Dec. 27, 2008 The public's concerns about costs and increased promiscuity among teenagers appear to be hindering use of a vaccine against the human papilloma virus (HPV) to prevent life-threatening diseases, according to a study by researchers at Yale School of Public Health.
There is an ongoing public health campaign promoting the vaccination of girls against HPV to prevent against genital warts and cervical cancer, but the Yale study showed the public believes that the benefits are outweighed by potential disadvantages. The Yale researchers—Sanjay Basu, a Ph.D. candidate, and Alison Galvani, assistant professor in the Division of Epidemiology of Microbial Diseases— studied how concerns about adolescent promiscuity and everyday economics lead many parents and guardians to not have their children treated.
The vast majority of those surveyed believed the risk of cervical cancer and genital warts (which are largely spread through sexual contact) is far lower with the HPV vaccine. But the same group of 326 adults in the United States also thought adolescent sexual activity would nearly double among those receiving the vaccine. Concern about increased promiscuity was the single biggest factor in the decision not to vaccinate, according to the study.
The Centers for Disease Control and Prevention recommends the HPV vaccination be administered to young girls between 11- and 12-years-old (and also to administer catch-up vaccinations to young women ranging from 13- to 26-years-old). But currently less than 25 percent of the target population has received even one of the three recommended vaccinations, far below the target needed to maximize the vaccine's potential public health benefit. An estimated 11,000 women in the United States alone were diagnosed in 2007 with invasive cervical cancer.
The researchers applied "game theory" to create a mathematical model of how such external factors as a fear of encouraging promiscuity and money influence perceptions and ultimately affect public health goals.
According to Basu and Galvani, the study suggests that educational programs that address specific public concerns might be needed to convince parents that the vaccine's benefits outweigh other factors.
In the past, other health campaigns have been hampered by the public's unwillingness to participate in sufficient numbers. "A fundamental but often-neglected aspect of developing and implementing an optimal intervention program is human psychology, which influences adherence to recommendations," Galvani said.
Financial considerations also influenced people's choices. The research found that even with health insurance and other financial assistance, the average family still had to spend $181 out of pocket to provide a child with all three vaccinations. The researchers estimated that the price of each vaccination would have to be cut by $55 per dose to significantly influence decision making in favor of the vaccine.
Even if an individual's perception on an issue such as HPV vaccination is not rational or well-informed, it is still a major factor in the decision-making process, the researchers said. If negative perceptions are widely held, they added, the effectiveness of a public health campaign could be crippled.
Gretchen B. Chapman of Rutgers University also participated in the study.
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- Sanjay Basu, Gretchen B. Chapman, Alison P. Galvani. Integrating epidemiology, psychology, and economics to achieve HPV vaccination targets. Proceedings of the National Academy of Sciences, 2008; 105 (48): 19018 DOI: 10.1073/pnas.0808114105
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