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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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EBEVEYNLERİN HPV AŞISI HAKKINDAKİ BİLGİ DÜZEYLERİ VE YAKLAŞIMLARI
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Acharya, S., Aechtner, T., Venaik, S., & Dhir, S. (2024) · Journal of Risk Research · doi:10.1080/13669877.2024.2317318 · Cited by 10
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There’s Much Yet to be Done: Diverse Perspectives on HPV Vaccination
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Unveiling the complexity of vaccine hesitancy: A narrative review focusing on dengue vaccination
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“The positive-negative framework is closely associated with the notion of misinformation or inadequate information, which many studies link to HPV vaccine hesitancy (Karafillakis et al., 2019).”
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“Surprisingly, the study published by Karafillakis in 2019 mentioned that in the European region, including Romania, there is the lowest level of trust in vaccination, especially regarding the safety of vaccines [42].”
Domaradzki, J., Jabkowski, P., & Walkowiak, D. (2024) · BMC Medical Education · doi:10.1186/s12909-024-06057-y · Cited by 5
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“Der Aufbau und das Aufrechterhalten von Vertrauen sollten hierbei eine wesentliche Rolle einneh-men [22].”
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“Vaccine confidence in European contexts depended on the context and population according to a systematic review which included the quantity and quality of information sources for the HPV vaccine, worries about side effects, mistrust of health authorities/workers, and new vaccines [14].”
Zi, W., Yang, Q., Su, J., He, Y. O., & Xie, J. (2022) · Heliyon · doi:10.1016/j.heliyon.2022.e11515 · Cited by 6
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Algren, M. H., Gazibara, T. M., Valentiner‐Branth, P., Timmermann, C. A. G., Thygesen, L. C., & Tolstrup, J. S. (2024) · Scandinavian Journal of Public Health · doi:10.1177/14034948241232462 · Cited by 5
“…hesitancy in europe showed that the most frequent concerns were a perceived lack of knowledge and fear of potential HPV-vaccine side effects [28]. even though there is evidence of the HPV-vaccine’s efficacy and safety [29], fear of side effects of the HPV vaccine has been associated with…”
HPV vaccination intention among guardians of female secondary school students in Chongqing, China
Bai, N., Wang, Q., Shao, J., Chen, L., Wang, C., Xiao, X., Yu, L., & Xu, B. (2024) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2024.2381293 · Cited by 5
Potenzial und Limitationen von Schulimpfprogrammen zur Steigerung der HPV-Impfquoten in Deutschland
Takla, A., Schmid-Küpke, N., & Wichmann, O. (2025) · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz · doi:10.1007/s00103-025-04029-1 · Cited by 5
Henschke, N., Bergman, H., Villanueva, G., Loke, Y. K., Golder, S., Crosbie, E. J., Kyrgiou, M., Dwan, K. M., & Morrison, J. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015363 · Cited by 6
Dkhar, S. A., Jeelani, A., Quansar, R., & Khan, M. S. (2022) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_383_21 · Cited by 5
“Vaccine hesitancy to a newly introduced vaccine is not new and has been also present with previously introduced vaccines though the level of hesitancy found for COVID‑19 vaccine is higher than that found for vaccines like HPV and MR.[13,14] Similar findings were seen in various studies conducted in different parts of…”
ResultHuman Papillomavirus Vaccination: Past, Present and Future
Aimagambetova, G. N., & Azizan, A. (2022) · Vaccines · doi:10.3390/vaccines10091398 · Cited by 5
Primary prevention of HPV-related diseases from the patients’ perspective in Poland
Trojnarska, D., & Jach, R. (2023) · European Journal of Cancer Prevention · doi:10.1097/cej.0000000000000866 · Cited by 4
“…one dose of a prophylactic HPVv (Human Papillomavirus, 2023). has led to a significant reduction in the incidence and prevalence of HPV-related cancers, it is important to note that the outcomes of these campaigns vary on a global scale (Karafillakis et al ., 2019; Aimagambetova and Azizan, 2022).”
