HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

Karafillakis, Emilie; Simas, Clarissa; Jarrett, Caitlin; Verger, Pierre; Peretti-Watel, Patrick; Dib, Fadia; De Angelis, Stefania; Takacs, Judit; Ali, Karam Adel; Pastore Celentano, Lucia; Larson, Heidi

doi:10.1080/21645515.2018.1564436

Cited by 328Vaccine Coverage and HesitancyCervical Cancer and HPV ResearchWomen's cancer prevention and management

HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

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Karafillakis, Emilie, Simas, Clarissa, Jarrett, Caitlin, Verger, Pierre, Peretti-Watel, Patrick, Dib, Fadia, De Angelis, Stefania, Takacs, Judit +3 more·2019·Human Vaccines & Immunotherapeutics

DOI 10.1080/21645515.2018.1564436PMC PMC6783136

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Abstract

Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.

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Low rates of vaccine compliance, particularly with the HPV vaccine, highlight challenges to overcoming potential vaccine hesitancy regarding SARS-CoV-2 vaccines in children.
“Low rates of vaccine compliance, particularly with the HPV vaccine,48 provide additional cautionary notes and highlight the challenges to be faced in overcoming potential vaccine hesitancy regarding SARS-CoV-2 vaccines in children.”
From SARS-CoV-2 vaccine testing and trials in the pediatric population: biologic, ethical, research, and implementation challenges (2021) · cites this paper as [48]

