Multi-level determinants of HPV vaccine uptake in Sub-Saharan Africa: Socio-cultural, structural, and systemic perspectives

 Corresponding author: James Success ODUBIA Copyright © 2025 Author(s) retain the copyright of this article. This article is published under the terms of the Creative Commons Attribution Liscense 4.0. Multi-level determinants of HPV vaccine uptake in Sub-Saharan Africa: Socio-cultural, structural, and systemic perspectives James Success ODUBIA 1, *, Sunday Ezekiel AJILEYE 2, Marvelous Oyeboade OYEDIRAN 2, Blessing Okah ADAGBON 2, Florence Abosede SAMUEL 2 and Damilola Halimot NURENI 2 1 Department of Health Promotion, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria. 2 Department of Epidemiology and Medical Statistics, Faculty of Public Health, Ibadan University of Ibadan. 3 Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 Publication history: Received on 22 July 2025; revised on 27 August 2025; accepted on 01 September 2025 Article DOI: https://doi.org/10.30574/wjbphs.2025.23.3.0791 Abstract Background: Human papillomavirus (HPV) is a leading cause of cervical cancer and related diseases, placing a disproportionate burden on women in Sub-Saharan Africa (SSA). Despite the availability of highly effective vaccines, uptake across the region remains markedly low. Research Design: This study is a systematic review examining the socio-cultural, structural, and systemic factors that shape HPV vaccination uptake in SSA. Methods: Guided by the Population, Exposure, Outcome (PEO) framework and the Socio-Ecological Model, evidence was synthesized from 12 qualitative, quantitative, and mixed-methods studies identified through peer-reviewed databases and grey literature. Thematic analysis was applied to extract determinants influencing vaccine uptake. Findings: Persistent barriers included misinformation linking vaccination to infertility and side effects, spiritual and cultural concerns, low parental education, weak health infrastructure, and inconsistent vaccine supply. Conversely, uptake was facilitated by strong government leadership, school-based vaccination programs, the involvement of trusted community figures, and transparent public health campaigns. Rwanda emerged as a success case where political commitment and integrated strategies significantly boosted coverage. Conclusion: HPV vaccine uptake in SSA is mediated by interconnected cultural narratives, health system capacity, and institutional trust. Improving coverage requires multi-level interventions that integrate community-based education, expanded delivery strategies, and sustained political and policy commitment. Keywords: HPV vaccination barriers; HPV vaccination facilitators; Sub-Saharan Africa; Vaccine acceptance; Public health interventions 1. Introduction Human papillomavirus (HPV) is one of the most common sexually transmitted infections globally and a major cause of cervical cancer, as well as other malignancies including anal, penile, oropharyngeal cancers, and genital warts (Jensen et al., 2024). Cervical cancer alone ranks as the fourth most common cancer among women worldwide, accounting for nearly 690,000 new cases annually, of which about 90% are attributed to HPV infection (Martel et al., 2020). The burden is particularly acute in Sub-Saharan Africa (SSA), where HPV prevalence is estimated at 24%, the highest globally, World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 7 compared to 14% in Latin America (WHO, 2024). This disproportionate prevalence contributes to high morbidity and mortality in the region, exacerbated by limited access to prevention and screening services. The introduction of HPV vaccines Cervarix, Gardasil, and Gardasil 9 marks a significant milestone in global cancer prevention. These vaccines are safe, highly immunogenic, and effective against the most oncogenic HPV strains (Bergman et al., 2019). Yet, despite clear evidence of effectiveness, vaccine uptake in SSA remains alarmingly low. WHO (2024) reports that first-dose coverage in the region was just 33% in 2022, far below the 90% global target set under the WHO’s cervical cancer elimination strategy for 2030. Several countries in SSA, such as Rwanda, The Gambia, Kenya, Liberia, and more recently Nigeria, have integrated HPV vaccination into their national immunisation programs, often supported by international partnerships and local awareness campaigns (Kanmodi et al., 2023). Rwanda, in particular, is frequently cited as a model of success, where strong government commitment and community engagement achieved impressive coverage rates. Nonetheless, across much of the region, uptake remains limited, leading to rising incidence and mortality from cervical cancer and other HPV-related diseases. Existing studies have largely documented barriers to HPV vaccine uptake in SSA, including misinformation about infertility, fears of side effects, cultural and religious resistance, weak health infrastructure, and vaccine supply challenges (Dzinamarira et al., 2023). While these obstacles are critical, there has been less systematic exploration of the enabling factors such as government policy, school-based vaccination, and trusted community advocacy that promote uptake. Moreover, most available evidence is countryspecific, limiting comprehensive regional insights into the interplay between barriers and facilitators. This study therefore seeks to address this gap by synthesising evidence on the multi-level determinants of HPV vaccination uptake in SSA. By examining socio-cultural, structural, and systemic influences, it aims to provide context-sensitive evidence that can inform strategies to expand vaccine coverage and advance progress toward the WHO’s 2030 cervical cancer elimination goals. 