Human Papillomavirus Vaccine Hesitancy Highly Evident among Caregivers of Girls Attending South African Private Schools

"...misinformation was the major driver of the very low HPV vaccination uptake by private-sector school girls whose caregivers participated in this study..."

The viral spread of social media misinformation and disinformation regarding human papillomavirus (HPV) vaccination safety has resulted in widespread vaccine hesitancy and suboptimal HPV vaccination uptake in many countries globally, including South Africa. Previous research indicates that, in 2018, only 19.4% of age-eligible girls in South Africa's private schools (where free HPV vaccination is not offered) had received one or more HPV vaccine doses. The present article reports on reasons given by caregivers for why their daughters were unvaccinated. The results may guide the South African National Department of Health in implementing interventions aimed at increasing public demand for HPV vaccination.

An online survey was administered to caregivers of girls in grades 4-7 attending South African private schools who were not vaccinated or whose vaccination status was unknown (to the caregivers). Most reasons were related to vaccine hesitancy (61.4%), especially safety concerns. Caregivers of private-school girls in South Africa do not receive HPV vaccination information through school authorities, so those who do seek this information may turn to the internet, where they are highly likely to find misinformation and disinformation, leading to vaccine hesitancy.Other major reasons cited were lack of access to the vaccine (21.3%) and lack of information (15.7%) - the latter being mainly that they had "never thought about it". Caregivers who reported a lack of information were statistically significantly less likely to have some tertiary education and access to medical insurance for their daughters than caregivers reporting other reasons.

The researchers point out that the majority (98.4% (314/319)) of respondents provided reasons that could be targeted by interventions to increase public demand and HPV vaccination coverage among age-eligible girls in South Africa. For example, the finding that 20.4% of vaccine-hesitant respondents were willing to vaccinate their daughters if the vaccine was provided free of charge at their daughter's school indicates that these caregivers are on the "acceptance even when in doubt" end of the vaccine hesitancy spectrum. Even though none of these respondents cited additional reasons related to lack of access, the prospect of being provided with access appears to be a sufficient "nudge" to move them towards vaccine acceptance. An additional explanation could be that these respondents may regard school authorities as independent and trustworthy decision makers and are thus prepared to take the lead from them, which "confirms that the trust that caregivers have in school authorities could be leveraged to build public demand for HPV vaccination."

Unsurprising to researchers is the finding that 83.8% of respondents reporting reasons related to lack of access were willing to vaccinate their daughters if the vaccine was provided free at their daughter's school. Most noteworthy is that the major reason for not being willing despite having this free and easy access to HPV vaccination was because their healthcare provider had not recommended HPV vaccination for their daughter. This finding underscores the important role that healthcare providers play in increasing HPV vaccination uptake.

In conclusion: "HPV vaccination coverage among age-eligible girls can be improved by including private-sector schools in the South African HPV vaccination programme, training healthcare providers to advocate for HPV vaccination and extending HPV vaccination advocacy campaigns to include private-sector educators."