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BackgroundInfluential
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BackgroundResultInfluential
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“Qualitative results Some participants in qualitative studies expressed a perceived lack of need for the HPV vaccine due to a perceived low risk of contracting HPV and/or cervical cancer,(55,59,66,80,100,109,115) a perceived low severity of the disease,(63,66,81) and/or the availability of alternative prevention method…”
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“Qualitative results A few qualitative studies reported that some participants were against all vaccines.(54,57,59,69,99,104) 6 E.”
BackgroundInfluential
A semi-qualitative study of attitudes to vaccinating adolescents against human papillomavirus without parental consent
Brabin, L., Roberts, S. A., & Kitchener, H. C. (2007) · BMC Public Health · doi:10.1186/1471-2458-7-20 · Cited by 56 · cited 1× · see citing works
“Qualitative results Healthcare professionals, including school nurses and GPs, were commonly referred to in qualitative studies as having the most influence on HPV vaccination decisions.(52,57,68,80,99,104,117) Additionally, the influence of family members, friends, and parents of other children who did not vaccinate…”
Background
Parental Response to the Introduction of a Vaccine Against Human Papilloma Virus
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“Qualitative results Some participants in qualitative studies expressed a perceived lack of need for the HPV vaccine due to a perceived low risk of contracting HPV and/or cervical cancer,(55,59,66,80,100,109,115) a perceived low severity of the disease,(63,66,81) and/or the availability of alternative prevention method…”
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Temporal perspective and parental intention to accept the human papillomavirus vaccination for their daughter
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Increasing fear of adverse effects drops intention to vaccinate after the introduction of prophylactic HPV vaccine
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Background
Trust versus concerns—how parents reason when they accept HPV vaccination for their young daughter
Gottvall, M., Grandahl, M., Höglund, A. T., Larsson, M., Stenhammar, C., Andrae, B., & Tydén, T. (2013) · Upsala Journal of Medical Sciences · doi:10.3109/03009734.2013.809039 · Cited by 49 · cited 1× · see citing works
“In Sweden, study participants in 2012 worried about the safety of HPV vaccination due to reports of narcolepsy following H1N1 vaccination.(56)”
Background
Comparatively low attendance during Human Papillomavirus catch-up vaccination among teenage girls in the Netherlands: Insights from a behavioral survey among parents
Gefenaitė, G., Smit, M., Nijman, H. W., Tami, A., Drijfhout, I. H., Pascal, A., Postma, M. J., Wolters, B., van Delden, J. J. M., Wilschut, J., et al. (2012) · BMC Public Health · doi:10.1186/1471-2458-12-498 · Cited by 49 · cited 6× · see citing works
“Quantitative results Across all studies, an average of 34% of hesitant participants were found to doubt the effectiveness of the vaccine, 75,77,114 as well as 39% of general participants(43,46,82,84-86,96) and 3% of favourable participants.(26,37) Perceived low vaccine effec-”
BackgroundResultInfluential
Human papillomavirus (HPV) vaccination: Perception and practice among French general practitioners in the year since licensing
Lutringer-Magnin, D., Kalecinski, J., Barone, G., Léocmach, Y., Denois, V. R., Jacquard, A. C., Soubeyrand, B., Vanhems, P., Chauvin, F., & Lasset, C. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.05.006 · Cited by 49 · cited 4× · see citing works
“newness of the HPV vaccine was reported by an average of 36% of hesitant study participants.(22,27,45,74,75,107,111,112) In French studies, concerns about the newness of the vaccine,”
BackgroundInfluential
Human papillomavirus vaccine uptake, knowledge and attitude among 10th grade students in Berlin, Germany, 2010
Stöcker, P., Dehnert, M., Schuster, M., Wichmann, O., & Deleré, Y. (2012) · Human Vaccines & Immunotherapeutics · doi:10.4161/hv.22192 · Cited by 47 · see citing works
Parental attitudes and information needs in an adolescent HPV vaccination programme
Stretch, R., Roberts, S. A., McCann, R., Baxter, D. N., Chambers, G., Kitchener, H. C., & Brabin, L. (2008) · British Journal of Cancer · doi:10.1038/sj.bjc.6604766 · Cited by 47 · cited 4× · see citing works
“The belief that HPV vaccination might encourage promiscuity or earlier sexual debut in young girls was observed in an average of 11% of hesitant study participants.(22,23,26,32,50,71) This belief was also reported among 30% of general study participants(51,75,85,89,90,110,118) and 6% of favourable study participants.”
BackgroundResultInfluential
Predictors of HPV vaccination uptake: a longitudinal study among parents
Hofman, R. M., van Empelen, P., Richardus, J. H., de Kok, I. M. C. M., de Koning, H. J., van Ballegooijen, M., & Korfage, I. J. (2013) · Health Education Research · doi:10.1093/her/cyt092 · Cited by 47 · see citing works
Attitudes to HPV vaccination among mothers in the British Jewish community: Reasons for accepting or declining the vaccine
Gordon, D., Waller, J., & Marlow, L. A. V. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.07.083 · Cited by 45 · see citing works
Attitudes towards human papillomavirus vaccination: a qualitative study of vaccinated and unvaccinated girls aged 17–18 years
Williams, K., Forster, A. S., Marlow, L. A. V., & Waller, J. (2011) · Journal of Family Planning and Reproductive Health Care · doi:10.1136/jfprhc.2010.0017 · Cited by 44 · cited 3× · see citing works
“Another access barrier was the inconvenience of going to get multiple injections.(67,115)”
BackgroundResult
Acceptability of HPV vaccination among young adults aged 18–30 years–a population based survey in Sweden
Sundström, K., Tran, T. N., Lundholm, C., Young, C., Sparén, P., & Arnheim‐Dahlström, L. (2010) · Vaccine · doi:10.1016/j.vaccine.2010.09.007 · Cited by 43 · see citing works
A qualitative study to assess school nurses' views on vaccinating 12–13 year old school girls against human papillomavirus without parental consent
Stretch, R., McCann, R., Roberts, S. A., Elton, P., Baxter, D. N., & Brabin, L. (2009) · BMC Public Health · doi:10.1186/1471-2458-9-254 · Cited by 43 · cited 1× · see citing works
“Additionally, some participants mentioned that the vaccine is being given to girls when they are too young because they have not started to menstruate, are not yet sexually active or married,(54,57,58,61,100,108) or because they are too “naïve and immature” to give their consent.(98,103) Some also reported that it is…”
Background
Knowledge, attitude, and uptake related to human papillomavirus vaccination among young women in Germany recruited via a social media site
Remschmidt, C., Walter, D., Schmich, P., Wetzstein, M., Deleré, Y., & Wichmann, O. (2014) · Human Vaccines & Immunotherapeutics · doi:10.4161/21645515.2014.970920 · Cited by 41 · cited 2× · see citing works
“Quantitative results Across all studies, an average of 34% of hesitant participants were found to doubt the effectiveness of the vaccine, 75,77,114 as well as 39% of general participants(43,46,82,84-86,96) and 3% of favourable participants.(26,37) Perceived low vaccine effec-”
BackgroundResult
Human Papillomavirus Infection: Knowledge, Attitudes, and Behaviors among Lesbian, Gay Men, and Bisexual in Italy
Pelullo, C. P., Giuseppe, G. D., & Angelillo, I. F. (2012) · PLoS ONE · doi:10.1371/journal.pone.0042856 · Cited by 39 · cited 2× · see citing works
“Some also reported that it is not easy to talk about HPV vaccination with girls that are so young.(20,53,54,59,61,63,79,98,99,105,108,114) Finally, cultural and religious influences on vaccine acceptance reported in studies included perceived low risk of infec-”
Background
Attitudes towards HPV immunization of Italian mothers of adolescent girls and potential role of health professionals in the immunization program
Tozzi, A. E., Ravà, L., Stat, D., Pandolfi, E., Marino, M. G., & Ugazio, A. G. (2009) · Vaccine · doi:10.1016/j.vaccine.2009.02.050 · Cited by 37 · cited 3× · see citing works
“The belief that HPV vaccination might encourage promiscuity or earlier sexual debut in young girls was observed in an average of 11% of hesitant study participants.(22,23,26,32,50,71) This belief was also reported among 30% of general study participants(51,75,85,89,90,110,118) and 6% of favourable study participants.”
Background
Exploring reasons for non-vaccination against human papillomavirus in Italy
VALORE, L. R. F., Giambi, C., D’Ancona, F. “., Manso, M. D., Mei, B. D., Giovannelli, I., Cattaneo, C., Possenti, V., & Declich, S. (2014) · BMC Infectious Diseases · doi:10.1186/s12879-014-0545-9 · Cited by 34 · cited 2× · see citing works
“newness of the HPV vaccine was reported by an average of 36% of hesitant study participants.(22,27,45,74,75,107,111,112) In French studies, concerns about the newness of the vaccine,”
Background
The association of human papillomavirus vaccination with sexual behaviours and human papillomavirus knowledge: a systematic review
Coles, V., Patel, A. S., Allen, F., Keeping, S. T., & Carroll, S. (2014) · International Journal of STD & AIDS · doi:10.1177/0956462414554629 · Cited by 34 · see citing works
“Knowledge and attitudes of Spanish adolescent girls towards human papillomavirus infection: where to intervene to improve vaccination coverage”
Navarro‐Illana, P., Díez‐Domingo, J., Navarro-Illana, E., Tuells, J., Alemán, S., & Puig‐Barberà, J. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-490 · Cited by 33 · see citing works
Facilitators and barriers HPV unvaccinated girls after 5 years of program implementation
Firenze, A., Marsala, M. G. L., Bonanno, V., Maranto, M., Ferrara, C., Giovannelli, L., & Restivo, V. (2014) · Human Vaccines & Immunotherapeutics · doi:10.4161/hv.36158 · Cited by 32 · cited 2× · see citing works
“newness of the HPV vaccine was reported by an average of 36% of hesitant study participants.(22,27,45,74,75,107,111,112) In French studies, concerns about the newness of the vaccine,”
Background
Romanian adolescents’ knowledge and attitudes towards human papillomavirus infection and prophylactic vaccination
Maier, C., Maier, T., Neagu, C., & Vlădăreanu, R. (2015) · European Journal of Obstetrics & Gynecology and Reproductive Biology · doi:10.1016/j.ejogrb.2015.09.029 · Cited by 32 · cited 1× · see citing works
