Human Papillomavirus (HPV) vaccination in Africa: Urgent steps needed to address low uptake amid rising hesitancy
Cervical cancer, caused by persistent infection of HPV, is one of the leading causes of cancer-related deaths among women in sub-Saharan Africa. The World Health Organization (WHO) estimates that 94% of global cervical cancer deaths occur in low- and middle-income countries, with sub-Saharan Africa heavily affected. [2]
Studies indicate that, globally, about 12% of women with normal cervical cytology are found to have an HPV infection. This prevalence doubles to around 24% in sub-Saharan Africa. Young women under 25 are particularly vulnerable, with an HPV prevalence rate of 43.9% in Africa compared to the global rate of 19.2%. [3]
A 2023 report indicated that cervical cancer ranks as the 13th most frequent cancer among women in Egypt and the 9th most frequent among women aged 15 to 44 years. [4] In Kigali, Rwanda, before the national HPV vaccination programme, 54% of women aged 19 years and younger were found to have received an HPV-positive result. [5] The high mortality rate in Ghana further demonstrates the burden, with approximately 3,000 women diagnosed with cervical cancer annually, resulting in around 2,000 deaths each year. [6]
Vaccine hesitancy, defined as a delay in acceptance or refusal of vaccines despite their availability, remains a challenge in the fight against preventable diseases such as cervical cancer. Misinformation, cultural beliefs, and accessibility issues further compound the low uptake of HPV vaccines. As global health organisations and local health authorities strive to eliminate preventable diseases, understanding and addressing vaccine hesitancy has never been more urgent. [1]
Understanding vaccine hesitancy
The Vaccine Confidence Report highlights several drivers of HPV vaccine hesitancy, including safety concerns, mistrust in healthcare systems, and misinformation on social media. According to Prof. Meyer, despite clear scientific evidence, many still believe vaccines are harmful. [1] 'This reluctance is troubling,' she said, 'given the direct link between HPV and cervical cancer. Addressing these fears with credible information is vital to reducing the burden in sub-Saharan Africa.'
An external study titled 'Vaccine Hesitancy and Trust in sub-Saharan Africa' published in Scientific Reports in May 2023 examined vaccination behaviours and attitudes across six sub-Saharan African countries: Ghana, Kenya, Nigeria, South Africa, Tanzania, and Uganda. The study found that only about 10% of respondents reported receiving at least one HPV vaccination. Vaccine hesitancy rates varied across countries, with South Africa exhibiting the highest rate at 17.15% and Kenya the lowest at 8.3%. [7]
Impact of misinformation, funding gaps and immunisation disruption Misinformation remains a major driver of vaccine hesitancy in Africa, especially through online platforms. It has shaped public attitudes and eroded trust in immunisation programmes. At the same time, shifting global priorities and economic pressures have led to reduced funding for vaccination efforts, limiting access in low-income communities. [8] 'Routine immunisation has saved millions of lives,' said Dr Alima Essoh, Regional Director of the Preventive Medicine Agency for Africa (AMP Africa). 'When misinformation and resource constraints disrupt these efforts, we risk undoing decades of progress.' Expanding HPV vaccination is critical to reducing cervical cancer, but it requires tackling misinformation head-on and improving access across the continent.
Broader implications for public health
While HPV vaccination remains a key focus, vaccine hesitancy extends to other preventable diseases. The World Health Organization (WHO) has set a target to eliminate cervical cancer as a public health concern by 2030, which includes ensuring that 90% of girls are fully vaccinated against HPV by age 15. [9] According to Prof Meyer, vaccine hesitancy threatens to derail this goal and broader efforts to achieve high immunisation rates for other preventable illnesses such as measles, polio, and influenza.
Rethinking the fight against HPV-related cervical cancer: Community action and vaccine confidence
Efforts to eliminate HPV and reduce HPV-related cervical cancer in Africa necessitate innovative, community-driven solutions. Dr Sabrina Kitaka, Senior Lecturer at Makerere University, states that engaging and accessible tools, such as comic books and school-based vaccination, have significantly enhanced vaccine uptake among young people. She adds that reminder systems, such as SMS and automated phone calls, help ensure adolescents complete the HPV vaccine schedule. If implemented on a large scale, these strategies could strengthen vaccine coverage across the region. She further states that, tackling vaccine hesitancy will require a coordinated approach involving governments, healthcare workers, civil society, and the private sector. This means improving health communication, building trust through local partnerships, and tailoring outreach to meet communities where they are.
'There is no time to waste,' says Prof. Meyer. 'We must work together to share accurate information, address concerns, and make vaccines truly accessible. Only then can we protect future generations from preventable diseases.'
Disclaimer: The views and opinions expressed by the speakers in this document are their own and do not necessarily reflect the views or positions of MSD.
References
MSD South Africa., Meyer, JC. 2025. Vaccination Hesitancy Study. Accessed 07 April 2025 'Human papillomavirus and cancer', World Health Organization, 5 March 2024: http://apo-opa.co/3Glx3fK. High Burden of Human Papillomavirus (HPV) Infection Among Young Women in KwaZulu-Natal, South Africa' PLOS One, 19 January 2016: https://apo-opa.co/4cTdfNc. Accessed 07 April 2025. 'Egypt HPV and Related Cancers, Fact sheet 2023, https://apo-opa.co/3YMStZv? Accessed 2 April 2025. 'Human papillomavirus infection in Rwanda at the moment of implementation of a national HPV vaccination programme', National Library of Medicine, National Centre for Biotechnology Information, 24 May 2016: https://apo-opa.co/4jORArD. Accessed 07 April 2025. 'Human Papillomavirus and Related Diseases Report', HPV Information Centre, 10 March 2023: https://apo-opa.co/3RzzoGn. Accessed 07 April 2025. 'Vaccine hesitancy and trust in sub-Saharan Africa', Scientific Reports (https://apo-opa.co/4jGlMVQ), 13 May 2024: https://apo-opa.co/4cQyUp9. Accessed 10 April 2025. UNICEF, Global immunization coverage stalled in 2021, leaving millions of children unprotected – WHO and UNICEF, 2022: http://apo-opa.co/3RTv3OB. WHO. HPV&Cancer. Available at: Human papillomavirus and cancer (http://apo-opa.co/4cSGTSM). Accessed: 07 April 2025
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