Abstract 988: Impact of the COVID-19 pandemic on HPV vaccine hesitancy

Abstract Background: A major reason for suboptimal HPV vaccination coverage in the US is parental vaccine hesitancy. The COVID-19 pandemic and the vaccine had an impact on public trust in public health authorities, science, and medicine. The novelty of the disease and concerns over safety and efficacy of COVID-19 vaccine led to several people refusing the vaccine and increasing hesitancy towards other vaccines, including the HPV vaccine. We examined if HPV vaccine hesitancy among parents with unvaccinated children have changed due to the COVID-19 pandemic in the US. Methods: This study used data from the 2018, 2019, 2022, 2023 National Immunization Survey - Teen. Hesitancy was defined by responses to the question, “How likely is it that [your teen] will receive HPV shots in the next 12 months?” as “not too likely, ” “not likely at all, ” or “not sure/don't know.” The Fisher exact test with FDR control was applied to identify significant predictors among adolescent’s age, gender, race, healthcare engagement, poverty level, doctor recommendation, geographic region; and mother’s age, marital status, education, number of children under 18, COVID-19 phases (2018-2019 as pre-COVID, and 2022-2023 as post-COVID), and their interactions. Next, logistic regression with forward selection was employed to quantify the effects of these predictors. Results: Analysis included 103, 977 unvaccinated adolescents (i.e., had not received any HPV vaccine doses at the time of the survey) whose parents were classified as vaccine hesitant. All demographic predictors and the COVID-19 timeline significantly influenced HPV vaccine hesitancy based on the two-stage estimation. In adjusted difference-in-difference analyses, overall, parental hesitancy during post-COVID years decreased compared to the pre-COVID years (aOR=0.84; 95% CI 0.79, 0.88). The impact of children's age and race and mother’s age showed consistent and significant changes from pre-COVID to post-COVID years. HPV vaccine hesitancy increased from pre-COVID to post-COVID years among parents of adolescents who were 15 (aOR=1.38; 95% CI 1.28, 1.46), 16 (aOR=1.40; 95% CI 1.31, 1.51) and 17 (aOR=1.52; 95% CI 1.40, 1.63), and among mothers who were over 45 years or older (aOR=1.06; 95% CI 1.01, 1.13). Conversely, HPV vaccine hesitancy of parents of non-Hispanic black adolescents (aOR=0.90; 95% CI 0.83, 0.98) decreased from pre-COVID to post-COVID years. Incorporating COVID-related features significantly enhances the ability to predict hesitancy. Conclusions: HPV vaccine hesitancy among parents of unvaccinated adolescents decreased overall from pre-COVID to post-COVID years. However, hesitancy increased within specific groups, notably among parents of adolescents aged 15 to 17 and mothers aged 45 years and older age. These trends highlight the need for future research to explore the underlying factors driving these differences, enabling more targeted and effective public health interventions. Citation Format: Eric Adjei Boakye, Jun Jin, Mrudula Nair, Dakshu Jindal, Joel Fokom Domgue, Olivia Aspiras, Samantha H. Tam, Nosayaba Osazuwa-Peters. Impact of the COVID-19 pandemic on HPV vaccine hesitancy. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 988.