BackgroundKacperczyk-Bartnik, J. P., Hajj, H. E., Tóth, I., Bizzarri, N., Tóth, R., Razumova, Z., Zwimpfer, T. A., Taumberger, N., Bilir, E., Strojna, A. N., et al. (2025) · International Journal of Gynecological Cancer · doi:10.1016/j.ijgc.2025.101902 · Cited by 7
Abudurexiti, G., Muhetaer, K., Yang, J., Zhuo, Q., Qi, T., Saimi, Z., Ouyang, Y., Yu, H., Yilamujiang, P., Adili, N., et al. (2025) · BMC Public Health · doi:10.1186/s12889-025-25209-3 · Cited by 4
“These fears mirror global trends, where vaccine hesitancy in regions such as the EU and EEA is similarly driven by uncertainties regarding safety and effectiveness [28, 29].”
Tomoi, H., Hanley, S. J. B., Larson, H. J., Tomoi, H., & Masuda, K. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.128111 · Cited by 4
Self-citationTopçu, E. G., Ubom, A. E., Roy, P., & Ruiloba, F. J. (2024) · Journal of Turkish Society of Obstetric and Gynecology · doi:10.4274/tjod.galenos.2024.31369 · Cited by 4
“Ob/Gyns’ level of knowledge of HPV and HPV vaccination influences their willingness to recommend the vaccine to clients (12) , and recommendation by a healthcare provider (HCP) has consistently been identified as a significant driver of HPV vaccine uptake (15,16) .”
BackgroundCould be better: adolescent access to health information and care
Herriman, Z., Tchen, H., & Cafferty, P. W. (2024) · European Journal of Pediatrics · doi:10.1007/s00431-024-05868-x · Cited by 4
Pay-it-forward as a strategy to increase vaccine uptake
Li, Y., Li, J., Tucker, J. D., Geng, E. H., & Wu, D. (2025) · BMC Global and Public Health · doi:10.1186/s44263-025-00151-z · Cited by 4
“In high-income countries, low uptake is often attributed to vaccine hesitancy, which is frequently driven by concerns related to vaccine safety, misinformation, and declining confidence in vaccination programs [1].”
Trends Towards Enhanced Rates and Sex Parity in HPV Vaccination in Croatia (2016–2023)
Raic, L., Šimetin, I. P., Brađašević, E., Jezidzic, A., Blažić, T. N., & Poljičanin, T. (2025) · Vaccines · doi:10.3390/vaccines13040410 · Cited by 4
“Implementing targeted public health initiatives, expanding access through school-based programs, and addressing vaccine misconceptions through community engagement and education campaigns could potentially improve the vaccination coverage in these regions [32,33].”
Üzüm, Ö., İnce, G., Eliaçık, K., Kanık, A., Elmali, F., & Helvacı, M. (2023) · Cureus · doi:10.7759/cureus.34218 · Cited by 4
“The common usage of social media and other communication channels leverages vaccine hesitancy to reach wider audiences and increase their share [9,10].”
BackgroundDilemmas Associated with COVID-19 Vaccine Hesitancy in Zimbabwe
Mbulayi, S. P., Makuyana, A., Zindi, B., & Kang’ethe, S. M. (2023) · Perspectives on Global Development and Technology · doi:10.1163/15691497-12341632 · Cited by 4
Olsen, S. O., & Tuu, H. H. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e25901 · Cited by 4
“These perceived risks reduce confidence in new vaccines, increase concerns and contribute to vaccine hesitancy [48].”
