In the article by Sonawane et al, the important question of parental hesitancy regarding adolescent human papillomavirus (HPV) vaccination is examined. The authors reported an increase in hesitancy over a 6-year period (from 50% to 64%) among US parents asked about it. This apparent increase is due to progressively restricting the denominator in later years. Most importantly, the analytic choice masks a more general truth: HPV vaccine hesitancy actually fell among parents overall.

To make sense of this seeming paradox, let us start by observing that HPV vaccine initiation increased during that time period. The National Immunization Survey (NIS)–Teen found that in 2012, ∼62.7% of US adolescents had not received HPV vaccination. By 2018, the percentage of unvaccinated children fell to 31.9%. Next, we can observe that the NIS assessed hesitancy only among parents of unvaccinated children; thus, there were fewer parents to ask about hesitancy in later years....

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