Parents More Likely to Support HPV Vaccine Requirements for School Enrollment If Able to Opt-Out

A new study published in Cancer Epidemiology, Biomarkers, & Prevention, a journal of the American Association for Cancer Research, found that when it comes to the idea of making the human papillomavirus (HPV) vaccine mandatory for school enrollment, parents are more likely to support it if they have the option to opt-out.

However, William A. Calo, PhD, JD, a postdoctoral research associate in the Department of Health Policy and Management at the University of North Carolina, Gillings School of Global Public Health, warns that the option to opt-out may impact the effectiveness of the HPV vaccine requirements, according to a press release.

The Centers for Disease Control and Prevention (CDC) states that, out of all of the sexually transmitted infections, HPV is the most common. In fact, almost all women and men who are sexually active will get it, making vaccination important. Vaccines can prevent HPV from developing into genital warts or cervical cancer. The CDC recommends that beginning at 11 or 12 years of age, girls and boys should receive the three-dose HPV vaccination. However, according to statistics provided by the CDC, only 22% of boys and 40% of girls between the ages of 13 and 17 have actually completed the three-dose HPV vaccination series. Despite the fact that the majority of HPV-caused cancers can be prevented through vaccination, vaccination remains low.

According to Dr. Calo, previous studies have shown that requiring boys and girls to get vaccinated for Hepatitis B, Tdap, and MMR in order to enroll in school, resulted in high uptake rates. According to the press release, since 2006, almost half of the state legislatures have attempted to add HPV to the required vaccination list for school enrollment, but due to “parental disapproval or ethical, political, or legal concerns,” their measures have been rejected; only Rhode Island, Virginia, and the District of Columbia require HPV vaccines, all of them with an “opt-out” option.

Dr. Calo and his colleagues, including Noel Brewer, PhD, the study’s senior author, professor of health behavior at the University of North Carolina, and a member of the UNC Lineberger Comprehensive Cancer Center, set out to understand where parents stood when it came to mandatory HPV vaccination in schools. From November 2014 to January 2015, the researchers led a web-based survey consisting of 1,501 parents who had to have at least one child living in the household between the ages of 11 and 17.

According to the press release, “The survey stated, ‘Some states are trying to pass laws that would require all 11- and 12-year-olds to get HPV vaccine before they are allowed to start sixth grade.’ Parents were then asked whether they agreed with the statement, ‘I think these laws are a good idea.’” The results showed that 54% of parents disagreed with the statement and only 21% agreed with the mandatory HPV vaccination for school enrollment. For the 25% who neither agreed nor disagreed, Dr. Calo commented that if this group were informed of the benefits of the HPV vaccination, they may be more likely to be in favor of it.

For the parents who said that they disagree with the aforementioned statement, they were then asked if they agreed with the statement, “It is okay to have these laws only if parents can opt out when they want to,” according to the press release. When given the option to opt-out of the required vaccination, 57% of the parents then agreed with the mandatory vaccination requirement, and 21% disagreed.

When speaking of the implications of having the option to opt-out, Dr. Calo said, “Any process for requesting an opt-out should have an educational component and encourage parents to carefully consider their decision.” Furthermore, Dr. Calo noted that if a large number of families decided to opt-out, then the HPV vaccination would not be as effective.

In addition to these findings, the web-based survey also discovered some of the reasons why parents did not support the HPV vaccination. A total of 32% of the parents who took the survey felt that “the vaccine was being promoted to make money for drug companies” and “only 40% felt that the vaccine was effective in preventing cervical cancer,” according to the press release.

When speaking of the need to change these perceptions, Dr. Calo said, “HPV vaccination saves lives. We have an unprecedented opportunity to prevent thousands of HPV-associated cancers through vaccination and unfortunately, we are missing that opportunity.”

Dr. Brewer noted that once other state efforts to raise HPV vaccination rates have proven successful, then HPV vaccination should be considered as a requirement for school enrollment. He recommended having state health departments centralize reminders to vaccinate, having states focus on quality-improvement visits to healthcare providers on HPV vaccination, and having states train physicians on how to use announcements as a way to introduce HPV vaccination.

The authors of the study noted that though the survey results were helpful, it did have its limitations. They felt that the respondents’ opinions might have differed if they had been prompted to discuss actual laws rather than hypothetic requirements. If the survey described the scope of opt-out provisions (medical, religious, or philosophical reasons) then the respondents’ answers may have varied even more.