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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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“These studies revealed that the availability of information about the HPV vaccination and the potential side effects were the main reasons for vaccine hesitancy (33).”
Marginalized voices on HPV vaccination in India: exploring knowledge, attitudes, and acceptance
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A qualitative assessment of influenza vaccine uptake among children in Kenya
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Lian, Y., Qiao, J., Ming, W., & Wu, Y. (2023) · Vaccines · doi:10.3390/vaccines11010133 · Cited by 2
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BackgroundInfluentialKognitivni prediktori oklijevanja s cijepljenjem protiv bolesti SARS-CoV-2 među mladima u Hrvatskoj
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“A systematic literature review of determinants of HPV vaccine hesitancy in Europe reported concerns of potential side effects of the vaccine, alongside mistrust of health authorities, healthcare workers and to new vaccines (Karafillakis et al., 2019).”
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Cost‐Effectiveness of Human Papillomavirus Vaccination for Adolescent Girls in Moscow, Russia
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InfluentialDeterminants of HPV vaccine hesitancy in South Asia: a systematic review
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InfluentialHealth Outcome Determinants of Human Papillomavirus Vaccination in Adult Women in Spain
de la Fuente-Valero, J., Rejas‐Gutiérrez, J., Pino, M. L. D., González‐Granados, C., Oliva-Sánchez, R., Procas‐Ramon, B., Mena, M. R., Cohen-Castiel, A., Torres, J. C., Fasero, M., et al. (2026) · Vaccines · doi:10.3390/vaccines14050460 · Cited by 1
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Improving public trust in vaccination programmes
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Epidemiological significance of human papillomavirus
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García, S., Hopfer, S., Miller-Day, M. A., McCain, J. C., & Hecht, M. L. (2024) · Journal of Family Communication · doi:10.1080/15267431.2024.2404865 · Cited by 2
“Although the literature has acknowledged the prevalence of needle phobia (Baxter et al., 2017; Karafillakis et al., 2019), there has been an insufficient focus on how this fear influences conversations about vaccines between parents and their children and that parental negotiation skills often…”
van Wees, S. H., Bakare, A. A., Akinsola, K. O., Salako, J., Bakare, D., Gobbo, E., Hanson, C., Falade, A. G., & King, C. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-098308 · Cited by 1
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“…to this study, vaccination coverage across the region has been a stalemate (70%), and even on a declining course in some speci c settings, where the number of under- ve children missing the third dose of DTP3 vaccines was estimated at 7.4 million (Naimoli, 2008; Mihigo, 2017; Lafond et al., 2015).”
BackgroundInfluentialFactor Affecting COVID-19 Vaccine Hesitancy in Bangladesh: An Empirical InvestigationPreprint
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“…policies (Grandahl et al., 2014; Kara llakis et al., 2019) and the government’s intimacy with the vaccine manufacturers (Craciun & Baban, 2012; Kara llakis et al., 2019) or hiding the information on the side effects, and due to the lower level of trust in the pharmaceutical companies for their…”
BackgroundInfluentialHygiene, J. O. P. M. A. (2022) · PubMed Central · doi:10.15167/2421-4248/jpmh2022.63.1s1 · Cited by 1
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Exploring vaccine decision-making to identify and address barriers to vaccine uptake in Ireland
Marshall, S. M. (2020) · Cork Open Research Archive (University College Cork, Ireland)
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Precáncer anogenital: nuevos horizontes para el ginecólogo
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Koczkodaj, P., Dillner, J., & Mańczuk, M. (2022) · Nowotwory Journal of Oncology · doi:10.5603/njo.a2021.0078
Types of anticipated affect that encourage and discourage vaccination: a scoping review protocol
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Preventing human papilloma virus infection: another vaccination success
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Exploring Enablers and Barriers to COVID-19 Vaccine Acceptance Among Arabs: A Qualitative StudyPreprint
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) · SSRN Electronic Journal · doi:10.2139/ssrn.4062495
Zi, W., Yang, Q., Su, J., He, Y. O., & Xie, J. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4100914
الشیمی, م. ل. (2021) · Al-Maǧallah Al-Miṣriyyaẗ Li-Buḥūṯ Al-Iʿlām · doi:10.21608/ejsc.2021.224632
Leitão, A. M. D. S., & Bacatum, C. M. J. (2022) · Revista Recien · doi:10.24276/rrecien2022.12.38.149-156
Tubaş, F., Taplak, A. Ş., & Tatar, S. B. (2022) · Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection · doi:10.5578/ced.20229753
Tubaş, F., Taplak, A. Ş., & Tatar, S. B. (2022) · Çocuk Enfeksiyon Dergisi/Journal of Pediatric Infection · doi:10.5578/ced.20229749
“Aşılanma istekliliği, özellikle sağlık çalışanlarına duyulan güvensizlik ile derinden etkilenmektedir (10).”
Doctors’ Attitudes and Practises Regarding Human Papıllomavirus Vaccination: A Qualitative Study
Aksoy, H., & Döner, P. (2023) · Ankara Medical Journal · doi:10.5505/amj.2023.09609
Human Papillomavirus vaccines: Call for a European change to tackle current and future shortages
Maviglia, A., Bitar, E., Schmidt, J., Winters, P., de Souza, S., & Clemens, T. (2023) · South Eastern European Journal of Public Health · doi:10.56801/seejph.vi.368
A humán papillomavírus elleni védőoltást megelőző betegtájékoztatás egyes különleges szempontjai.
