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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
Open accessAbstract
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,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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“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,…”
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Self-citationUnderstanding medical mistrust and HPV vaccine hesitancy among multiethnic parents in Los Angeles
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“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.”
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“Furthermore, a review on the human papillomavirus (HPV) vaccine identified ten thematic categories of VH determinants [17].”
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“[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.”
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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”
Boulley, G. E., Mandrik, O., Préau, M., Herrero, R., & Villain, P. (2020) · Preventive Medicine · doi:10.1016/j.ypmed.2020.106323 · Cited by 23
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
“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…”
ResultJiboc, N. M., Paşca, A., Tăut, D., & Băban, A. (2023) · Psycho-Oncology · doi:10.1002/pon.6242 · Cited by 22
“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.”
BackgroundShahbari, 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 23
Ryan, G. W., Avdic, L., Daly, E., Askelson, N. M., Farris, P. E., Shannon, J., McRee, A., Hanson, J. D., Kenyon, D. B., & Seegmiller, L. E. (2020) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2020.1839290 · Cited by 28
Brohman, I., Blank, G., Mitchell, H., Dubé, È., & Bettinger, J. A. (2024) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2024.2326779 · Cited by 21
“37 39 It is thus crucial from both a humanitarian and public health perspective to reduce vaccine-related anxiety.”
BackgroundMcKinley, C. J., Olivier, E., & Ward, J. K. (2023) · Vaccines · doi:10.3390/vaccines11081319 · Cited by 20
“A systematic review of 25 European countries—including France—showed that trust in health authorities was a central determinant of HPV vaccine hesitancy [32].”
BackgroundMarshall, S., Fleming, A., Sahm, L. J., & Moore, A. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.01.025 · Cited by 25
Sabat, I., Neumann‐Böhme, S., Barros, P. P., Torbica, A., van Exel, J. N. A., Brouwer, W. B. F., Stargardt, T., & Schreyögg, J. (2023) · Vaccine · doi:10.1016/j.vaccine.2023.07.017 · Cited by 20
Okunowo, A. A., Ugwu, A. O., Kuku, J. O., Soibi-Harry, A. P., Okunowo, B. O., Ani-Ugwu, N. K., Osunwusi, B. O., & Adenekan, M. A. (2021) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2021.101643 · Cited by 19
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
Rivera, A. F., Dussault, J. M., Doglioni, D. O., Chyderiotis, S., Sicsic, J., Barret, A., Raude, J., Gauchet, A., Gagneux‐Brunon, A., Bruel, S., et al. (2024) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2024.2381300 · Cited by 19
“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.”
BackgroundHviid, A. P., & Thiesson, E. M. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.20391 · Cited by 21
Bennett, C. L., Edwards, D. J., Sherman, S., Baker, P., Waheed, D.-E.-N., Vorsters, A., Çevik, H. S., Karafillakis, E., Prue, G., & Kelly, D. M. (2022) · Sexually Transmitted Infections · doi:10.1136/sextrans-2022-055504 · Cited by 21
“After removal of duplicates, initial screening and eligibility assessment, 10 systematic reviews were considered suitable for inclusion.”
Self-citationBocquier, 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
Changes in general and COVID-19 vaccine hesitancy among U.S. adults from 2021 to 2022
Nguyen, K. H., Chung, L., McChesney, C., Vasudevan, L., Allen, J. D., & Bednarczyk, R. A. (2024) · Annals of Medicine · doi:10.1080/07853890.2024.2357230 · Cited by 18
Gauna, F., Raude, J., Khouri, C., Cracowski, J., & Ward, J. K. (2025) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2025.2471225 · Cited by 17
Factors affecting children’s HPV vaccination in Austria: Evidence from a parent survey
Waser, M., Heiss, R., & Borena, W. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2126251 · Cited by 20
“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.”
BackgroundResultInfluentialCameron, R. L., Palmer, T. J., Cuschieri, K. S., Kavanagh, K., & Roy, K. (2024) · Vaccine · doi:10.1016/j.vaccine.2024.126177 · Cited by 17
Fakonti, G., Hadjikou, A., Tzira, E., Kyprianidou, M., & Giannakou, K. (2022) · Frontiers in Pediatrics · doi:10.3389/fped.2022.951039 · Cited by 17
Parental Factors Affecting Decision to Vaccinate Their Daughters against Human Papillomavirus
Park, Y., Ki, M., Lee, H., Lee, J. K., & Oh, J. (2023) · Cancer Prevention Research · doi:10.1158/1940-6207.capr-22-0412 · Cited by 16
Alarcão, V., & Zdravkova, B. (2022) · Societies · doi:10.3390/soc12050131 · Cited by 16
“HPV vaccination coverage rates are affected by social norms (including of one’s family, friends, healthcare professionals, and religious or community leaders) [10].”
BackgroundInfluentialCooper, 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 20
Henschke, N., Bergman, H., Buckley, B. S., Crosbie, E. J., Dwan, K. M., Golder, S., Kyrgiou, M., Loke, Y. K., McIntosh, H. M., Probyn, K., et al. (2025) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015363.pub2 · Cited by 17
The Effectiveness of Interventions Targeting Adolescents in HPV Vaccination—A Scoping Review
Iova, C. F., Daina, L., Daina, M. D., & Ghitea, T. C. (2024) · Medicina · doi:10.3390/medicina60091550 · Cited by 15
“Distrust of vaccines in general, concerns about vaccine efficacy [57], doubts about the benefits of vaccines, and low perception of disease risk and disease severity are important barriers to vaccination [51,52].”
BackgroundInfluentialLin, 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
“In addition, compared with hesitation for other vaccines (18, 19), there was a higher proportion of hesitation for the COVID-19 vaccine, suggesting that the Chinese population still has a certain degree of nervousness about the COVID-19 vaccine.”
BackgroundProkopovich, K., Phillipson, L., West, L., Stanoevska, B., Street, J., & Braunack‐Mayer, A. (2023) · Health Expectations · doi:10.1111/hex.13703 · Cited by 15
Dib, F., Mayaud, P., Renaudie, C., Launay, O., & Chauvin, P. (2022) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2022.2083894 · Cited by 14
Self-citationWarsi, 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
Metadata
- 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
- 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
- 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
- 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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