“Additionally, 11% of hesitant adolescent girls from a 2015 study from Romania reported that their parents thought the vaccine was unsafe.(30) An average of 75% of hesitant parents from a 2010 study from Romania(79) and 39% of hesitant young women from a 2013 study from Germany(37) reported being influenced by”
Background
‘Just that Little Bit of Doubt’: Scottish Parents', Teenage Girls' and Health Professionals' Views of the MMR, H1N1 and HPV Vaccines
Kennedy, C. M., Brunton, C. G., & Hogg, R. (2013) · International Journal of Behavioral Medicine · doi:10.1007/s12529-013-9356-4 · Cited by 31 · cited 2× · see citing works
“Additionally, some participants recommended providing information in schools, for instance by organising peer discussion groups with vaccinated girls(53,55-57,61,62,67,69); while others preferred social media or communication methods that allow more discretion.(52-54,62,69)”
Background
Parents’ preferences for vaccinating daughters against human papillomavirus in the Netherlands: a discrete choice experiment
Hofman, R., de Bekker-Grob, E. W., Raat, H., Helmerhorst, T. J. M., van Ballegooijen, M., & Korfage, I. J. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-454 · Cited by 30 · see citing works
Challenges and opportunities of a new HPV immunization program
Gottvall, M., Tydén, T., Larsson, M., Stenhammar, C., & Höglund, A. T. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.04.054 · Cited by 29 · see citing works
Understanding adolescents’ intentions to have the HPV vaccine
Forster, A. S., Marlow, L. A. V., Wardle, J., Stephenson, J., & Waller, J. (2009) · Vaccine · doi:10.1016/j.vaccine.2009.11.082 · Cited by 29 · see citing works
School nurses’ attitudes and experiences regarding the human papillomavirus vaccination programme in Sweden: a population-based survey
Grandahl, M., Tydén, T., Rosenblad, A., Oscarsson, M. G., Nevéus, T., & Stenhammar, C. (2014) · BMC Public Health · doi:10.1186/1471-2458-14-540 · Cited by 29 · cited 2× · see citing works
“monly reported by hesitant parents in a study in the Netherlands (2009, 52%)(26) and hesitant school nurses in a study in Sweden (2013, 48%).(110) The concern that it is too difficult to discussHPV vaccination with adolescent girls was also discussed in studies by an average of 21% of hesitant parents and paediatricia…”
Background
UNderstanding uptake of Immunisations in TravellIng aNd Gypsy communities (UNITING): a qualitative interview study
Jackson, C., Dyson, L., Bedford, H. E., Cheater, F., Condon, L., Crocker, A., Emslie, C., Ireland, L., Kemsley, P., Kerr, S., et al. (2016) · Health Technology Assessment · doi:10.3310/hta20720 · Cited by 29 · see citing works
Working with vaccine-hesitant parents
MacDonald, N. E., Finlay, J. C., & Canadian Paediatric Society (2013) · Paediatrics & Child Health · doi:10.1093/pch/18.5.265 · Cited by 27 · see citing works
Parental attitudes towards vaccinating sons with human papillomavirus vaccine.
Mortensen, G. L. (2010) · PubMed · Cited by 27 · see citing works
Knowledge and acceptance of human papillomavirus (HPV) and HPV vaccination in adolescent boys worldwide: A systematic review
Prue, G., Shapiro, G. K., Maybin, R., Santin, O., & Lawler, M. (2016) · Journal of Cancer Policy · doi:10.1016/j.jcpo.2016.09.009 · Cited by 27 · see citing works
Perceptions of Human Papillomavirus (HPV) infection and acceptability of HPV vaccine among men attending a sexual health clinic differ according to sexual orientation
Giuliani, M., Vescio, M. F., Donà, M. G., Latini, A., Frasca, M., Colafigli, M., Farinella, M., Rezza, G., & Cristaudo, A. (2016) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2015.1115935 · Cited by 26 · cited 1× · see citing works
“attended sexual health clinics reported receiving contradictory advice.(87) Some adolescents also reported being influenced by their parents, with 25% of hesitant adolescent girls from studies in the UK (2008–2013),(23,68) 39% of general adolescent girls from a study in Germany (2010)(95) and 1% of general adolescent…”
Background
Young women’s decision-making process for HPV vaccination
Oscarsson, M. G., Hannerfors, A.-K., & Tydén, T. (2012) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2012.10.002 · Cited by 25 · cited 1× · see citing works
“In qualitative studies, the most commonly reported perceived side effect by parents was infertility.(52,57,59,60,65,100,102,106) Other perceived side effects included: autoimmune complications,(56,57,64,99,104,108) resistance of the virus to vaccines and/or treatment,(99,102,105) cancer,(52)menstrual complications,(65…”
Background
The world must accept that the HPV vaccine is safe
Larson, H. J. (2015) · Nature · doi:10.1038/528009a · Cited by 25 · see citing works
Self-citation
HPV vaccine acceptability in HIV-infected and HIV negative men who have sex with men (MSM) in Ireland
Sadlier, C., Lynam, A., O’Dea, S., Delamere, S., Quinlan, M., Clarke, S., Sheils, O. M., & Bergin, C. J. (2016) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2016.1151588 · Cited by 25 · cited 2× · see citing works
“In quantitative studies, cost was raised as an issue by an average of 32% of hesitant participants,31,38,74,75,80 particularly in studies in Denmark (2009, 62%)80 and Greece (2008–2014, 54%),31 and was also raised as a concern for an average of 47% of general study participants in Germany, Greece, Hungary, Ireland, an…”
Background
Estimated acceptance of HPV vaccination among Italian women aged 18–26 years
Giambi, C., Donati, S., Declich, S., Salmaso, S., Atti, M. L. C. D., Alibrandi, M. P., Brezzi, S., Carozzi, F., Collina, N., Franchi, D., et al. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.08.079 · Cited by 24 · see citing works
Girls’ explanations for being unvaccinated or under vaccinated against human papillomavirus: a content analysis of survey responses
Forster, A. S., Waller, J., Bowyer, H. L., & Marlow, L. A. V. (2015) · BMC Public Health · doi:10.1186/s12889-015-2657-6 · Cited by 24 · cited 5× · see citing works
“A perceived lack of need for the HPV vaccine was reported by an average of 14% of hesitant study participants,(25,31,32,36,38,70,75,121) 5% of general study participants,(88,95) and 2% of favourable study participants.(25) A perceived low risk of contracting HPV infection or developing cervical cancer was reported by…”
BackgroundInfluential
The evaluation of an evidence-based clinical answer format for pediatricians
Seto, I., Foisy, M., Arkison, B., Klassen, T. P., & Williams, K. J. (2012) · BMC Pediatrics · doi:10.1186/1471-2431-12-34 · Cited by 22 · see citing works
Midwives at youth clinics attitude to HPV vaccination and their role in cervical cancer prevention
Oscarsson, M. G., Dahlberg, A., & Tydén, T. (2011) · Sexual & Reproductive Healthcare · doi:10.1016/j.srhc.2011.09.001 · Cited by 22 · cited 2× · see citing works
“Almost all qualitative articles described concerns about potential side effects of HPV vaccination,(52-57,59,60,62,64,66,69,98-107) often described as fears of long-term side effects not yet identified through trials.(54,55,59,60,62,64,66,69,81,98-104,106) In qualitative studies, the most commonly reported perceived s…”
Background
Greek health professionals’ perceptions of the HPV vaccine, state policy recommendations and their own role with regards to communication of relevant health information
Karamanidou, C., & Dimopoulos, Κ. (2016) · BMC Public Health · doi:10.1186/s12889-016-2831-5 · Cited by 22 · cited 4× · see citing works
“Qualitative results Healthcare professionals, including school nurses and GPs, were commonly referred to in qualitative studies as having the most influence on HPV vaccination decisions.(52,57,68,80,99,104,117) Additionally, the influence of family members, friends, and parents of other children who did not vaccinate…”
BackgroundInfluential
HPV vaccination: vaccine acceptance, side effects and screening intentions.
Paul-Ebhohimhen, V., Huc, S., Tissington, H., Oates, K., & Stark, C. R. (2010) · PubMed · Cited by 21 · see citing works
Évaluation de la couverture vaccinale du vaccin anti-hpv : résultats d’une enquête auprès des lycéennes et étudiantes de la région PACA
Sabiani, L., Bremond, A. G., Mortier, I., Lécuyer, M., Boubli, L., & Carcopino, X. (2011) · Journal de gynécologie, obstétrique et biologie de la reproduction. Supplément/Journal de gynécologie obstétrique et biologie de la reproduction · doi:10.1016/j.jgyn.2011.10.001 · Cited by 21 · see citing works
Working with vaccine-hesitant parents: An update
MacDonald, N. E., Desai, S. N., & Gerstein, B. (2018) · Paediatrics & Child Health · doi:10.1093/pch/pxy144 · Cited by 21 · see citing works
Uptake of the HPV vaccination programme in England: a cross-sectional survey of young women attending sexual health services
Sacks, R., Copas, A. J., Wilkinson, D., & Robinson, A. J. (2014) · Sexually Transmitted Infections · doi:10.1136/sextrans-2013-051179 · Cited by 20 · see citing works
Difficulties in the prevention of cervical cancer: Adults’ attitudes towards HPV vaccination 3 years after introducing the vaccine in Hungary
Marek, E., Dergez, T., Kricskovics, A., Kovács, K., Rébék-Nagy, G., Gőcze, K., Kiss, I., Ember, I., & Göcze, P. (2011) · Vaccine · doi:10.1016/j.vaccine.2011.05.048 · Cited by 20 · see citing works
Women show mixed intentions regarding the uptake of HPV vaccinations in pre-adolescents: A questionnaire study
Korfage, I. J., Essink‐Bot, M., Daamen, R., Mols, F., & van Ballegooijen, M. (2008) · European Journal of Cancer · doi:10.1016/j.ejca.2008.03.018 · Cited by 19 · cited 1× · see citing works
“Concerns about girls being too young were reported by an average of 13% of hesitant study participants(23,26,27,29,30,32,35,45,75) and 30% of general study participants.(48,110) It was most com-”
Background
HPV vaccination acceptability in young boys.
Tisi, G., Salinaro, F., Apostoli, P., Bassani, R., Bellicini, A., Groppi, L., Donarini, P., & Pecorelli, S. (2013) · PubMed · doi:10.4415/ann_13_03_09 · Cited by 19 · see citing works
Parental Decisional Strategies Regarding HPV Vaccination Before Media Debates: A Focus Group Study
Hofman, R., van Empelen, P., Vogel, I., Raat, H., van Ballegooijen, M., & Korfage, I. J. (2013) · Journal of Health Communication · doi:10.1080/10810730.2012.757390 · Cited by 18 · cited 3× · see citing works
“In qualitative studies, the most commonly reported perceived side effect by parents was infertility.(52,57,59,60,65,100,102,106) Other perceived side effects included: autoimmune complications,(56,57,64,99,104,108) resistance of the virus to vaccines and/or treatment,(99,102,105) cancer,(52)menstrual complications,(65…”
