Shaping public health: How immunisation research is addressing communication for Scotland’s HPV vaccine

The HPV vaccine programme was introduced in Scotland in September 2008 – but uptake rates have dropped globally since the Covid pandemic.

Now, researchers at Edinburgh Napier University are looking into ways to reach vulnerable and hard-to-reach groups and improve communication messaging with them more effectively to boost the numbers that are vaccinated and prevent future cancer cases.

Academics from the University’s Centre for Biomedicine and Global Health are among those at the forefront of the work to help Public Health Scotland increase understanding of the need for protection in different communities.

Moving beyond ‘one size fits all’ messaging

The number of S1 pupils having one dose of HPV vaccine dropped in 2023/24 according to Public Health Scotland, continuing a long-term gradual decline in HPV coverage rates over the past decade.

The reasons for the lowered uptake are many and varied, which is why Edinburgh Napier University researchers like Dr Carol Gray Brunton, a research psychologist who lectures in Health and Social Care Sciences, and Dr Janette Pow a lecturer and former Health Visitor who leads the Master of Public Health Programme for the School of Health and Social Care, are focused on better understanding “vaccine hesitancy” among hard-to-reach groups.

As Carol explains, it’s only by listening to and working with the views of vulnerable groups, such as those with an intellectual disability, or sexual minority groups (like gay, bisexual, men-who-have-sex with men) and ethnically diverse groups, that any barriers to vaccination can be addressed through targeted communications.

“Since the pandemic we’ve seen lowered rates of vaccines across the population, which means increased risks of disease and outbreaks.

“So that is why we are looking at and applying theoretical insights from behavioural and psychological science, for example, to a real public health problem and trying to reach people who are most vulnerable because sometimes it is the most vulnerable groups in society who aren't being vaccinated.”

The pair have a long history of working together to understand the way different people view the HPV vaccine (read more here).

"Prevention is one of the key principles of public health: health protection and improvement. And vaccination, or immunisation, is one of the methods we use to protect the public; we want to ensure that we are meeting vaccination uptake levels because we need what's called ‘herd immunity’,” explains Janette.

“In Scotland, we do have high uptake rates, but we still aren’t reaching the pre-pandemic level . The World Health Organisation wants to see 90% of all girls vaccinated by 15 for cervical cancer elimination . We’ve concentrated our research on HPV, however other diseases like measles, where the uptake rates for the measles, mumps and rubella (MMR) vaccine have declined and outbreaks have occurred as a result.”

Sharing knowledge to prevent cancer

Thanks to insights from the Centre’s ongoing research, different ways are being considered to address the stigma around HPV and the vaccine.

"This is a cancer prevention vaccine; what we're keen to communicate is that this is a vaccine that was really highly successful in Scotland before the pandemic,”* says Carol. “It was called ‘the Jade Goody effect’ because the link between HPV and cancers became more widely understood after a celebrity died from cervical cancer; it helped to highlight the need for vaccination prior to being sexually active.

“Post-Covid, with the global slump in vaccination in general, and with boys being introduced into the national school-based vaccination programme later in 2019 in Scotland, somehow the messages for cancers affecting boys/men haven’t been as widespread like head and neck, penile and anal cancers. We need to get that message out around cancer prevention for boys themselves but also protection for their future partners as well.

“In this case it’s about knowledge and appropriate communication for parents and young people so when they come to make the decisions about the vaccine they understand what it is and why it’s important.”

‘A mission to tackle real-world health challenges’

At Edinburgh Napier’s Centre for Biomedicine and Global Health, a team of experts from different disciplines are working together to explore the full arc of human health from early development through to adulthood to uncover the root causes of disease.

“Our research is driven by a clear purpose: to tackle real-world health challenges through innovative, translational science. As part of our applied research portfolio, we look to deliver practical solutions to complex biomedical challenges — bridging the gap between fundamental discovery and health improvement worldwide,” says its director, Professor Peter Barlow.

As he explains, the research on increasing uptake of the human papillomavirus (HPV) vaccine has delivered critical insights into how gender, vulnerability, and social factors can affect vaccine access and acceptance. “By addressing the barriers faced by girls and women, boys and men, together with marginalised populations, this work is helping shape inclusive, evidence-based public health strategies — both in the UK and internationally.”

Elsewhere within the centre, its impact spans a number of areas of global health from Professor Mick Rae’s pioneering work on polycystic ovary syndrome (PCOS) to Dr Fiona Kerr’s work on neuro-inflammation and mechanisms of brain ageing and neurodegeneration. Internationally, Dr Mary Abboah’s leadership of the ExtraCECI trial in Ghana aims to generate evidence around community-based, person-centred care to improve outcomes for people living with HIV/AIDS. Professor Eva Malone is also leading some work with international partners around piloting HPV educational interactional workshops aimed at S1 pupils to increase their HPV knowledge and awareness, and is working with Carol.

Continuing to engage with Scotland’s minorities

And the work on improving vaccine uptake doesn't stop there: other ENU academics like Dr Elaine Carnegie are collaborating with Janette and Carol to better communicate and understand young men with intellectual disabilities’ perceptions of HPV and HPV vaccine, for example, a very neglected group. Development of a cross-cultural HPV community engagement model within Scotland was undertaken to examine cultural barriers and solutions regarding acceptance and uptake of the vaccine from the perspective of Scottish Black, Asian, Minority Ethnic young people. .

As Janette explains, the team have worked and plan to work closely with Public Health Scotland to help inform their work but "we've only really touched the surface of reaching some of these vulnerable groups to find out how we can get messages across to particular vulnerable and harder-to-reach groups”..

"We've explored some of the things to communicate in the studies we've been involved in over the last 12 years. So what seems to be important is using tailored and sensitive messages for specific groups, having trusted and respected community leaders advocate for the vaccines alongside public health messages and wider cancer-prevention messages that include boys/young men as well as girls/women and reduce stigma,” adds Carol.

To find out more about the Centre for Biomedicine & Global Health, visit the website here

For details on studying at Edinburgh Napier University, click here.

*Source Cuschieri K, Palmer T, Graham C, Cameron R, Roy K. The changing nature of HPV associated with high grade cervical lesions in vaccinated populations, a retrospective study of over 1700 cases in Scotland. Br J Cancer. 2023 Oct;129(7):1134-1141. doi: 10.1038/s41416-023-02386-9. Epub 2023 Aug 10. PMID: 37563221; PMCID: PMC10539290.