Improving Vaccination Uptake: Overcoming the Myth of the Invincible Teen
Education and open dialogue are key to improving vaccine acceptance among teenagers, parents, and the community. Adolescent vaccines reduce the risk of preventable illnesses in this age group and may also help protect family members.
Professor of Pediatrics
“I think that a key component of the approach to adolescent vaccination is to not treat the adolescent like a child; however, at the same time, it is also important to ask them questions to determine 'where the teen is' in terms of their thinking.”
It is critically important that teenagers receive their recommended vaccines, whether they are the human papillomavirus (HPV), COVID-19, or influenza vaccines. While most teenagers who get infections such as influenza or COVID-19 do not become severely ill, we often cannot predict which individuals are going to be the ones who do become severely ill. Further, by vaccinating teenagers, we are helping to decrease the spread of infections to others. For example, vaccinating teenagers against pertussis—even if they are unlikely to become severely ill from pertussis—protects them and reduces the risk of them passing it to younger children at home who could potentially become extremely ill. Despite their importance, vaccines are not always accepted by teenagers, parents, and/or members of the community.
We recognize 18-year-old patients as being adults, which is interesting in that this is more of a social construct than a psychological or physiological construct. For instance, some people start developing an adult body at age 13 or 14 years, while, in others, this development may not start until after age 18 years. Still, when given the facts, a teenager, even at only 13 or 14 years of age, may have complex decision-making abilities that are similar to those of a 20- or 30-year-old adult.
I think that a key component of the approach to adolescent vaccination is to not treat the adolescent like a child; however, at the same time, it is also important to ask them questions to determine "where the teen is" in terms of their thinking. Teenagers are smart and can process information. If they feel like you are respecting them and respecting their intelligence, you are more likely to get a lot of information through to them.
It is true that some teenagers may be impulsive, may engage in fantasy thinking, or may not believe that bad things could ever happen to them. So, with that in mind, framing the HPV vaccine as being a means of cancer prevention is important. In addition, sometimes a picture is worth a thousand words. In an HPV vaccine–hesitant older teen, for example, it may help to solidify their decision to get vaccinated if they were shown photos of the genital warts that may develop in someone with HPV to understand what genital warts are, how they appear, and how they manifest.
The approach to vaccine hesitancy will vary depending on the scenario. Sometimes it is the parents who are hesitant and the teens actually want to receive the vaccine. Currently, if the patient is under 18 years of age, the parent has to provide permission for their child to be vaccinated. Even in circumstances in which the parents are reluctant to give permission for their child to be vaccinated, providing teenagers with information on vaccines and vaccination may encourage them to go back to their parents and continue the conversation. Parents who are resistant may change their view if their child is saying that getting vaccinated is what they want.
I think that we have all learned a lot over the last 3 years with COVID-19. I was working with some of our psychologists, especially in the black and brown communities, and we were trying to explain the need for COVID-19 vaccines. One of our psychology professors commented, “Everybody has to come to things in their own time, but today is your day. Today is your day to make the decision that it is okay to go get vaccinated.” You need to give people time to come to their own decisions regarding vaccination; you should not ostracize someone in this situation or make them out to be a bad person. I can disagree with somebody. That does not make them a bad person.
Abdullahi LH, Kagina BM, Ndze VN, Hussey GD, Wiysonge CS. Improving vaccination uptake among adolescents. Cochrane Database Syst Rev. 2020;1(1):CD011895. doi:10.1002/14651858.CD011895.pub2
Altman JD, Miner DS, Lee AA, et al. Factors affecting vaccine attitudes influenced by the COVID-19 pandemic. Vaccines (Basel). 2023;11(3):516. doi:10.3390/vaccines11030516
Delgado JR, Mansfield LN, Bruxvoort K, et al. Adolescent self-consent for COVID-19 vaccination: views of healthcare workers and their adolescent children on vaccination autonomy. J Adolesc Health. 2023;72(5):674-681. doi:10.1016/j.jadohealth.2022.12.018
Ford CA, Skiles MP, English A, et al. Minor consent and delivery of adolescent vaccines. J Adolesc Health. 2014;54(2):183-189. doi:10.1016/j.jadohealth.2013.07.028
Isaacs D, Britton PN. Perceptions of risk around COVID-19 and COVID-19 vaccines. J Paediatr Child Health. 2023;59(1):6-8. doi:10.1111/jpc.15778
Khairat S, Zou B, Adler-Milstein J. Factors and reasons associated with low COVID-19 vaccine uptake among highly hesitant communities in the US [published correction appears in Am J Infect Control. 2022;50(5):591]. Am J Infect Control. 2022;50(3):262-267. doi:10.1016/j.ajic.2021.12.013
Quinn SC, Jamison AM, An J, Hancock GR, Freimuth VS. Measuring vaccine hesitancy, confidence, trust and flu vaccine uptake: results of a national survey of White and African American adults. Vaccine. 2019;37(9):1168-1173. doi:10.1016/j.vaccine.2019.01.033
Szilagyi PG, Shah MD, Delgado JR, et al. Parents' intentions and perceptions about COVID-19 vaccination for their children: results from a national survey. Pediatrics. 2021;148(4):e2021052335. doi:10.1542/peds.2021-052335