Background
Vaccination against Human Papillomavirus in relation to Financial Crisis: The “Evaluation and Education of Greek Female Adolescents on Human Papillomaviruses’ Prevention Strategies” ELEFTHERIA Study
Mammas, I., Theodoridou, M. N., Koutsaftiki, C., Bertsias, G. K., Sourvinos, G., & Spandidos, D. A. (2015) · Journal of Pediatric and Adolescent Gynecology · doi:10.1016/j.jpag.2015.12.007 · Cited by 18 · cited 2× · see citing works
“Concerns about side effects were particularly prevalent among hesitant participants from studies in the Netherlands (2009–2011, 69%),(26,28) Romania (2010, 60%),(79) and Greece (2005–2014, 54%).(31,34,40,42,78)”
Background
Female students receiving post-secondary education in Greece: the results of a collaborative human papillomavirus knowledge survey
Michail, G., Smaili, M., Vozikis, A., Jelastopulu, E., Adonakis, G. L., & Poulas, K. A. (2014) · Public Health · doi:10.1016/j.puhe.2014.09.005 · Cited by 17 · cited 1× · see citing works
“Concerns about side effects were particularly prevalent among hesitant participants from studies in the Netherlands (2009–2011, 69%),(26,28) Romania (2010, 60%),(79) and Greece (2005–2014, 54%).(31,34,40,42,78)”
Background
Opinions et pratiques des médecins généralistes face à la vaccination anti-Papillomavirus
Piana, L., Noel, G., Uters, M., Laporte, R., & Minodier, P. (2009) · Médecine et Maladies Infectieuses · doi:10.1016/j.medmal.2009.08.007 · Cited by 17 · see citing works
Vaccination against human papillomavirus among 865 female students from the health professions in central Greece: a questionnaire- based cross-sectional study
Rachiotis, G., Papagiannis, D., Symvoulakis, E. K., Daponte, A. I., Grivea, I. N., Syrogiannopoulos, G. A., & Hadjichristodoulou, C. S. (2013) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s49558 · Cited by 17 · cited 2× · see citing works
“Concerns about side effects were particularly prevalent among hesitant participants from studies in the Netherlands (2009–2011, 69%),(26,28) Romania (2010, 60%),(79) and Greece (2005–2014, 54%).(31,34,40,42,78)”
Background
Practices and opinions regarding HPV vaccination among French general practitioners: evaluation through two cross-sectional studies in 2007 and 2010
Lasset, C., Kalecinski, J., Denois, V. R., Barone, G., Léocmach, Y., Vanhems, P., Chauvin, F., & Lutringer-Magnin, D. (2014) · International Journal of Public Health · doi:10.1007/s00038-014-0555-9 · Cited by 17 · see citing works
Managing Uncertainty: Healthcare Professionals' Meanings Regarding the HPV Vaccine
Todorova, I. L. G., Alexandrova‐Karamanova, A., Panayotova, Y., Dimitrova, E., & Kotzeva, T. (2013) · International Journal of Behavioral Medicine · doi:10.1007/s12529-013-9343-9 · Cited by 17 · cited 3× · see citing works
“Qualitative results Healthcare professionals, including school nurses and GPs, were commonly referred to in qualitative studies as having the most influence on HPV vaccination decisions.(52,57,68,80,99,104,117) Additionally, the influence of family members, friends, and parents of other children who did not vaccinate…”
Background
Aceptabilidad de la vacuna contra el virus del papiloma humano en madres de la provincia de Valencia (España)
Navarro‐Illana, P., Caballero, P., Tuells, J., Puig‐Barberà, J., & Díez‐Domingo, J. (2015) · Anales de Pediatría · doi:10.1016/j.anpedi.2014.11.018 · Cited by 14 · see citing works
HPV vaccine acceptance among female Greek students
Bakogianni, G. D., Nikolakopoulos, K. M., & Nikoleta M Nikolakopoulou (2010) · International Journal of Adolescent Medicine and Health · doi:10.1515/ijamh.2010.22.2.271 · Cited by 13 · cited 1× · see citing works
“Concerns about side effects were particularly prevalent among hesitant participants from studies in the Netherlands (2009–2011, 69%),(26,28) Romania (2010, 60%),(79) and Greece (2005–2014, 54%).(31,34,40,42,78)”
Background
Impact of medical education on knowledge and attitudes regarding the human papilloma virus and vaccination: Comparison before and 6 years after the introduction of the vaccines
D’Hauwers, K., Gadet, P. F. E., Donders, A. R. T., & Tjalma, W. A. A. (2013) · Vaccine · doi:10.1016/j.vaccine.2013.09.068 · Cited by 13 · see citing works
Young Women's Constructions of the HPV Vaccine: A Cross-Cultural, Qualitative Study in Scotland, Spain, Serbia and Bulgaria
Brunton, C. G., Farver-Vestergaard, I., Jaeger, M., Lenneis, A., Parve, K., Patarcic, D., Petrova, D., Hogg, R., Kennedy, C. M., García‐Retamero, R., et al. (2013) · International Journal of Behavioral Medicine · doi:10.1007/s12529-013-9357-3 · Cited by 12 · cited 4× · see citing works
“and perceptions that doctors were dismissive and deliberately withheld information about side effects.(52,65,98,104) Mistrust of pharmaceutical companies due to their underlying profitmaking motives and doubts about the trustworthiness of vaccine trials and safety claims were also reported in studies in Bulgaria (2009…”
BackgroundInfluential
Cross-sectional study about primary health care professionals views on the inclusion of the vaccine against human papillomavirus in the vaccine schedules
Pérez, R. O., Violeta, V. B., del Campo, A. V., Ruiz, C., Castaño, S. Y., Conde, L. P. P., & López, J. S. J. (2015) · Infectious Agents and Cancer · doi:10.1186/s13027-015-0034-9 · Cited by 12 · see citing works
L’engagement des médecins généralistes français dans la vaccination : l’étude DIVA (Déterminants des Intentions de Vaccination)
Martinez, L., Tugaut, B., Raineri, F., Arnould, B., Seyler, D., Arnould, P., Benmedjahed, K., Coindard, G., Denis, F., Gallais, J.-L., et al. (2016) · Santé Publique · doi:10.3917/spub.161.0019 · Cited by 12 · cited 4× · see citing works
“Another access barrier was the inconvenience of going to get multiple injections.(67,115)”
BackgroundInfluential
Sexual healthcare professionals’ views on HPV vaccination for men in the UK
Nadarzynski, T., Smith, H. E., Richardson, D., Ford, E. M., & Llewellyn, C. D. (2015) · British Journal of Cancer · doi:10.1038/bjc.2015.403 · Cited by 12 · see citing works
Cervical cancer narratives: invoking ‘God's will’ to re-appropriate reproductive rights in present-day Romania
Pop, C. A. (2014) · Culture Health & Sexuality · doi:10.1080/13691058.2014.948491 · Cited by 10 · cited 1× · see citing works
“tion because of certain lifestyles (being virgins when marrying, having only one partner),(54,57,60,61,65,99,100,105,108,109) and having a strong sense of fatality and/or belief that God will protect girls.(113)”
Background
Vacuna contra el virus del papiloma humano en adolescentes: Análisis mediante grupos focales
Puig, R. C., & Sanchis, M. M. (2015) · Revista de Salud Pública · doi:10.15446/rsap.v16n5.41021 · Cited by 9 · cited 2× · see citing works
“Qualitative results Healthcare professionals, including school nurses and GPs, were commonly referred to in qualitative studies as having the most influence on HPV vaccination decisions.(52,57,68,80,99,104,117) Additionally, the influence of family members, friends, and parents of other children who did not vaccinate…”
Background
Pratiques et attitudes des médecins généralistes de Besançon vis-à-vis de la vaccination anti-HPV
Bouvret, P., Mougin, C., Prétet, J., Meurisse, A., Bonnetain, F., & Fiteni, F. (2016) · Journal de gynécologie, obstétrique et biologie de la reproduction. Supplément/Journal de gynécologie obstétrique et biologie de la reproduction · doi:10.1016/j.jgyn.2015.12.002 · Cited by 9 · see citing works
Acceptability of human papillomavirus vaccine in mothers from Valencia (Spain)
Navarro‐Illana, P., Caballero, P., Tuells, J., Puig‐Barberà, J., & Díez‐Domingo, J. (2015) · Anales de Pediatría (English Edition) · doi:10.1016/j.anpede.2015.09.021 · Cited by 9 · see citing works
Perceptions of HPV vaccine amongst UK university students
Martin, E., Senior, N., Abdullah, A., Brown, J., Collings, S., Racktoo, S., Walpole, S. C., Zeiton, M. A., & Heffernan, C. (2011) · Health Education · doi:10.1108/09654281111180481 · Cited by 7 · cited 1× · see citing works
“Qualitative results Qualitative studies reported beliefs that HPV vaccination might encourage promiscuity or earlier sexual debut in young girls(61,65-67,100,101,106,108,119) and that the vaccine could lead to unsafe sexual behaviour and a decrease in the use of condoms and cervical cancer screening.(55,57,63,64,66,67…”
Background
Perception et pratique de la vaccination HPV par les gynécologues : une étude quantitative et qualitative en Rhône-Alpes
Lutringer-Magnin, D., Kalecinski, J., Barone, G., Borne, H., Denois, V. R., Vanhems, P., Chauvin, F., & Lasset, C. (2011) · Gynécologie Obstétrique & Fertilité · doi:10.1016/j.gyobfe.2011.07.015 · Cited by 6 · see citing works
[Reasons not to have your daughter vaccinated against the human papilloma virus in Twente: a questionnaire study].
van der Berg, J. D., Roorda, J., & Westerman, M. J. (2010) · PubMed · Cited by 5 · see citing works
Entscheidungsfindung zur HPV-Impfung – Eine qualitative Studie mit jugendlichen Mädchen
Klötzler, A., & Kolip, P. (2011) · Das Gesundheitswesen · doi:10.1055/s-0031-1286270 · Cited by 4 · cited 5× · see citing works
“Qualitative results A few qualitative studies reported that some participants were against all vaccines.(54,57,59,69,99,104) 6 E.”
BackgroundInfluential
Allaying parental concerns about the human papillomavirus vaccine
Hutton, S., & Finlay, F. (2009) · Nursing Children and Young People · doi:10.7748/paed2009.11.21.9.20.c7356 · Cited by 3 · see citing works
Hpv vaccination acceptance among women in Greek provincial areas
Βολτυράκη, Ε. Γ., Τσετσέκου, Ε., Marneras, C., Krapis, K., Yfantis, A., & Νούλα, Μ. (2010) · Cited by 3 · see citing works
Ansichten und Erfahrungswerte über die Praxis der Früherkennungs- und Präventionsmaßnahmen von Gebärmutterhalskrebs
Kuitto, K., Pickel, S., & Jahn, D. (2010) · Prävention und Gesundheitsförderung · doi:10.1007/s11553-010-0235-4 · Cited by 2 · see citing works
Parents' awareness and acceptance of HPV vaccination in Italy.
Baglioni, A. J., Ceriale, E., Bagnoli, A., Mercone, A., Nante, N., & Messina, G. (2014) · PubMed · Cited by 2 · see citing works
[Vaccination against papillomavirus: words of adolescents].
Fidalgo, C., Mauron, C., Nyffeler, S., Pache, B. C.-E., & Pereira, P. P. (2013) · PubMed · Cited by 2 · see citing works
[Posters at scientific congresses].
Steinert, T. (2012) · PubMed · Cited by 1 · see citing works

