Research Explores Link Between COVID-19 Vaccine Hesitancy and HBV, HPV Uptake

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An analysis into correlation between COVID-19 vaccine uptake and that of more established vaccines showed research is lacking—yet troubling all the same.

A review of scarcely available research into correlations between COVID-19, human papillomavirus (HPV) and hepatitis B virus (HBV) vaccine hesitancies suggests there may be an associated likelihood of the latter 2 when the former is present.1

New research from a team of investigators at the University of Minnesota showed little analysis has conveyed whether COVID-19 vaccine hesitancy may be linked to other forms of vaccine hesitancy for common conditions like HPV and HBV. The research that was available for review, however, suggests a “potential spillover” worth further longitudinal analysis into the correlation.

A team of investigators led by Emily K. Vraga, PhD, of the Hubbard School of Journalism and Mass Communication, sought to interpret whether public hesitancy toward the relatively newer vaccines developed to prevent COVID-19 has been associated with hesitancy toward more historically established vaccines. They additionally wanted to learn whether exposure to social media-based misinformation on COVID-19 vaccines is linked to increased risk of other vaccine hesitancy. They described the COVID-19 pandemic as a “perfect storm in terms of preexisting vaccine hesitancy and a media environment that was well suited to amplify concerns and misinformation” regarding the COVID-19 vaccine’s development, and efficacy and safety.

“We answer these questions in the context of the HPV and HBV vaccines because the former has been received with hesitancy by some segments of the public, as was COVID-19,” Vraga and colleagues wrote. “This is due in part to the politicization of these vaccines. We also include HBV vaccination to determine whether the impact extends to other cancer-related vaccines.”

The team systematically reviewed 322 reports regarding vaccine uptake, intention and hesitancy for each of HPV, HBV and COVID-19 prophylaxes; only 7 trials, each cross-sectionally designed and excluding HBV vaccine data, met their review criteria. Among those, 5 observed significant associations between COVID-19 and HPV vaccine hesitancies after adjusting for potential confounders, and 1 observed associations when unadjusted for covariates.

Among 4 cross-sectional trials that framed their analysis as to whether HPV constructs impacted COVID-19 constructs, 3 showed cohort who received HPV vaccines were each more than 2-fold likely to receive or intending to receive a COVID-19 vaccination.

In 1 trial that lacked a statistical comparison of the relationship between COVID-19 and HPV or HBV constructs, just 58% of parents who stated that they would be likely to vaccinate their child against HPV would also do the same against COVID-19.

Regarding their research question as to whether misinformation on COVID-19 vaccines from social media was linked to other vaccine hesitancies, Vraga and colleagues noted that none of the 72 identified trials pertaining to those parameters met their research criteria.

“Studies identified as potential candidates by our literature search generally described COVID-19 vaccine misinformation on social media, without examining whether exposure to misinformation on social media was associated with HPV or HBV vaccine hesitancy, intention, or uptake among individuals within social media networks,” they wrote.

In discussing the findings, investigators stressed the need to further research the possible spillover effect of vaccine hesitancy, intention or uptake during the COVID-19 era.

“Our systematic review also points to the need for innovative work to explore the impact of social media exposure to COVID-19 misinformation on HPV and HBV vaccine attitudes,” they wrote. “Existing research is often limited to documenting the prevalence of vaccine misinformation on social media or looking at the association between social media use and vaccine attitudes.”

In an HCPLive Peer Exchange panel discussion last year, Wendy Wright, DNP, ANP-BC, an adult and family nurse practitioner at Wright & Associates Family Healthcare, stressed the importance of her clinician peers targeting “the movable middle” of the vaccine-hesitant population.2

“That’s the 20% to 40% of the population who will go based on a trusted source,” Wright said. “If they trust you and you make that recommendation, they’ll listen. With people in the middle, we have to take a breath, meet them where they’re at, be honest with them, give them what they’re asking, and don’t go into too much detail.”


Vraga EK, Brady SS, Gansen C, et al. A review of HPV and HBV vaccine hesitancy, intention, and uptake in the era of social media and COVID-19. Elife. 2023;12:e85743. Published 2023 Aug 18. doi:10.7554/eLife.85743

Rodhe R, Wright W, Abdul-Mutakabbir J, King M. Addressing Vaccine Hesitancy and Uptake for SARS-CoV-2. HCPLive. Published November 30, 2022.