Peer-reviewed article
Investigating HPV Vaccination in the Republic of Palau: Assessment of the School-Based Program from 2020 to 2024.
Landon K Decherong, Merlyn B Basilius, Haley L Cash McGinley, Stephanie Kern-Allely ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined HPV vaccination coverage among 5th grade girls in Palau's school-based program between 2020 and 2024. Although 93% of parents returned consent forms and 70% gave permission for vaccination, only 42% of girls actually received at least one dose. Vaccine refusals were uncommon but increased in the most recent year. The gap between parental consent and actual vaccination suggests problems in the vaccination delivery process that need investigation.
Key points
- Among 467 enrolled 5th grade girls, 434 (93%) returned consent forms and 326 (70%) received parental consent for HPV vaccination
- Only 198 girls (42%) received at least one dose of HPV vaccine according to immunization records
- Vaccine refusals were uncommon (8% of returned forms) but increased to 24% in the 2023-2024 school year
- Responses to the HPV vaccine question were missing on 17% of returned consent forms
- A gap exists between parental consent and documented vaccination, suggesting process problems in vaccine delivery
Limitations
This is a descriptive cross-sectional study that cannot explain the causes of the gap between consent and vaccination or identify specific implementation barriers. The study does not investigate parental attitudes, vaccine availability, or school-level factors contributing to the low vaccination rate.
Abstract
Cervical cancer, caused primarily by human papillomavirus (HPV), causes substantial health burden in the Republic of Palau. Despite availability of the HPV vaccine through a school-based vaccination program for girls beginning in 5th grade, HPV vaccination coverage in Palau has declined since 2020. To understand why, this descriptive cross-sectional study analyzed data from the first opportunity for vaccination for all 5th grade girls enrolled at Koror and Babelthaob schools between August 1, 2020 and June 30, 2024. Data were retrieved from the Ministry of Education, School Health Program, and national Immunization Information System (IIS). The proportion of 5th grade girls who returned the consent form, responses to the HPV vaccine consent question, and vaccination coverage with at least 1 dose were analyzed. Among girls enrolled in Palau elementary schools during the period (n=467), although most consent forms were returned (n=434, 93%) and most girls (n=326, 70%) received consent for HPV vaccination, only 42% (n=198) received at least 1 dose of HPV vaccine according to IIS. Responses were missing for the HPV vaccine consent question on 17% of returned forms (n=73). Refusal of the vaccine was uncommon on returned forms (n=35, 8%), but there was an increase in refusals in the latest school year (n=25, 24% of 2023-2024 returned forms). An investigation into the process from the consent form to vaccination outreach in the schools is needed to understand why girls who received consent for vaccination did not receive the vaccine according to IIS. Improving the school-based vaccination program is critical to achieve 90% HPV vaccination coverage and reduce the cervical cancer burden in Palau.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- School-based HPV vaccination program for girls beginning in 5th grade with parental consent process
- Population
- 5th grade girls enrolled in Koror and Babelthaob elementary schools in Palau (n=467)
Key finding
Only 42% (198/467) of 5th grade girls received at least one HPV vaccine dose despite 70% parental consent
Decherong et al. · PubMed (US National Library of Medicine) · 3 Sept 2026