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Clinical Effectiveness Group

Young women not in mainstream education are missing out on vital protection against cervical cancer

HPV vaccination prevents several serious diseases caused by the Human papillomavirus, including cervical cancer. The UK has been vaccinating young women, aged 12-13 years, against HPV since 2008 through a school-based programme. Uptake is high – around 84% of young women are fully immunised through the programme*, but new research published in Vaccine reveals some groups are less likely to be vaccinated than others.

Young woman about to receive a vaccine

The study, by researchers at Queen Mary University of London and UCL, found that young women were more likely to miss their first HPV vaccination if they:

  • didn’t attend a mainstream school (five times more likely)
  • had ever been excluded from school (twice as likely)
  • were from low-income families (twice as likely compared with high-income families)
  • were from Black African or ‘Other’ ethnic minority backgrounds (twice as likely compared with White backgrounds)

Most young women in the study (92%) started their HPV vaccination course. Parents of the 8% who had not yet started were asked why, and reported this was a result of:

  • a conscious decision, citing concerns about side effects, fear of needles, or not believing in the vaccine (for 50% of those not started)
  • practical reasons, such as not being at school on the day vaccines were being given (for 25% of those not started

This is the first UK-wide study investigating inequalities in uptake of the HPV vaccine, and the first to include those not attending a mainstream school. The research was carried out before the Covid-19 pandemic and associated school closures, which has significantly disrupted the HPV vaccination programme.

Helen Bedford, Professor of Children’s Health at UCL, says: 

“Infection with HPV can lead to cervical cancer, which can be life threatening. It is preventable through vaccination and everyone deserves the same opportunity to be protected, regardless of their background or schooling circumstances.

“We found important educational, socioeconomic and ethnic inequalities among those left unprotected against HPV. These are deeply concerning, particularly in the wake of Coronavirus school closures when many more young women missed the vaccination than usual. There is now an urgent need to catch up, while making sure these inequalities are addressed.”

Carol Dezateux, Professor of Clinical Epidemiology and Health Data Science at Queen Mary University of London, says: 

“Our findings highlight that the success of the HPV vaccination programme is not just about high coverage, but about making sure every young person has a fair chance of receiving this simple and safe vaccination to prevent cancer, irrespective of their background.

“With schools reopening, there are things we can do now to reduce these inequalities, including creating opportunities for young people and their parents to talk to a healthcare professional, and systematically adding school vaccination details to the GP record so unvaccinated patients can be contacted and offered vaccination at the GP surgery. We hope this study adds impetus to the efforts already being made by GPs, local authorities and school nurses to protect young people.”

* Last complete year pre-pandemic.


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