Fogarasi, I. A., Kovács, J., & Belicza, É. (2023) · Orvosi Hetilap · doi:10.1556/650.2023.32904
Kordasiabi, M. C., & Naghibi, S. A. (2023) · Iranian Journal Of Health Sciences · doi:10.32598/ijhs.11.4.834.3
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Getova-Kolarova, V., Zlatareva, A., & Kumanov, I. (2024) · Pharmacia · doi:10.3897/pharmacia.71.e122666
“The underestimation of complications and risks related to vaccine-preventable diseases are also reasons for poor vaccine coverage (Karafillakis et al. 2019).”
BackgroundYoshioka, T., Goto, A., Mizushima, T., Suzuki, Y., Ueda, Y., Yagi, A., Sekine, M., Kudo, R., Garland, S. M., Kumaresamy, S., et al. (2024) · doi:10.2196/preprints.67778
A Bayesian spatio-temporal model for cluster detection: identifying HPV suboptimal vaccine coverage
López‐Lacort, M., Vallet, A. C., Briz‐Redón, Á., Gómez, F. J. S., Muñoz-Quiles, C., & Orrico‐Sánchez, A. (2024) · Stochastic Environmental Research and Risk Assessment · doi:10.1007/s00477-024-02815-y
“Comparative analyses indicated that confidence determinants differed by country and population groups (Gefenaite et al. 2012 ; Karafillakis et al. 2019).”
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OECD (2024) · OECD health policy studies · doi:10.1787/0cdc42ae-fr
OECD (2024) · OECD health policy studies · doi:10.1787/c0f28aca-en
Colón‐López, V., Muñoz‐Torres, F. J., Escabí-Wojna, E., Jimenez, I. V., Diaz-miranda, O. L., Medina-Laabes, D. T., Wells, K. B., Ortiz, A. P., Hull, P. C., & Suarez, E. L. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0002852
“A study [30] found that 44% of hesitant participants indicated a lack of available information about the HPV vaccine.”
Knowledge and Behavioral Beliefs Related to Vaccination Hesitancy Among Healthcare Workers
(2025) · Frontiers research topics · doi:10.3389/978-2-8325-5893-5
Magcamit, M., & Chinudomsub, P. (2024) · Japanese Journal of Political Science · doi:10.1017/s146810992400015x
Xiong, Y., Wu, C., Zhang, Y., Guo, D., Wang, J., Du, L., Yang, L., & Cheng, J. (2025) · Vaccine · doi:10.1016/j.vaccine.2025.127208
van der Werf, E. E. M. W., van Heugten, J. I., Bisschops, K. M. C., Lovell, C., & Boender, T. S. (2025) · JMIR Infodemiology · doi:10.2196/73803
Pooled Vaccine Communication Actions to Promote Vaccination in the European Union: The Case of Italy
Possenti, V., Croci, R., Terlizzi, R., Nobile, A., Fucili, L., Mirra, M., Lucattini, S., Gregorio, M. D., Giammarioli, A. M., Pizzarelli, S., et al. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251342097
Deng, Y., Wang, T., Li, Y., Fu, X., Luo, Y., & Fei, C. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1649455
“However, people are often misled by unofficial misinformation that leads to skepticism and misunderstanding about the value and safety of vaccines (66).”
Niazyan, L., Grigoryan, S., Simonyan, P., Karapetyan, L., Karapetyan, D. G., Zohrabyan, A., Pivazyan, A., Grigoryan, S., Atoyan, S. A., & Datta, S. S. (2025) · Discover Public Health · doi:10.1186/s12982-025-01007-5
“However, globally, myths and stigma surrounding the safety of the HPV vaccine persist [15, 16].”
Duradoni, M., Baroni, M., Colombini, G., Gori, N., Maggiora, N. D., Saviozzi, V., Macrì, E., Zanobini, P., Materassi, L., & Guazzini, A. (2025) · Journal of Public Health · doi:10.1007/s10389-025-02624-9
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Li, A., Wang, P., Li, J., Chen, W., & Chang, J. (2025) · Health Policy and Planning · doi:10.1093/heapol/czaf087 · Cited by 1
“Information scarcity is a key barrier to vaccine uptake (Holman et al. 2014, Karafillakis et al. 2019, Della Polla et al. 2020, Purvis et al. 2024).”
HPV vaccination intention among guardians of male junior high school students in Chongqing, China
He, X., Bai, N., Xu, J., Wan, N., Xiao, Y., & Xu, B. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1692814
McKinley, C. J., & Lauby, F. (2025) · Mass Communication & Society · doi:10.1080/15205436.2025.2589983
“Consequently, multiple investigations document the direct relationship between reduced institutional trust and more negative vaccine attitudes (Karafillakis et al., 2019; McKinley et al., 2023; Vinck et al., 2019).”
Salako, J., Bakare, D., Akinsola, K. O., Bakare, A. A., Bakare, O. R., Emmanuel, O., Gobbo, E., Hanson, C., van Wees, S. H., Jerome, A., et al. (2025) · Expert Review of Vaccines · doi:10.1080/14760584.2025.2597456
“More recently this general distrust of government has been linked to similar suspicions and rumors around the COVID-19 vaccine and HPV vaccines [55,56].”
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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