Flagged first, then by citations

1 of the 132 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

[4]European Centre for Disease Prevention and Control Rapid literature review on motivating hesitant population groups in Europe to vaccinate. Stockholm, Sweden: ECDC; 2015.
[11]SAGE Report of the SAGE working group on vaccine hesitancy. Geneva, Switzerland: WHO; 2014 10 Report No.
[12]Pope C, Mays N, Jennie P Synthesising qualitative and quantitative health evidence: a guide to methods. Maidenhead, England: Open University Press; 2007.
[68]Camano-Puig R, Sanchis-Martinez MM Human papilloma virus vaccination in teenage girls: a focus group evaluation. Revista de Salud Publica. 2014; 16: 646– 57. 26120751
[79]Abram Z, Tar G Health education of mothers about their girls’ vaccination. 4th world conference on educational sciences. Procedia Soc Behav Sci. 2012; 462012: 5330– 34.

Sorted by citations

Vaccine hesitancy in the era of COVID-19
Troiano, G., & Nardi, A. (2021) · Public Health · doi:10.1016/j.puhe.2021.02.025 · Cited by 1,342 · see citing works
COVID-19 vaccine hesitancy in the UK: the Oxford coronavirus explanations, attitudes, and narratives survey (Oceans) II
Freeman, D. H., Loe, B. S., Chadwick, A., Vaccari, C., Waite, F., Rosebrock, L. E., Jenner, L., Petit, A., Lewandowsky, S., Vanderslott, S., et al. (2020) · Psychological Medicine · doi:10.1017/s0033291720005188 · Cited by 764 · see citing works
The Vaccine-Hesitant Moment
Larson, H. J., Gakidou, E. E., & Murray, C. J. L. (2022) · New England Journal of Medicine · doi:10.1056/nejmra2106441 · Cited by 516 · see citing works
Self-citation
An Asia-Pacific study on healthcare workers’ perceptions of, and willingness to receive, the COVID-19 vaccination
Chew, N., Cheong, C., Kong, G., Phua, K., Ngiam, J. N., Tan, B. Y., Wang, B., Hao, F., Tan, W., Han, X., et al. (2021) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2021.03.069 · Cited by 177 · see citing works
Overcoming COVID-19 vaccine hesitancy among ethnic minorities: A systematic review of UK studies
Hussain, B., Latif, A., Timmons, S., Nkhoma, K. B., & Nellums, L. B. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.04.030 · Cited by 135 · see citing works
“Misconceptions about the immunisation process [45], lack of trust in government or healthcare [46], newness of a vaccine [47], perceived incompatibility of vaccines with religious and cultural beliefs [25] and conspiracy theories [48] were highlighted as factors known to aggravate lack of confidence in vaccines.”
HPV knowledge and vaccine acceptance among European adolescents and their parents: a systematic literature review
López, N., Garcés‐Sánchez, M., Panizo, M. B., de la Cueva, I. S., Artés, M. T., Ramos, B., & Cotarelo, M. (2020) · Public health reviews · doi:10.1186/s40985-020-00126-5 · Cited by 122 · see citing works
“In terms of geographical distribution, publications included in this review were produced in 16 European countries, the UK having most publications, 20 (28.6%), followed by Italy, ten (14.3%), and Sweden, eight (11.4%).”
BackgroundInfluential
Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia
Wong, L.-P., Wong, P.-F., Hashim, M. M. A. A. M., Han, L.-Y., Lin, Y.-L., Hu, Z.-J., Zhao, Q.-J., & Zimet, G. (2020) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2020.1756670 · Cited by 116 · see citing works
“sanctioning by families, and the creditability of traditional healers were also among the reasons that people in Asia prefer traditional remedies for cancer and vaccination.(17,57) The public should be warned against anecdotal evidence cautioned about the use of traditional medicines in the treatment and prevention of…”
Background
European Groundshot—addressing Europe's cancer research challenges: a Lancet Oncology Commission
Lawler, M., Davies, L., Oberst, S., Oliver, K. R., Eggermont, A. M. M., Schmutz, A., Vecchia, C. L., Allemani, C., Lievens, Y. N., Naredi, P. L. J., et al. (2022) · The Lancet Oncology · doi:10.1016/s1470-2045(22)00540-x · Cited by 111 · see citing works
Vaccine hesitancy and the resurgence of vaccine preventable diseases: the way forward for Malaysia, a Southeast Asian country
Wong, L. P., Wong, P., & AbuBakar, S. (2020) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2019.1706935 · Cited by 109 · see citing works
Parental intent to initiate and complete the human papillomavirus vaccine series in the USA: a nationwide, cross-sectional survey
Sonawane, K., Zhu, Y., Montealegre, J. R., Lairson, D. R., Bauer, C., McGee, L. U., Giuliano, A. R., & Deshmukh, A. A. (2020) · The Lancet Public Health · doi:10.1016/s2468-2667(20)30139-0 · Cited by 105 · see citing works
Interest in COVID-19 vaccine trials participation among young adults in China: Willingness, reasons for hesitancy, and demographic and psychosocial determinants
Sun, S., Lin, D., & Operario, D. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2021.101350 · Cited by 106 · see citing works
“Mistrust of health authorities has shown to affect willingness for vaccination and vaccine trials of HPV and HIV, in Europe and United States (Strauss et al., 2001; Karafillakis et al., 2019).”
Bibliometric analysis of global scientific literature on vaccine hesitancy in peer-reviewed journals (1990–2019)
Sweileh, W. M. (2020) · BMC Public Health · doi:10.1186/s12889-020-09368-z · Cited by 83 · see citing works
A longitudinal study of vaccine hesitancy attitudes and social influence as predictors of COVID-19 vaccine uptake in the US
Latkin, C. A., Dayton, L., Miller, J., Yi, G. T., Balaban, A., Boodram, B., Uzzi, M., & Falade-Nwulia, O. O. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2043102 · Cited by 81 · see citing works
Global burden of HPV ‐attributable squamous cell carcinoma of the anus in 2020, according to sex and HIV status: A worldwide analysis
Deshmukh, A. A., Damgacioglu, H., Georges, D., Sonawane, K., Ferlay, J., Bray, F., & Clifford, G. M. (2022) · International Journal of Cancer · doi:10.1002/ijc.34269 · Cited by 82 · see citing works
Childhood vaccination coverage in Europe: impact of different public health policies
Bechini, A., Boccalini, S., Ninci, A., Zanobini, P., Sartor, G., Bonaccorsi, G., Grazzini, M., & Bonanni, P. (2019) · Expert Review of Vaccines · doi:10.1080/14760584.2019.1639502 · Cited by 81 · see citing works
Social media and HPV vaccination: Unsolicited public comments on a Facebook post by the Western Cape Department of Health provide insights into determinants of vaccine hesitancy in South Africa
Wiyeh, A. B., Cooper, S., Jaca, A., Mavundza, E. J., Ndwandwe, D. E., & Wiysonge, C. S. (2019) · Vaccine · doi:10.1016/j.vaccine.2019.09.019 · Cited by 79 · see citing works
Understanding the determinants of vaccine hesitancy and vaccine confidence among adolescents: a systematic review
Cadeddu, C., Castagna, C., Sapienza, M., Lanza, T. E., Messina, R., Chiavarini, M., Ricciardi, W., & de Waure, C. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.1961466 · Cited by 79 · see citing works
“Actually, there has been an increase in papers on adolescents’vaccinations acceptance(5) but they mainly focused on vaccination against Human Papilloma Virus (HPV).(16,17) Nevertheless, depending on country-specific immunization programmes, vaccinations intended for adolescents also include those against hepatitis B,…”
BackgroundResultInfluential
Correlates of COVID-19 Vaccine Hesitancy among a Community Sample of African Americans Living in the Southern United States
Moore, J. X., Gilbert, K. L., Lively, K. L., Laurent, C., Chawla, R., Li, C., Johnson, R., Petcu, R., Mehra, M., Spooner, A., et al. (2021) · Vaccines · doi:10.3390/vaccines9080879 · Cited by 66 · see citing works
“Confidence is especially important when a vaccine is new [74].”
Background
Mistrust in public health institutions is a stronger predictor of vaccine hesitancy and uptake than Trust in Trump
Choi, Y., & FOX, A. M. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.115440 · Cited by 67 · see citing works
“Vaccines for pregnant women…?! Absurd” – Mapping maternal vaccination discourse and stance on social media over six months
Martin, S., Kilich, E., Dada, S., Kummervold, P. E., Denny, C., Paterson, P., & Larson, H. J. (2020) · Vaccine · doi:10.1016/j.vaccine.2020.07.072 · Cited by 66 · see citing works
Self-citation
Understanding medical mistrust and HPV vaccine hesitancy among multiethnic parents in Los Angeles
Tsui, J., Martínez, B., Shin, M., Allee-Munoz, A., Rodriguez, I., Navarro, J., Thomas-Barrios, K. R., Kast, W. M., & Baezconde-Garbanati, L. A. (2022) · Journal of Behavioral Medicine · doi:10.1007/s10865-022-00283-9 · Cited by 60 · see citing works
Multi-perspectives systematic review on the applications of sentiment analysis for vaccine hesitancy
Alamoodi, A. H., Zaidan, B. B., Al-Masawa, M. E., Taresh, S. M., Noman, S., Ahmaro, I. Y. Y., Garfan, S., Chen, J., Ahmed, M. A., Zaidan, A. A., et al. (2021) · Computers in Biology and Medicine · doi:10.1016/j.compbiomed.2021.104957 · Cited by 61 · see citing works
“As for the health system factors, mistrust in the health care workers [17], governments [18], and/or health agencies [19] all contribute to the vaccine hesitancy phenomenon.”
SARS-CoV-2 vaccine testing and trials in the pediatric population: biologic, ethical, research, and implementation challenges
Cooper, D. M., Afghani, B., Byington, C. L., Cunningham, C. K., Golub, S., Lu, K. D., Radom-Aizik, S., Ross, L. F., Singh, J., Smoyer, W. E., et al. (2021) · Pediatric Research · doi:10.1038/s41390-021-01402-z · Cited by 55 · see citing works
Impact of Parental Knowledge and Beliefs on HPV Vaccine Hesitancy in Kenya—Findings and Implications
Kolek, C. O., Opanga, S. A., Okalebo, F., Birichi, A. R., Kurdi, A. B., Godman, B., & Meyer, J. C. (2022) · Vaccines · doi:10.3390/vaccines10081185 · Cited by 55 · see citing works
Factors influencing healthcare professionals’ confidence in vaccination in Europe: a literature review
