Abstract PO-040: Understanding views against the HPV vaccine school-entry requirement in Puerto Rico
Authors: Rivas Gloriany , Soto-Abreu Roxana , Arroyo-Morales Glizette O. , Medina-Laabes Diana T. , Díaz-Miranda Olga L. , Vázquez-Otero Coralia , Colón-López Vivian 
Published: January 2022

Abstract
Introduction: Individuals and groups against vaccination have used various outlets, such as mass media, social media, and legislative hearings to express doubts about the human papillomavirus (HPV) vaccine. In 2018, the Puerto Rico Department of Health included the HPV vaccine as a school-entry requirement for children ages 11-12. Currently, the requirement extends to students ages 11-16. Since the announcement in 2017 of the new school-entry requirement as a preventive cancer strategy, many groups have expressed opposition. Although studies have documented the barriers and facilitators for implementing this policy on the island, qualitative studies assessing stakeholders' views against the implementation of the new requirement are lacking. We aimed to describe stakeholders' perspectives who opposed the HPV vaccine and the implementation as a school-entry requirement in PR. Methods: In-depth interviews (n=8) were conducted between March 2019-January 2020. Healthcare providers, religious leaders, and coalition spokespersons were interviewed. The Consolidated Framework for Research Implementation (CFIR) was used to develop the semi-structured interview guide. CFIR domains (and constructs) included were characteristics of individuals (knowledge, attitudes, and beliefs about the HPV vaccination, school-entry requirement, and exemptions), intervention characteristics (current practices, advantages and disadvantages of the implementation), and implementation procedures (planning, commitment of implementers and evaluation). Interviews were audio-recorded and transcribed in Spanish. Transcripts were analyzed using qualitative thematic analysis. Additional constructs were derived from CFIR constructs and emergent codes were included. Results: The most common CFIR domain observed was individual characteristics (knowledge and beliefs), of which HPV hesitancy and vaccine distrust were emergent themes. Arguments against the policy also cited the adverse effects of the vaccine under the intervention characteristics domain (evidence strength and quality). Lastly, excessive government interference was discussed by stakeholders in which concerns regarding the HPV vaccine school-entry requirement and how this policy does not align with their values of religious freedom, parental, educational and sexual rights were mentioned. Conclusion: Despite the recent documented positive impact of the school-entry requirement in HPV immunization rates in PR, many continue to oppose the vaccine mandate. Stakeholders' arguments against the HPV vaccine policy, including knowledge and beliefs, and excessive government interference, echo concerns of other mandated vaccines reported in the literature. Understanding arguments against school-entry requirements is necessary to tailor educational campaigns to increase vaccination rates, which were affected by the COVID-19 pandemic, prevent HPV-related cancers, and reduce the hesitancy in of school-entry policies in the future.
Citation Format: Gloriany Rivas, Roxana Soto-Abreu, Glizette O. Arroyo-Morales, Diana T. Medina-Laabes, Olga L. Díaz-Miranda, Coralia Vázquez-Otero, Vivian Colón-López. Understanding views against the HPV vaccine school-entry requirement in Puerto Rico [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-040.