Inequalities in uptake of the HPV vaccine

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By Harriet Fisher

Human Papillomavirus (HPV) is a highly prevalent, sexually transmitted infection. Most people will be infected at least once in their lifetime, and the first time usually occurs during adolescence.  Persistent infection with HPV can lead to the development of genital warts and, more rarely, cervical cancer and other HPV-related cancers.

In England, measures are in place to both prevent the development of cervical cancer, and detect it in the early stages when it does occur. Since 2008, a national programme has offered the HPV vaccine to all young women in year 8 (aged 12 to 13) at school. During the first two years, young women aged 13 to 18 were also offered the HPV vaccine in a ‘catch-up’ programme. Additionally, cervical screening is routinely offered to women in England aged between 25 and 64. This detects early abnormalities which, if left untreated, could lead to cervical cancer.

Recently BBC News reported the results from a study carried out by University College London, which looked at psychological factors associated with whether young women intended to receive the HPV vaccine and whether they received it. The study participants were young women aged 16 to 17 who were eligible for the ‘catch-up’ HPV vaccination programme, who were questioned once at the start of the study and a second time after 12 months. The study found that although participants from an Asian background were as likely to receive the HPV vaccine as White young women, those from Black or ‘Other’ ethnic backgrounds were less likely to have received the vaccine.

This news piece was of particular interest to me as it is highly relevant to my PhD research. This is examining how socioeconomic and cultural factors contribute to inequalities in uptake of the HPV vaccine (the likelihood of opting to have the vaccine) for young women from disadvantaged backgrounds and those from Black and Minority Ethnic (BME) groups.  

Earlier this year we published a study which confirms and supports the findings of the research described above. We showed that young women aged 12 to 13 from a BME group who were eligible for the ‘routine’ HPV vaccination programme were less likely to receive the HPV vaccine than White British young women. As the BBC piece commented, this is particularly important given that findings from a study undertaken by the charity Jo’s Cervical Cancer Trust, which showed that BME adult women were more likely than White adult women to report that they had never attended a cervical screening appointment.

‘Intervention generated inequalities’ can emerge if effective public health interventions are not used fairly and equally by different population groups (see this paper by White et al. for a full discussion of this). Differences in uptake of the HPV vaccine and cervical screening by different ethnic groups may increase ethnic inequalities in cervical cancer. Now that these inequalities have been identified, it is really important that more research is carried out to help address these.

As part of my PhD, I have been carrying out a qualitative study involving young women from three schools in England with a high proportion of students from BME backgrounds. This study is trying to find out the barriers and facilitators to receiving the HPV vaccine, and ways to help more young women receive the HPV vaccine if they want it. I am currently carrying out data analysis for this study, which we hope will lead to recommendations to improve HPV vaccination uptake for these groups. Future research is also needed to try to find ways to help more women from BME groups attend for cervical cancer screening. 


Harriet Fisher is a DECIPHer PhD student based at the University of Bristol.

1 Comment

  1. Peter Baker

    A very interesting article. Improving vaccination rates among girls is very important. But girls could also be protected by vaccinating boys as part of the national programme. This would also protect boys against a range of cancers and genital warts and be of particular benefit to men who have sex with men as they derive little protection from a girls-only programme. Vaccinating both sexes, as now happens in Australia and is recomemnded in the USA and Canada, would also mean that responsibility for preventing HPV-related diseases is equitably shared and not seen as the sole responsibility of girls and women.

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