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Pieces of the Continent #18: Emilie Karafillakis

Emilie Karafillakis is European Research Lead at the Vaccine Confidence Project (VCP), based at the London School of Hygiene & Tropical Medicine.

Q: Please introduce yourself and tell us a bit about your work.

As a social scientist, my work focuses on understanding the why and the how: for me, research primarily consists of listening and understanding how people feel about vaccination. This information is essential to guide strategies and interventions to maintain and restore trust in vaccination and therefore ensure high vaccination uptake. I’ve interviewed parents, pregnant women, adolescents and healthcare professionals, focusing on their views and acceptance of different vaccines: from seasonal influenza to HPV vaccination.

Q: What are the main responses you have seen to the HPV vaccine?

HPV vaccination is widely accepted by the public in most countries, reflected in high vaccine uptake rates. Yet, in some countries or communities, the introduction of HPV vaccination has been met with suspicion, mistrust and fears from both parents and adolescents. Concerns around possible short- and long-term side effects of the vaccines have been raised, together with beliefs that the vaccine may not be effective in preventing HPV or associated cancers. Despite HPV vaccination having been introduced in Europe around 15 years ago, these concerns are often raised together with perceptions of the vaccine as too ‘new’, with insufficient evidence on its safety and effectiveness. Parents and adolescents in Europe have also questioned the need to provide a vaccine against a sexually transmitted infection to adolescents that have not had sex yet, with some religious communities referring to a lower risk of HPV in their communities because adolescent girls do not have sex before marriage.

Q: How have the issues of trust and confidence towards the HPV vaccine changed since its development?

Public confidence in and acceptance of HPV vaccination has evolved differently in different countries. In some countries, such as the UK, HPV vaccine confidence has remained high since the vaccine was first introduced. In others, such as Denmark or Ireland, the vaccination programme was successful at first but the spread of rumours about possible side effects of the vaccine on social and digital media led to a drop in vaccine uptake. Countries were able to restore public confidence in the vaccine by engaging the public in developing targeted solutions, such as the improvement of communication on social media. Unfortunately, some countries, such as France, are still struggling with public controversies around HPV vaccination disseminated online as well as through more mainstream media. Uptake of HPV vaccination remains low, in part due to low recommendations by healthcare professionals.

Q: How can we tackle vaccine hesitancy in Europe?

There is no silver bullet for improving people’s confidence in vaccination: efforts to restore trust in vaccination take time and require a mix of diverse and context-specific interventions. What might work in one European country or even in one community might not work in another. This is why the first step in any strategy to tackle vaccine hesitancy should always be focused on listening and trying to understand people’s beliefs, perceptions and possible concerns around vaccination. Strategies then need to be adapted to these concerns and the best way to do this is to engage the public in the co creation of strategies to restore trust in vaccination. As healthcare providers are the most trusted source of information for vaccination, they should also play a central role in addressing vaccine hesitancy. For example, they should provide two-way communication and prioritise open, transparent and clear discussions with parents over the simple delivery of information that can sometimes be perceived as paternalistic or even judgmental.

Q: How do the internet and social media affect attitudes towards the HPV vaccine and vaccines in general?

The internet and social media have changed the way we communicate and access information, including around health and vaccination. Access to the internet have helped parents become more informed, more engaged, and more empowered in their health decisions. Unfortunately, this has often been criticised by health professionals, judging parents for looking up information on Google before their appointments. We need to acknowledge that the internet is now a part of our life and understand how it can be used to improve confidence in vaccination rather than simply trying to remove misinformation. While the internet and social media have indeed facilitated the global and rapid spread of misinformation about vaccination (what happened with the spread of rumours around HPV vaccination on social media in Denmark and Ireland is a good example of this), our efforts should focus on improving access to positive information about vaccination and providing parents with the tools to evaluate the quality of information they encounter.

Q: What do you see as the greatest obstacle to take-up of the HPV vaccine? How can we overcome this?

While in many low- and middle-income countries, which have the highest burden of HPV related cancers, access and affordability issues remain key barriers to HPV vaccination, low public confidence in HPV vaccination could be considered as one of the greatest obstacle to take-up of the vaccine in Europe. However, instead of placing the blame on parents and adolescents, we should focus on what we, as a scientific and health community can do to improve people’s trust in the vaccine and in those who recommend it.

Learn more about the HPV and the vaccine.


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