Urgent steps needed to address low uptake of vaccinations amid rising hesitancy  

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The World Health Organisation (WHO) estimates that 94% of global cervical cancer deaths occur in low- and middle-income countries, with Sub-Saharan Africa heavily affected.

The Human Papillomavirus (HPV) fuels high cervical cancer rates in Sub-Saharan Africa despite the availability of effective vaccines. Yet uptake remains low, largely driven by vaccine hesitancy.

In SA alone, most participants (71%) were hesitant to receive at least one of the vaccines in the country, according to the Vaccine Confidence Report by MSD and Professor Hannelie Meyer, the head of the South African Vaccination and Immunisation Centre.

The report was launched at the European Society of Clinical Microbiology and Infectious Diseases and during the SSA HPV Media Roundtable held during World and Africa Immunisation Week (April 24 to 30). Cervical cancer, caused by persistent HPV infection, is one of the leading causes of cancer-related deaths among women in Sub-Saharan Africa.

Studies indicate that, globally, about 12% of women with normal cervical cytology have an HPV infection. This prevalence doubles to around 24% in Sub-Saharan Africa. Women under 25 are particularly vulnerable, with an HPV prevalence rate of 43.9% in Africa compared to the global rate of 19.2%.

Vaccine hesitancy, defined as a delay in acceptance or refusal of vaccines despite their availability, remains a challenge in the fight against preventable diseases like 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.

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 Meyer, despite clear scientific evidence, many still believe vaccines are harmful.

“This reluctance is troubling, 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,” she said.

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, SA, 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 SA exhibiting the highest rate at 17.15% and Kenya the lowest at 8.3%.

The 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. “Routine immunisation has saved millions of lives,” said Dr Alima Essoh, the 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 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 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.

According to 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, a senior lecturer at Makerere University, says engaging and accessible tools, such as comic books and school-based vaccination, have significantly enhanced vaccine uptake among young people.

She says 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 says tackling vaccine hesitancy will require a co-ordinated 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. 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,” says Meyer.