The Role of Cognitive Bias in Suboptimal HPV Vaccine Uptake.

Abstract

* Abbreviations: HPV — : human papillomavirus MCV4 — : meningococcal conjugate Tdap — : tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed Human papillomavirus (HPV) vaccination coverage in the United States is suboptimal, leaving many adolescents and young adults vulnerable to infection. In 2014, only 40% of girls and 22% of boys aged 13 to 17 years received all 3 recommended doses.1 This level of coverage results in 14 million US adolescents inadequately immunized against HPV. In sharp contrast, coverage for other vaccines that are also recommended for routine use in adolescents is substantially higher, including 88% for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis, adsorbed (Tdap) and 79% for meningococcal conjugate (MCV4) vaccines. Many studies have demonstrated that a key factor hindering better coverage for HPV vaccine is lack of strong recommendations from clinicians.2 Clinicians have reported several reasons for this, including anticipated parental hesitancy, lack of perceived risk among their patients, and concern about the need for time-consuming conversations or discussions about sexual activity.3 Another factor that potentially limits higher coverage is clinicians’ cognitive biases against HPV-associated diseases. This topic is receiving substantially less (if any) attention in the scientific literature because it is not likely to be reported by clinicians themselves who may be unaware of the impact of these preconceived notions. HPV-associated diseases include 6 types of cancer and genital warts that cause a substantial amount of morbidity and mortality. The current burden of diseases … Address correspondence to Linda M. Niccolai, PhD, Yale School of Public Health, 60 College St, New Haven, CT 06520. E-mail: linda.niccolai{at}yale.edu