BackgroundAdamu, A. A., Jalo, R. I., Ndwandwe, D. E., & Wiysonge, C. S. (2024) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2024.2381922 · Cited by 4
Okoli, G. N., Moon, A. G., Soos, A. E., Neilson, C. J., Kimmel, H. J., Etsell, K., Grewal, A., Caeseele, P. G. V., Richardson, C. R., & Harper, D. M. (2024) · Public Health in Practice · doi:10.1016/j.puhip.2024.100562 · Cited by 4
“While there have been some published systematic reviews of factors that may influence HPV vaccination, they are mostly narrative, focused on qualitative factors, and limited to a few socioeconomic/health-related factors (not extensive) [7 – 11].”
Fobian, S., Amin, M., Sacchetti, A., Oei, A. L., & ten Hagen, T. L. M. (2025) · Journal of Controlled Release · doi:10.1016/j.jconrel.2025.01.014 · Cited by 5
Cernasev, A., Barenie, R. E., Jasmin, H., Yatsko, A., & Stultz, J. S. (2024) · Women · doi:10.3390/women4020012 · Cited by 4
“Karafillakis et. al., 2019, concluded that there are multiple ways to tackle this issue, and some strategies could focus on providing adequate information to patients regarding safety and efficacy, which would lead to regaining trust in the healthcare system [53].”
BackgroundJol, G., van Charldorp, T. C., Molder, H. T., & van Trommel, N. E. (2024) · SSM - Qualitative Research in Health · doi:10.1016/j.ssmqr.2024.100456 · Cited by 4
Chen, N. N. (2023) · Risk Analysis · doi:10.1111/risa.14220 · Cited by 3
Kaundal, A., Renjhen, P., Sharma, S., Prasad, S., Marwaha, P. D., & Kaur, H. (2025) · Annals of African Medicine · doi:10.4103/aam.aam_86_24 · Cited by 3
“[1,2] Since the data regarding reasons for poor uptake of the HPV vaccine are scarce from our country, this study was conducted with the intention to understand the barriers to optimal vaccine coverage in the country so as to guide us and policymakers to plan a strategy for the successful…”
Cao, X., Borah, P., Lee, D. K. L., Vishnevskaya, A., Su, Y., & Lorenzano, K. J. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.127760 · Cited by 3
Berhanu, W., Gobbo, E., van Wees, S. H., Hanson, C., & Addissie, A. (2025) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2025.2578894 · Cited by 3
Patlolla, N. R., Yeldandi, V. V., Aralikar, S., Sangireddy, S., Siddiqua, J., Varghese, A. M., Chandralekha, Sameem, M. A., Madani, Chaitanya, S. V., et al. (2026) · Clinical and Experimental Vaccine Research · doi:10.7774/cevr.2026.15.e8 · Cited by 3
“…or safety concerns is supported by international observations: similar hesitancy rates (including uncertainty about necessity and concerns about adverse effects) are seen across demographic groups, sometimes amplified by social media misinformation or the absence of trusted messengers [17-19].”
Uptake of HPV vaccination and associated factors in France: a nationwide study from 2007 to 2023
Dufour, L., Drouin, J., Dray‐Spira, R., & Vu, S. L. (2026) · Vaccine · doi:10.1016/j.vaccine.2026.128308 · Cited by 3
Hermet, L., Soupey, S., Descamps, A., Coraci, P., & Touboul-Lundgren, P. (2026) · Vaccine · doi:10.1016/j.vaccine.2026.128639 · Cited by 3
Park, D., Schivinski, B., Duns-McKay, H., Heeren, B., & McLachlan, E. (2023) · Journal of Marketing Communications · doi:10.1080/13527266.2023.2191618 · Cited by 3
“Along with vaccine efficacy, safety of the vaccine has been found to be a major concern for people who are reluctant to get vaccinated against communicable diseases (Schmid et al. 2017; Karafillakis et al. 2019).”
Kim, Y., & Lim, M. K. (2024) · PLoS ONE · doi:10.1371/journal.pone.0312309 · Cited by 3
“Therefore, understanding the factors influencing vaccine hesitancy and promoting vaccination is crucial not only for controlling current outbreaks but also for preparing for future pandemics [14–21].”
Background
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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