Countering Myths, Conspiracy Beliefs and Attempts to Discredit Public Health Interventions: How Should HPV Vaccination Program Efforts Proceed?

Vaccines and family planning rank among the most significant public health achievements, but in many countries, their success has done little to diminish controversies that have marked their histories. Programs have been disrupted by patient fears and anxieties, provider hesitancy, misinformation, localized sociocultural dynamics, and anti-vaccination and anti-birth control movements. This paper describes the commonality of such problems across fields and contexts, assesses measures taken to address these challenges, and derives lessons to improve program efforts, particularly for African countries now starting to introduce human papillomavirus (HPV) vaccination and struggling to raise low contraceptive prevalence rates. Regarding these challenges, we (1) set out and compare major misperceptions regarding contraceptives and HPV vaccines, efforts made to dispel such myths, and reasons for their chequered success; (2) compare and contrast the roles of junk science and scientific uncertainty in such controversies, along with research strategies to counteract their impact and to improve communication of risk; (3) compare strategies of movements against vaccination, abortion and family planning, and how they can be mitigated; and (4) compare the role of policies across countries, particularly regarding HPV vaccination, for youth in the WHO recommended vaccination ages of 10-14 years. The situations in Africa and the USA are given greater weight. The U.S. helped pioneer family planning and HPV vaccination programs, being the first country to distribute the HPV vaccine in 2006, but its potential to prevent morbidity and mortality is still not being met. By mid-2016, 65 countries had established HPV vaccination programs. This includes few African countries, yet Rwanda now has among the highest HPV vaccination rates in the world, comparable to those in Australian and the UK which have also pursued successful school-based HPV vaccination programs. This paper addresses lessons for both the U.S. and African nations now implementing HPV vaccination programs.