Barriers and supports for uptake of human papillomavirus vaccination in Indigenous people globally: A systematic review

Abstract

Despite the availability of effective and safe human papillomavirus (HPV) vaccines that reduce the incidence and impact of cervical cancer and other cancers, HPV vaccine coverage rates remain persistently low and the cervical cancer burden disproportionately high among Indigenous people globally. This study aimed to systematically identify, appraise, and summarize the literature on documented barriers and supports to HPV vaccination in Indigenous populations internationally. Forty-three studies were included and an inductive, qualitative, thematic synthesis was applied. We report on 10 barrier themes and 7 support themes to vaccine uptake, and provide a quantitative summary of metrics. Focusing on Indigenous perspectives reported in the literature, we propose recommendations on community-research collaboration, culturally safe intergenerational and gender-equitable community HPV vaccine education, as well as multi-level transparency to ensure informed consent is secured in the context of reciprocal relationships. Although the voices of key informant groups (e.g., HPV-vaccine eligible youth and community Elders) are underrepresented in the literature, the identification of barriers and supports to HPV vaccination in a global Indigenous context might help inform researchers and health policy makers who aim to improve HPV vaccine uptake in Indigenous populations.

High-risk HPV prevalence and vaccination coverage among Indigenous women in the Colombian Amazon: Implications for cervical cancer prevention. Cross-sectional study

“…This study describes the epidemiological characteristics of HPV infection of a population group with particular race and cultural attributes that deserve a special approach. Thus, it contributes to decrease the social gap related to Indigenous communities around the world [ 15 , 16 ]. Considering the fact that local health services do not routinely search for viral DNA and favor cytology as a screening mechanism for CC, this study provides more accurate information with which to work on the prevention and early detection in the women of the Paujil Reserve.…”

Knowledge, attitudes, and practices of HPV vaccination among pharmacy students and other health science students

“…For non‐pharmacy students, the primary barriers were concerns about side effects and some allergic reactions to the vaccine (15.3%), whereas the need for family consent (13.8%) was the major barrier for pharmacy students. The fear of side effects was reported to negatively impact the decision to get vaccinated against HPV 33 . Moreover, numerous studies have demonstrated parents' concerns regarding the safety of vaccines, hence most parents believe that their children must have their consent to make vaccination decisions 34,35 .…”

“…The fear of side effects was reported to negatively impact the decision to get vaccinated against HPV. 33 Moreover, numerous studies have demonstrated parents' concerns regarding the safety of vaccines, hence most parents believe that their children must have their consent to make vaccination decisions. 34,35 To address these barriers, several solutions can be implemented, such as enhancing awareness campaigns and education about the benefits of the HPV vaccine, alleviating concerns about side effects and allergies through the provision of accurate, transparent, and understandable scientific information to students, as well as promoting family engagement and support in the vaccination process to reduce barriers related to family consent, especially for pharmacy students.…”

“…3 There are currently four vaccines that have been prequalified by the WHO, all protecting against HPV types 16 and 18, which are known to cause at least 70% of cervical cancers. 3 In Vietnam, there are three licensed vaccines: Cervarix, which protects against two virus types, HPV 16 and HPV 18, Gardasil, which protects against HPV 6, 11, 16, 18, and Gardasil-9, which protects against HPV 6,11,16,18,31,33,45,52,58. In Vietnam, the prevalence of HPV vaccination among women and girls aged 15-29 in 2021 was reported at 12%.…”

Empowering Women’s Health: Insights Into HPV Vaccination and the Prevention of Invasive Cervical Cancer

“…This includes advocating for the inclusion of HPV vaccination in national immunization programs, ensuring coverage under healthcare plans, and implementing policies that support school-based vaccination programs [ 35 ]. Engaging with policymakers, healthcare professionals, and advocacy groups can amplify the voice for HPV vaccination, promote policies that enhance vaccine access, reduce financial barriers, and foster a supportive environment for vaccination efforts [ 36 ]. By implementing a multifaceted approach that combines education, improved access, cultural sensitivity, and policy advocacy, it is possible to promote HPV vaccination effectively, ultimately reducing the burden of cervical cancer and advancing women's health on a global scale [ 37 ].…”