Pavlovic, D., Sahoo, P., Larson, H. J., & Karafillakis, E. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2041360 · Cited by 53 · see citing works
Self-citation
Caregivers’ Willingness to Vaccinate Their Children against Childhood Diseases and Human Papillomavirus: A Cross-Sectional Study on Vaccine Hesitancy in Malawi
Adeyanju, G. C., Sprengholz, P., Betsch, C., & Essoh, T.-A. (2021) · Vaccines · doi:10.3390/vaccines9111231 · Cited by 51 · see citing works
Cervical Cancer and Human Papillomavirus Awareness among Women in Saudi Arabia
Akkour, K., Alghuson, L., Benabdelkamel, H., Alhalal, H., Alayed, N., AlQarni, A. A., & Arafah, M. (2021) · Medicina · doi:10.3390/medicina57121373 · Cited by 50 · see citing works
Vaccination against HPV: boosting coverage and tackling misinformation
Bigaard, J., & Franceschi, S. (2020) · Molecular Oncology · doi:10.1002/1878-0261.12808 · Cited by 50 · see citing works
COVID-19 Vaccine Hesitancy: The Role of Information Sources and Beliefs in Dutch Adults
de Vries, H., Verputten, W., Preissner, C. E., & Kok, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19063205 · Cited by 48 · see citing works
“Furthermore, a review on the human papillomavirus (HPV) vaccine identified ten thematic categories of VH determinants [17].”
Background
A natural language processing framework to analyse the opinions on HPV vaccination reflected in twitter over 10 years (2008 - 2017)
Luo, X., Zimet, G. D., & Shah, S. (2019) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2019.1627821 · Cited by 48 · see citing works
“20 There are several limitations of the work reported here, which also serve as a cautionary tale for analysis of social media posts.”
Background
Applying an extended protection motivation theory to predict Covid-19 vaccination intentions and uptake in 50–64 year olds in the UK
Griffin, B. L., Conner, M. T., & Norman, P. E. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.114819 · Cited by 45 · see citing works
Why don’t adolescent girls in a rural Uganda district initiate or complete routine 2-dose HPV vaccine series: Perspectives of adolescent girls, their caregivers, healthcare workers, community health workers and teachers
Rujumba, J., Akugizibwe, M., Basta, N. E., & Banura, C. (2021) · PLoS ONE · doi:10.1371/journal.pone.0253735 · Cited by 44 · see citing works
“Undoubtedly, the provision of scientific information alone will not help reduce uncertainty and anxiety around HPV vaccination [51].”
Background
Fear, mistrust, and vaccine hesitancy: Narratives of the dengue vaccine controversy in the Philippines
Yu, V. G., Lasco, G., & David, C. C. (2021) · Vaccine · doi:10.1016/j.vaccine.2021.07.051 · Cited by 44 · see citing works
Healthcare professional’s promotional strategies in improving Human papillomavirus (HPV) vaccination uptake in adolescents: A systematic review
Sackey, M. E., Markey, K., & Grealish, A. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.03.054 · Cited by 44 · see citing works
Global parental acceptance, attitudes, and knowledge regarding human papillomavirus vaccinations for their children: a systematic literature review and meta-analysis
Heyde, S., Osmani, V., Schauberger, G., Cooney, C., & Klug, S. J. (2024) · BMC Women s Health · doi:10.1186/s12905-024-03377-5 · Cited by 45 · see citing works
“%) are a major barrier to HPV vaccinations among parents in Europe [148].”
Background
Development and Validation of the Multidimensional COVID-19 Vaccine Hesitancy Scale
Kotta, I., Kálcza-Jánosi, K., Szabo, K., & Marschalkó, E. E. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.2007708 · Cited by 43 · see citing works
“Our results are in concordance with other findings, which highlighted the reaction of fear in COVID-19 vaccine delay decisions(26) and other vaccine uptake as well.(10,15,18) For rational health related decisions, strategies targeting the control of fear, skepticism and the attitude toward vaccine risks is advisable.”
BackgroundResult
Human papillomavirus and its vaccination: Knowledge and attitudes among female university students in Saudi Arabia
Altamimi, T. N. A. (2020) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_1205_19 · Cited by 41 · see citing works
“[10] There are many HPV‐related viruses or serotypes with the high‐risk HPV serotypes strongly correlated to cervical cancer.[11,12] Commonly observed high‐risk serotypes with oncogenic properties include HPV16 and 18.”
Background
HPV vaccine acceptance in West Africa: A systematic literature review
Wilson, R. (2021) · Vaccine · doi:10.1016/j.vaccine.2021.06.074 · Cited by 41 · see citing works
Examining enablers of vaccine hesitancy toward routine childhood and adolescent vaccination in Malawi
Adeyanju, G. C., Betsch, C., Adamu, A. A., Gumbi, K. S., Head, M., Aplogan, A., Tall, H., & Essoh, T.-A. (2022) · Global Health Research and Policy · doi:10.1186/s41256-022-00261-3 · Cited by 43 · see citing works
“The guide comprised the following themes and topics, based on validated measures in the same setting [26, 27, 30]: knowledge of immunisation (“What do you know or think about immunisation?”); knowledge of HPV/cervical cancer (“Do you know or have you heard about cervical cancer and/or the HPV vaccine?”); attitude towa…”
BackgroundMethod
Systematic review and meta-analysis comparing educational and reminder digital interventions for promoting HPV vaccination uptake
Chandeying, N., & Thongseiratch, T. (2023) · npj Digital Medicine · doi:10.1038/s41746-023-00912-w · Cited by 40 · see citing works
Knowledge and Attitudes on Vaccination in Southern Romanians: A Cross-Sectional Questionnaire
Popa, G., Muntean, A.-A., Muntean, M.-M., & Popa, M. (2020) · Vaccines · doi:10.3390/vaccines8040774 · Cited by 33 · see citing works
“Romania had initiated a program in 2008 but discontinued their HPV vaccination in 2014 due to a very low acceptance rate [18].”
Exploring enablers and barriers toward COVID-19 vaccine acceptance among Arabs: A qualitative study
Elbarazi, I., Yacoub, M. A., Reyad, O. A., Abdou, M. S. M., Elhadi, Y. A. M., Kheirallah, K. A., Ababneh, B. F., Hamada, B. A., Saeh, H. M. E., Ali, N., et al. (2022) · International Journal of Disaster Risk Reduction · doi:10.1016/j.ijdrr.2022.103304 · Cited by 38 · see citing works
The dynamics of trust and communication in COVID-19 vaccine decision making: A qualitative inquiry
Ledford, C. J. W., Cafferty, L. A., Moore, J. X., Roberts, C., Whisenant, E. B., Rychtarikova, A. G., & Seehusen, D. A. (2022) · Journal of Health Communication · doi:10.1080/10810730.2022.2028943 · Cited by 38 · see citing works
“Confidence is especially important when a vaccine is new (Karafillakis et al., 2019).”
Background
Stages of HPV Vaccine Hesitancy Among Guardians of Female Secondary School Students in China
Zheng, W., Liu, Y., Zhang, L., Sun, X., Jiang, Q., Li, Z., Wu, Y., & Fu, C. (2022) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2022.08.027 · Cited by 37 · see citing works
“Similar phenomena have been found in Romania, the Netherlands, and Denmark [38].”
Result
What Factors Are Associated with Attitudes towards HPV Vaccination among Kazakhstani Women? Exploratory Analysis of Cross-Sectional Survey Data
Aimagambetova, G. N., Babi, A., Issa, T., & Issanov, A. (2022) · Vaccines · doi:10.3390/vaccines10050824 · Cited by 37 · see citing works
“comparable with studies in European countries (Sweden, Hungary, France, and the UK), where mistrust of health authorities was reported by 47% to 55% of the respondents [46].”
BackgroundResultInfluential
Health Literacy, Vaccine Confidence and Influenza Vaccination Uptake among Nursing Home Staff: A Cross-Sectional Study Conducted in Tuscany
Lorini, C., Collini, F., Gasparini, F., Paolini, D., Grazzini, M., Ierardi, F., Galletti, G., Zanobini, P., Gemmi, F., & Bonaccorsi, G. (2020) · Vaccines · doi:10.3390/vaccines8020154 · Cited by 36 · see citing works
Vaccine hesitancy about the HPV vaccine among French young women and their parents: a telephone survey
Gauna, F., Verger, P., Fressard, L., Jardin, M., Ward, J. K., & Peretti‐Watel, P. (2023) · BMC Public Health · doi:10.1186/s12889-023-15334-2 · Cited by 35 · see citing works
Self-citation
Attitudes Toward HPV Vaccination in Sweden: A Survey Study
Wemrell, M., & Gunnarsson, L. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.729497 · Cited by 35 · see citing works
“A factor often found to influence decision-making is concerns for vaccine safety or side effects (10, 21, 38, 39, 42, 43, 46, 47, 49), which include references to the relative newness of the HPV vaccine (10, 46).”
BackgroundResultInfluential
To be or not to be vaccinated against COVID-19 – The adolescents’ perspective – A mixed-methods study in Sweden
Nilsson, S., Mattsson, J. Y., Berghammer, M. C., Brorsson, A.-L., Forsner, M., Nolbris, M. J., Kull, I., Olinder, A. L., Ragnarsson, S., Rullander, A.-C., et al. (2021) · Vaccine X · doi:10.1016/j.jvacx.2021.100117 · Cited by 34 · see citing works
Human Papillomavirus Infection and Vaccination: Knowledge, Attitude and Perception among Undergraduate Men and Women Healthcare University Students in Switzerland
Jeannot, É., Viviano, M., Follonier, M.-C., Kaech, C., Oberhauser, N., Mpinga, E. K., Vassilakos, P., Kaiser, B., & Petignat, P. (2019) · Vaccines · doi:10.3390/vaccines7040130 · Cited by 33 · see citing works
Association between quadrivalent human papillomavirus vaccination and selected syndromes with autonomic dysfunction in Danish females: population based, self-controlled, case series analysis
Hviid, A. P., Thorsen, N. M., Valentiner‐Branth, P., Frisch, M., & Mølbak, K. (2020) · BMJ · doi:10.1136/bmj.m2930 · Cited by 32 · see citing works
Vaccine Hesitancy Drives Low Human Papillomavirus Vaccination Coverage in Girls Attending Public Schools in South Africa
Khosa, L. A., Meyer, J. C., Motshwane, F. M. M., Dochez, C., & Burnett, R. J. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.860809 · Cited by 32 · see citing works
‘I trust them because my mum trusts them’: Exploring the role of trust in HPV vaccination decision-making among adolescent girls and their mothers in France
