Role of universal and targeted recommendations for vaccines for sexually transmitted infections in the USA, China and Indonesia: a cross-sectional study.

Background: Vaccines for sexually transmitted infections (STIs) are in development and little is known about their future acceptance. The type of recommendations released by National Immunisation Technical Advisory Groups could influence vaccine uptake. This study aims to understand how universal and targeted wording affects theoretical acceptance to vaccines for four common STIs (chlamydia, gonorrhoea, syphilis and genital herpes) in the USA, China and Indonesia. We also aim to understand how universal and targeted wording may influence acceptance among those who engage in high-risk sexual behaviours.

Methods: A total of 1941 adults between the ages of 18 and 45 were included in the final sample. For each country, the sample was stratified by sexual behaviours, then the proportion of those who accepted each vaccine under universal or targeted wording was reported. χ² tests were used to assess differences, and the likelihood of vaccine acceptance was represented using prevalence ratios (PRs) from Poisson regression models.

Results: Overall, vaccine acceptance for each STI and in every country sampled tended to be lower among those who received targeted wording compared with universal wording. Previous knowledge of STIs significantly affected vaccine acceptance. In the USA, there was significant interaction between recommendation wording type and having heard of the STI; individuals who had previously heard of STIs were more likely to accept an STI vaccine, and that this acceptance varied significantly based on whether they received a universal (PR: 1.30, 95% CI: 1.05 to 1.62) versus targeted recommendation (PR: 2.45, 95% CI: 1.69 to 3.56).

Conclusions: Our results are important for future vaccine recommendations as vaccine hesitancy and refusal are on the rise globally. Thus, wording and education surrounding sexual health and STIs are factors that influence decision-making. Our research also highlights the importance of appealing to certain high-risk groups and providing informative language when releasing vaccine recommendations.