Deciding to delay: Medical uncertainty, sexuality, and the timing of HPV vaccination

Background: Vaccines represent one of the most successful public health interventions in modern medicine. Despite successes, cultural anxieties over vaccine safety and necessity continue in the United States—most recently in the context of the human papillomavirus (HPV) vaccine. Politically charged discussions of the influence of pharmaceutical companies on HPV vaccination policies, and fears that HPV vaccination may lead to riskier sexual behavior have exacerbated existing cultural anxieties. Additionally, there has been some medical uncertainty over the vaccine, including debates over the cost and benefit of widespread vaccination, and limited evidence of the long-term effectiveness of cervical cancer prevention. While these uncertainties continue today, little is known about the impact these factors have on parental decisions to vaccinate their children against HPV. Methods: This project utilized a mixed-methods ethnographic approach including in-depth interviews, surveys, and participant observation. Parents living in the San Francisco Bay Area were recruited using parenting networks and flyers at community locations. Participants (n=40) completed a written survey and semi-structured interview designed to examine: 1) risk perceptions; 2) decision-making factors; 3) information seeking behaviors; 4) vaccine knowledge; and 5) parenting values. Survey data was analyzed statistically. Qualitative data was analyzed using the constant comparative method. Results: While the majority of parents did not report that publicized debates significantly impacted their vaccination decisions, many reported that the lack of long-term evidence concerning the potential risks and benefits of HPV vaccination played a role in their decision-making. Within this group, few had vaccinated their children; however, most felt they would vaccinate their children at a later age when they perceived them as more vulnerable to HPV exposure, and thus would receive more benefit from vaccination. Parents' perceptions of their child's sexuality (including personality traits and behaviors) shaped these considerations. Additionally, some parents reported that their healthcare provider supported—or even suggested—delaying vaccination. Discussion: For many parents, the decision to vaccinate their child against HPV may not be a matter of if, but when. Further research is needed to understand how parental decisions to delay HPV vaccination, and healthcare providers' perceptions of vaccination timing may contribute to suboptimal vaccination rates. As more long-term effectiveness data becomes available, recommended adolescent immunization schedules should be reviewed and altered to match medical evidence. Additionally, patient-provider communication may need to be tailored to ensure that parents understand the risks—and potential benefits—of delaying vaccination.