Karafillakis, E., Peretti‐Watel, P., Verger, P., Chantler, T., & Larson, H. J. (2022) · Vaccine · doi:10.1016/j.vaccine.2022.01.028 · Cited by 31 · see citing works
“The vaccine has also been described in this study and others as eliciting mistrust because of a perceived lack of scientific evidence around its safety and effectiveness [12,30].”
BackgroundResultSelf-citation
A comparison of seasonal influenza and novel Covid-19 vaccine intentions: A cross-sectional survey of vaccine hesitant adults in England during the 2020 pandemic
Antonopoulou, V., Goffe, L., Meyer, C., Grimani, A., Graham, F., Lecouturier, J., Tang, M. Y., Chadwick, P., & Sniehotta, F. F. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2085461 · Cited by 31 · see citing works
Acceptability of a hypothetical dengue vaccine and the potential impact of dengue vaccination on personal vector control behavior: a qualitative study in Fortaleza, Brazil
Scott, V. K., Pinheiro, M. S. N., Machado, M. M. T., & Castro, M. C. (2023) · BMC Public Health · doi:10.1186/s12889-023-17005-8 · Cited by 30 · see citing works
“Vaccine hesitancy is often driven by concerns about safety and possible side effects, as seen in hesitancy surrounding HPV vaccines [42–44] and, more recently, COVID-19 vaccines [45, 46].”
Background
Vaccine Hesitancy among European Parents—Psychological and Social Factors Influencing the Decision to Vaccinate against HPV: A Systematic Review and Meta-Analysis
Achimaș-Cadariu, T., Paşca, A., Jiboc, N. M., Puia, A., & Dumitrascu, D. L. (2024) · Vaccines · doi:10.3390/vaccines12020127 · Cited by 30 · see citing works
Evaluation of the acceptability in France of the vaccine against papillomavirus (HPV) among middle and high school students and their parents
Huon, J., Grégoire, A., Meireles, A. M., Lefebvre, M., Péré, M., Coutherut, J., Biron, C., Raffi, F., & Briend-Godet, V. (2020) · PLoS ONE · doi:10.1371/journal.pone.0234693 · Cited by 30 · see citing works
“In France, fear of the potential secondary effects is a predominant argument that is regularly cited [40].”
Background
Maternal level of awareness and predictors of willingness to vaccinate children against COVID 19; A multi-center study
Chinawa, A. T., Chinawa, J. M., Ossai, E. N., Nduagubam, O. C., Onukwuli, V. O., Aronu, A. E., & Manyike, C. P. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.1963172 · Cited by 29 · see citing works
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Self-citation
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Impact of a school-based and primary care-based multicomponent intervention on HPV vaccination coverage among French adolescents: a cluster randomised controlled trial protocol (the PrevHPV study)
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Human Papilloma Virus Vaccination: Focus on the Italian Situation
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“A recent systematic review has identified the perceived low efficacy of the vaccine, possible side effects, lack of trust in health authorities and inadequate and partial information as the main causes of vaccine hesitancy regarding HPV vaccination in Europe [43].”
Background
Understanding the societal factors of vaccine acceptance and hesitancy: evidence from Hong Kong
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“13,21 70% of young people aged between 15 and 26 participating in a recent study, had knowledge about HPV vaccination and the association with cervical cancer; the main sources of information reported were similar to those in our study: those from the school (53”
Cognitions and behaviours of general practitioners in France regarding HPV vaccination: A theory-based systematic review
Boulley, G. E., Mandrik, O., Préau, M., Herrero, R., & Villain, P. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106323 · Cited by 23 · see citing works
Determinants of Human Papillomavirus Vaccine Uptake by Adult Women Attending Cervical Cancer Screening in 9 European Countries
Robles, C., Bruni, L., Acera, A., Riera, J. C., Prats, L., Poljak, M., Mlakar, J., Oštrbenk, A., Eriksson, T., Lehtinen, M., et al. (2020) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2020.08.032 · Cited by 23 · see citing works
“This is consistent with the qualitative findings in a European systematic review where men and women of all ages were asked about HPV vaccine for adults and children.(39) Therefore, to achieve high acceptance rates of the HPV vaccine, irrespective of the targeted age groups of the programs, it is important to involve…”
Result
Factors influencing human papillomavirus vaccination uptake in European women and adolescents: A systematic review and meta‐analysis
Jiboc, N. M., Paşca, A., Tăut, D., & Băban, A. (2023) · Psycho-Oncology · doi:10.1002/pon.6242 · Cited by 22 · see citing works
“The most common reasons for vaccination hesitancy were fear of side effects, worrying about the new vaccine, beliefs, and lack of information regarding the vaccine, 22 and religion.”
Background
Factors associated with seasonal influenza and HPV vaccination uptake among different ethnic groups in Arab and Jewish society in Israel
Shahbari, N. A. E., Gesser‐Edelsburg, A., Davidovitch, N., Brammli‐Greenberg, S., Grifat, R., & Mesch, G. S. (2021) · International Journal for Equity in Health · doi:10.1186/s12939-021-01523-1 · Cited by 22 · see citing works
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Opportunities for HPV vaccine education in school-based immunization programs in British Columbia, Canada: A qualitative study
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“37 39 It is thus crucial from both a humanitarian and public health perspective to reduce vaccine-related anxiety.”
Background
The Influence of Social Media and Institutional Trust on Vaccine Hesitancy in France: Examining Direct and Mediating Processes
McKinley, C. J., Olivier, E., & Ward, J. K. (2023) · Vaccines · doi:10.3390/vaccines11081319 · Cited by 20 · see citing works
“A systematic review of 25 European countries—including France—showed that trust in health authorities was a central determinant of HPV vaccine hesitancy [32].”
Background
Identifying intervention strategies to improve HPV vaccine decision-making using behaviour change theory
Marshall, S., Fleming, A., Sahm, L. J., & Moore, A. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.01.025 · Cited by 20 · see citing works
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Impact of COVID-19 pandemic and vaccine perceptions on HPV vaccine hesitancy
Schelbar, N., Ward, C. N., Phillips, E. M., Herr, M. J., Acevedo, S., Conner, H., Greiner, A. K., & Corriveau, E. A. (2023) · American Journal of Otolaryngology · doi:10.1016/j.amjoto.2023.104172 · Cited by 19 · see citing works
Sociodemographic determinants of HPV vaccine awareness, uptake, and intention among parents of adolescents in France 2021-22
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“11,17,21,22 Consequently, young girls and women from underprivileged backgrounds have an increased risk of not benefiting from either of the two cervical cancer prevention measures throughout their lifetime.”
Background
Association Between Human Papillomavirus Vaccination and Primary Ovarian Insufficiency in a Nationwide Cohort
Hviid, A. P., & Thiesson, E. M. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.20391 · Cited by 18 · see citing works
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“After removal of duplicates, initial screening and eligibility assessment, 10 systematic reviews were considered suitable for inclusion.”
Self-citation
Co‐development of a school‐based and primary care‐based multicomponent intervention to improve HPV vaccine coverage amongst French adolescents (the PrevHPV Study)
Bocquier, A., Bruel, S., Michel, M., Duc-Banaszuk, A.-S. L., Bonnay, S., Branchereau, M., Chevreul, K., Chyderiotis, S., Gauchet, A., Giraudeau, B., et al. (2023) · Health Expectations · doi:10.1111/hex.13778 · Cited by 18 · see citing works
Changes in general and COVID-19 vaccine hesitancy among U.S. adults from 2021 to 2022
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“rejection, followed by concerns about the vaccine’s safety voiced via concerns about a fear of side effects.(46) The primary reasons for rejecting HPV vaccination (i.”
BackgroundResultInfluential
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BackgroundInfluential
Factors that influence caregivers’ and adolescents’ views and practices regarding human papillomavirus (HPV) vaccination for adolescents: a qualitative evidence synthesis
Cooper, S., Schmidt, B., Jama, N. A., Ryan, J., Leon, N., Mavundza, E. J., Burnett, R. J., Tanywe, A. C., & Wiysonge, C. S. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013430.pub2 · Cited by 15 · see citing works
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BackgroundInfluential
Relationship between knowledge, attitudes, and practices and COVID-19 vaccine hesitancy: A cross-sectional study in Taizhou, China
Lin, X., Zhang, M., Chen, Y., Xue, J.-J., Chen, H.-D., Tung, T., & Zhu, J. (2022) · Frontiers in Medicine · doi:10.3389/fmed.2022.770933 · Cited by 15 · see citing works
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Background
Using World Cafés to engage an Australian culturally and linguistically diverse community around human papillomavirus vaccination
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Determinants of human papillomavirus (HPV) vaccine uptake among girls in France: A population-based telephone survey
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Self-citation
Formative Research on HPV Vaccine Acceptance among Health Workers, Teachers, Parents, and Social Influencers in Uzbekistan
Warsi, S. K., Nielsen, S. M., Franklin, B. A. K., Abdullaev, S., Ruzmetova, D., Raimjanov, R., Nagiyeva, K., & Safaeva, K. (2023) · Vaccines · doi:10.3390/vaccines11040754 · Cited by 14 · see citing works

