This paper reviews the parental knowledge, attitudes, and behaviours toward having their daughters and sons vaccinated against cervical cancer. The parents in these studies were largely from a high resource background. The percentage of parents that participated in these surveys who had heard about HPV clearly rose over time (from 60% in 2005 to 93% in 2009). Parents' appreciation for the link between HPV infection and cervical cancer did rise (70% in 2003 to 91% in 2011). During the era of FDA approval of the vaccines, there appeared to be stronger awareness of the vaccines and this has waned with time. This same pattern is seen with the percentage of parents whose children had received the HPV vaccine (high of 84% in 2010 and now 36% in 2011). Unfortunately, this pattern is also seen with the intention to have a child vaccinated against HPV (peak at 80% in 2008 and now 41% in 2011).
In terms of barriers against the vaccine, parents still have safety and side-effect questions and they want more information. Parents view the vaccine like the oral contraceptive pill; it is best to invest in it only when you become at risk (i.e., you are sexually active). Parents who have high cancer worries and receive strong messages about HPV risks are more likely to advocate for the HPV vaccine. Parents look to their physicians to recommend the vaccine.
The strengths of this study are that it involves information gathered from a large number of parents from several countries. It shows trends in knowledge, attitudes, and behaviours over a time period just preceding the FDA approval of the vaccine; during the approval phase when there were extensive educational campaigns both by the pharmaceutical companies, professional societies, and media, after the FDA approval. The limitations of this study was an inability to validate parental responses, for example, determining how many parents had their child vaccinated with at least one dose of the vaccine.
It will be interesting to see if there are changes in parental attitudes as the types of information about HPV and the HPV vaccine continue to flood the literature. The information about the role of oncogenic HPV in more than cervical cancer is certainly evolving. We are just beginning to grasp the prevention implications of the HPV vaccine in the prevention of anal, oropharengeal, and a proportion of vulvovaginal, and penile cancers. The recent approval of the vaccine in young men may have an impact on decreasing condyloma transmission and having an impact on the rise of anal dysplasia/cancer in the male having sex with male population. As the cervical screening strategy moves toward primary HPV testing, this will also enhance education of the population. Although cost did not emerge as a significant barrier, as the vaccine prices continue to fall, it will be fascinating to see the impact on parental attitudes and behaviour. As public health looks at successful population-based prevention strategies, it will be interesting to look at parental attitudes toward passive consent versus active consent in school-based vaccination programs. Time will provide information on how durable the vaccine is and long-term sequelae; whether this will influence parental attitudes remains to be seen.
In terms of future implications for policy, when the goal is to preserve the health of the population, certainly the passive consent approach, whether it is for vaccination or cervical screening, seems to be showing profound benefits. There is preliminary data that shows women who are vaccinated have less need for cervical precancer procedures like biopsies and treatment, however, how this will impact guidelines and availability of such services in the future remains to be seen.