promotion identified that digital interventions are indeed capable of increasing knowledge about sexually transmitted infections (STI), such as HPV, and as well as produce short-term behavioural outcomes, such as attendance of HIV testing or chlamydia screening (Gabarron & Wynn, 2016).
For example, a recent study in the UK evaluated the effectiveness of a targeted advertisement for chlamydia screening on social media (Nadarzynski et al. 2019). The advertisement led to viewers to a Facebook-based sexual health promotion campaign which promoted a home-based chlamydia testing kit to adolescents and young adults, that could be ordered online. In the first part of the study researchers conducted face-to-face interviews with 19 young women to explore attitudes and preferences towards social media-based health promotion. Participants highlighted the importance of appropriate use of colour, level of interactivity, and use of humour for increasing engagement with promotional content in question. Facebook was the most preferred choice of social media and was perceived to be the most powerful platform for social interaction. However, the study findings also emphasized the need for anonymity when viewing sexual health adverts, as many participants were worried about their privacy and confidentiality. In the second part of the study researchers used Google and Facebook analytics. The findings showed that there was 277% increase in the visits on the chlamydia testing kit page and a 41% increase in chlamydia test kit orders, in comparison with the baseline period prior to the intervention (Nadarzynski et al., 2019).
A similar intervention could be developed for HPV home testing kits. However, the research in this area remains limited at present and so we need further studies to identify the effectiveness of such interventions in comparison to those delivered via traditional communication channels. But in the age of tailored advertisements, content and ‘cookies’, let’s hope that we will soon leverage social media to address public information needs and change the online dialogue to support the uptake of the HPV vaccination.
Edited by Dr Rebecca Richards
Bednarczyk, R. A., Davis, R., Ault, K., Orenstein, W., & Omer, S. B. (2012). Sexual activity-related outcomes after human papillomavirus vaccination of 11- to 12-year-olds. Pediatrics, 130(5), 798-805
Gabarron, E., & Wynn, R. (2016). Use of social media for sexual health promotion: a scoping review. Global health action, 9, 32193.
Gallup (2019). Attitudes to Vaccines. Wellcome Global Monitor – First Wave Findings.
https://wellcome.ac.uk/sites/default/files/wellcome-global-monitor-2018.pdf [Accessed 26 June 2019).
Grimes, D. (2016). We know it's effective. So why is there opposition to the HPV vaccine? Jo’s Cervical Cancer Trust https://www.jostrust.org.uk/blog/we-know-its-effective-so-why-there-opposition-hpv-vaccine [Accessed 21 June 2019].
Nadarzynski, T., Burton, J., Henderson, K., Zimmerman, D., Hill, O., & Graham, C. (2019). Targeted advertisement of chlamydia screening on social media: A mixed-methods analysis. Digital health, 5, 2055207619827193. doi:10.1177/2055207619827193
World Health Organization. (2019). Ten threats to global health in 2019.
https://www.who.int/ emergencies/ten-threats-to-global-health-in-2019 [Accessed 26 June 2019]