Understanding confidence in the human papillomavirus vaccine in Japan: a web-based survey of mothers, female adolescents, and healthcare professionals
Shuto, M., Kim, Y., Okuyama, K., Ouchi, K., Ueichi, H., Nnadi, C. D., Larson, H. J., Pérez, G., & Sasaki, S. (2021) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2021.1918042 · Cited by 19 · see citing works
Self-citation
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Self-citation
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Self-citation

Authors: Karafillakis, E., Simas, C., Jarrett, C., Verger, P., Peretti-Watel, P., Dib, F., De Angelis, S., Takacs, J., Ali, K. A., Pastore Celentano, L., & Larson, H.
Affiliations: London School of Hygiene & Tropical Medicine (GB)
Swiss Tropical and Public Health Institute (CH)
Inserm (FR)
Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, IHU-Méditerranée Infection, Marseille, France
Vaccine Preventable Disease Programme, European Centre for Disease Prevention and Control, Stockholm, Sweden
Centre for Social Sciences, Hungarian Academy of Sciences, Budapest, Hungary
European Centre for Disease Prevention and Control (SE)
University of Washington (US)
Corresponding author: Karafillakis, Emilie
ORCID: Karafillakis, Emilie
Simas, Clarissa
Jarrett, Caitlin
Verger, Pierre
Dib, Fadia
Larson, Heidi
Venue: Human Vaccines & Immunotherapeutics
Publisher: Informa UK Limited
Published: 2019-02-20
Volume: 15
Issue: 7-8
Pages: 1615-1627
ISSN: 2164-5515 (ISSN-L)
2164-554X
DOI: 10.1080/21645515.2018.1564436
PMC: PMC6783136
OpenAlex: W2910348912
Cited by: 328
References: 132
Citations by year: 2026: 43 · 2025: 53 · 2024: 49 · 2023: 48 · 2022: 63 · 2021: 36 · 2020: 25 · 2019: 11
FWCI: 7.18
Type: journal article
Language: en
Open access: hybrid
doi.org
Licence: cc-by-nc-nd
creativecommons.org/licenses/by-nc-nd/4.0/ (vor)
Locations: Human Vaccines & Immunotherapeutics (publishedVersion, cc-by-nc-nd)
PubMed Central (publishedVersion, cc-by-nc-nd)
PubMed (publishedVersion)
edoc (University of Basel) (acceptedVersion)
Repository of the Academy's Library (Library of the Hungarian Academy of Sciences) (acceptedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (acceptedVersion)
LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
HAL AMU (submittedVersion, cc-by-nc-nd)
Funders: European Centre for Disease Prevention and Control (OCS-2016-0UT-2050-MCTeFo)
Topics: Social Sciences › Health › Vaccine Coverage and Hesitancy
Health Sciences › Medicine › Epidemiology › Cervical Cancer and HPV Research
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Women's cancer prevention and management
Keywords: HPV vaccination, vaccine hesitancy, vaccine confidence, vaccine safety concerns, vaccine side effects, determinants of vaccine hesitancy, community participation, Europe
MeSH terms: Vaccination Refusal, Uterine Cervical Neoplasms, Europe, Female, Humans, Health Knowledge, Attitudes, Practice, Patient Acceptance of Health Care, Vaccination, Papillomavirus Infections, Uncertainty, Trust, Papillomavirus Vaccines

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HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

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