Concerning Youth and Vaccination Hesitancy

By Bethanne Bradshaw and Marcy Snyder

The classic picture of a rebellious teen generally entails breaking curfew or skipping class, but in a post-Covid world, rebellion has taken on a new form. Nicolas Montero, a 16-year-old Pennsylvania junior, was at odds with his anti-vax parents and opted to go to Philadelphia where the city permits children 11 and up to be vaccinated without parental consent. In Louisiana, a mother filed a complaint after her 16-year-old son received the Covid vaccine at a school-hosted mobile vaccination session. The consent form he had completed did not require the signature of a parent. Both of these cases raise an essential question: Are all minors clamoring to be vaccinated, and what role do teens want to play in their health?

Stories like the one above, have made for splashy news coverage, but are they representative of teenagers’ views on vaccination? The data is somewhat mixed on this point. Assuming a teen is undergoing the routine vaccination schedule that is recommended to all US teenagers (age 11+) with average risk levels, they need to receive two doses of human papillomavirus Vaccines (HPV), a yearly influenza vaccine, a twodose series of the meningococcal vaccine, and a Tdap vaccine with a booster dose (CDC vaccination schedule). However, only about 80% of teens make it all the way through this series. According to a recent survey by UNITY (a nonprofit dedicated to increasing vaccination rates in America), 23% of people aged 14-24 believe that vaccines are “only for babies” and 34% don’t know how vaccination helps them. 47% of teens do not like talking to their pediatricians or health care providers at all, which may be a cause for this information gap.

The long-term sequelae of avoiding vaccination can be deadly. HPV is a sexually transmitted disease that has become so common that almost all sexually active men and women will be exposed to it. The majority of infected people will be asymptomatic and heal on their own; but long-term exposure to an oncogenic strain can result in cancer. HPV is considered to be the cause of 90% of all cervical and anal cancers. It is also the cause of a variety of oropharyngeal, vulvar, vaginal and penile cancers. In the United States, an estimated 39,000 HPV-related cancers are diagnosed each year. 28,500 of these cancers are directly connected to HPV subtypes that may be prevented with the 9-valent vaccination. 10 The population that is most susceptible to developing an HPV-related malignancy is young adult and childhood cancer survivors. Despite being three times more likely than the general population to acquire a secondary neoplasm later in life, this demographic is vaccinated less than the general public.7

Interestingly, while it is broadly known that the vaccine hesitancy is a problem for uptake of the Covid19 vaccine, the pandemic impacted all vaccination rates negatively.

After March of 2020, visits to pediatricians plummeted and many children fell through the cracks of the system and didn’t receive their routine vaccinations.1 Vaccination rates have since returned to pre-pandemic levels, however the proportion of all children who are up to date on their vaccinations overall is down.1 While vaccine hesitancy due to misinformation is a massive problem, there are likely many teens who didn’t get vaccinated simply because they didn’t see their doctors as they might have otherwise during the pandemic. Given this situation, it is important to alert teenagers and their families to check with their pediatricians to make sure they are up to date on all of their vaccines, not just their recommended covid shots.

The covid vaccine is not currently considered part of the CDC’s routine vaccination schedule for children, though it is strongly recommended that teenagers receive the vaccine. Only about 68% of people ages 14-24 have received at least one dose of the covid vaccine, meaning its uptake is significantly lower than that of routine immunizations. 3 This is lower than the roughly 80% of teenagers who receive all of their recommended vaccines, and at least some of this discrepancy is likely due to vaccine misinformation posted by TikTokers and social media moms aimed at teens. Common myths targeted at teens included statements that it would harm someone’s future fertility or affect their journey through puberty adversely. Interestingly, many of the most pervasive myths about covid stem from facts or at least half-truths. It is true that many women reported changes to their periods after the vaccine, but it has not been demonstrated to change someone’s fertility.

Despite the pervasive myths and personal anecdotes shared via TikTok and Facebook, not all teens are turning to these platforms to receive information pertinent to their health. In fact, some teenagers have taken to the internet to encourage others to take responsibility for their own health. Kelly Danielpour, an undergraduate student at Stanford, created VaxTeen, a website designed to educate teenagers and young adults on the dangerous tide of misinformation, and encourage unvaccinated youth to catch up on the vaccines they are missing. The website includes resources that help teens to engage in difficult conversations with anti-vax parents and links to minor vaccination consent laws in each state. It even includes a link to a site that allows people to practice having vaccination conversations with skeptics.

Social media and the internet are not necessarily the enemy to increasing numbers of teenage vaccination. A hallmark of adolescence is the start of independent decision making, and equipping teens with the information they need to make informed decisions on their health, as well as the resources to carry out those decisions is the best way to raise up a generation of happier and healthier young people.

References

1. Brian P. Jenssen, M. D. (2022, January 1). Covid-19 and routine childhood vaccinations. JAMA Pediatrics. Retrieved January 17, 2023, from https://jamanetwork.com/journals/jamapediatrics/ fullarticle/2784889

2. Centers for Disease Control and Prevention. (2022, February 17). Birth-18 years immunization schedule. Centers for Disease Control and Prevention. Retrieved January 17, 2023, from https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html

3. Children and covid-19 vaccination trends. Home. (n.d.). Retrieved January 17, 2023, from https://www.aap.org/en/pages/2019novel-coronavirus-covid-19-infections/children-and-covid-19-vaccination-trends/

4. Daley, K. (n.d.). La. Mother threatens lawsuit after teen son gets covid-19 vaccine at school without permission. https://www.fox19.com. Retrieved January 17, 2023, from https://www.fox19.com/2021/10/25/la-mother-threatens-lawsuit-after-teen-son-vaccinated-against-covid-19-school-withoutpermission/

5. Danielpour, K. (n.d.). VaxTeen. Retrieved January 17, 2023, from https://www.vaxteen.org/

6. Feldman, N. (2022, February 16). This 16-year-old wanted to get the COVID vaccine. he had to hide it from his parents. NPR. Retrieved January 17, 2023, from https://www.npr.org/ sections/health-shots/2022/02/16/1074191656/this-16-year-oldwanted-to-get-the-covid-vaccine-he-had-to-hide-it-from-his-pare

7. Henderson TO, Fowler BW, Hamann HA, Nathan PC, Whitton J, Leisenring WM et al. Subsequent malignant neoplasms in the Childhood Cancer Survivor Study: Occurrence of cancer types in which human papillomavirus is an established etiologic risk factor. Cancer 2022; 128: 373-382.

8. Pandemic myths are all over social media-and they're dangerous for kids. National Geographic. (2021, October 6). Retrieved January 17, 2023, from https://www.nationalgeographic.co.uk/family/2021/10/pandemic-myths-are-all-over-social-media-and-theyr e-dangerous-for-kids

9. Vaccine Resource Hub. (n.d.). Retrieved January 17, 2023, from https://vaccineresourcehub.org

10. Viens LJ, Henley SJ, Watson M, Markowitz LE, Thomas CC, Thompson TD et al. Human Papillomavirus-Associated Cancers - United States, 2008-2012. MMWR Morb Mortal Wkly Rep 2016; 65: 661-666.