Human Papillomavirus Vaccination Acceptance and Hesitancy in South Africa: Research and Policy Agenda

"The extent and impact of vaccine hesitancy need to be investigated so that focused interventions may be implemented and appropriate policies developed and adopted."

Sub-Saharan Africa (SSA) is home to 10.5% of the global population of women 15 years of age or older; yet, the region accounts for 21.6% and 17.7% of the global burden of cervical cancer deaths and cases, respectively. Suboptimal uptake of human papillomavirus (HPV) vaccination to prevent cervical cancer is not unique to South Africa (SA) but remains a serious challenge worldwide. Reasons for poor uptake of HPV vaccination are multifactorial; one of them, which is the focus of this article, is vaccine hesitancy.

As noted here, research on HPV vaccine hesitancy in SA is limited. However, various studies conducted prior to the introduction of the school-based HPV vaccination programme in 2014 found that knowledge and understanding of cervical cancer, the relationship between HPV and cervical cancer, and the purpose of HPV vaccination were low amongst the public and recipients. The studies also revealed that parents might have various concerns regarding the HPV vaccine, including its safety and efficacy and its short- and long-term side effects, and that they worry HPV vaccination may encourage risky adolescent sexual behaviour. Parental concerns about safety may be linked to negative social media coverage of the HPV vaccine.

According to the authors of this article, the limited research on and context-specific issues of the HPV vaccination programme in SA point to a need for increased research on the potential existence, nature, and causes of vaccine hesitancy in this programme. The setting and circumstances are different than many of those in high-income countries (HICs), and, therefore, unique challenges and concerns might exist. For example, the programme does not include private schools and is not available at public healthcare facilities. This may be a source of concern and undermine trust, as some may question the National Department of Health (NDoH)'s motive for HPV vaccination in public schools. In that light, the article lays out specific research areas that the authors feel need to be addressed in SA and potentially other low- and middle-income countries (LMICs) - e.g., the benefits and risks of the current approach to obtaining consent for HPV vaccination to alternative approaches used in other parts of the world.

Although the literature on HPV vaccine hesitancy is largely based on research from HICs, the authors suggest that it provides LMICs, such as SA, with enough background to develop policies on HPV vaccination that can be continuously shaped by evidence from local research. They lay out a number of policy issues that they argue need to be addressed, such as communication and social mobilisation for HPV vaccination that are not only focused on parents and girls reached by the programme but that are broad based and widely accessible, as well as the role of the Department of Basic Education (DoE) in communicating and advocating for the HPV vaccination programme.

Along those lines, the authors contend that, being a school-based programme, issues relating to communication and social mobilisation for HPV vaccination should include various stakeholders, including the DoE (educators, school governing bodies, and parent associations). "This is an important recommendation, considering that the DoE has ongoing contact and collaboration with these stakeholders, while the NDoH does not. It may go a long way towards strengthening the role of educators in promoting the vaccine, and ameliorate the potential threat posed by educators who may be hesitant to recommend and advocate HPV vaccination."

In conclusion, it is envisaged that addressing the research and policy gaps outlined in this article could help improve uptake of the HPV vaccine, overcome HPV vaccination hesitancy, and move SA closer to attaining the goal of a society that values immunisation as a social good and demands it as their right and responsibility.