2. Methodology 2.1. Research Design This study adopted a systematic review to identify, select, and synthesise evidence on barriers and facilitators of HPV vaccine uptake in Sub-Saharan Africa (SSA). The approach was appropriate as it consolidates existing evidence rather than relying on anecdotal observations (Moosapour et al., 2021). Given the heterogeneity of health systems and sociocultural contexts in SSA, both qualitative and quantitative studies were included: quantitative research provided statistical generalisations, while qualitative studies offered insights into perceptions, cultural norms, and systemic issues that cannot be quantified. To minimise bias associated with geography or study design, particular attention was given to regional representation and under-researched populations, with critical reflections on patterns of research neglect (Shaheen et al., 2023). The review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines to ensure rigour, transparency, and reproducibility (Page et al., 2021). 2.2. Search Strategy Boolean operators “AND” and “OR” were applied to refine sensitivity and specificity, using the string: ("Human papillomavirus vaccines" OR "HPV vaccination") AND ("Uptake" OR "Acceptability" OR "Utilisation") AND ("Barriers" OR "Facilitators") AND ("Sub-Saharan Africa" OR list of SSA countries). Searches were conducted in PubMed, MEDLINE, EMBASE, and Google Scholar. To address the under-representation of African research in global databases (Asubiaro, 2023), grey literature sources, including organisational websites (e.g., WHO, Gavi, UNICEF), were also reviewed. Incorporating grey literature helped capture policy documents and programmatic reports that provide critical insights into implementation barriers and facilitators (Paez, 2017). 2.3. Inclusion Criteria • Studies involving individuals eligible for HPV vaccination in Sub-Saharan Africa (e.g., adolescents, parents/guardians, healthcare workers). • Research addressing HPV vaccine uptake, perceptions, barriers, or facilitators. • Studies published in English between 2015 and 2025. • Qualitative, quantitative, or mixed-methods designs. • Grey literature such as programmatic reports or policy documents relevant to SSA. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 8 2.4. Exclusion Criteria • Studies conducted outside Sub-Saharan Africa. • Research focusing solely on vaccine efficacy, immunogenicity, or biological mechanisms. • Non-English publications. • Studies not addressing barriers or facilitators of HPV vaccine uptake. 2.5. Study Selection The selection of studies followed the PRISMA 2020 guidelines to maintain transparency and methodological rigour (Figure 1). A total of 569 records were initially retrieved: 12 from PubMed, 5 from MEDLINE, none from EMBASE, and 552 from Google Scholar. An additional 6 records were identified through manual searches of grey literature and organisational websites such as WHO, Gavi, and UNICEF. After removing 103 duplicates, 472 unique records remained. These were screened by title and abstract using Rayyan software, which facilitated blinded and structured review, reducing the risk of selection bias. Of these, 430 were excluded for reasons including irrelevance to HPV vaccination in SSA, a sole focus on immunogenicity, or examination of non-eligible populations. Forty-two full-text articles were then reviewed, of which 30 were excluded for not addressing barriers or facilitators, concentrating only on vaccine efficacy, or lacking sufficient data on uptake. Ultimately, 12 studies met all eligibility criteria and were included in the final synthesis. Figure 1 PRISMA Flowchart 2.6. Data Extraction Information was retrieved on determinants of HPV vaccine uptake, focusing on cultural perceptions, community attitudes, institutional and policy support, and health system constraints (table 1). Studies spanned several SSA countries, offering diverse regional contexts. Of the twelve studies included, eight were qualitative, three employed mixed methods, and one was quantitative. Populations studied included adolescents, caregivers, educators, and health workers, while policymakers and male stakeholders were less represented. Variation in sample sizes limited crossstudy comparability and the extent of generalization. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 9 Table 1 Summary/Data Extracted from the Articles Included in the Review Authors and Date Title of Article Aim of the Study Type of Study Study Population Summary of Study Balogun and Omotade (2018) “She must have been sleeping around”…: Contextual interpretations of cervical cancer and views regarding HPV vaccination for adolescents in selected communities in Ibadan, Nigeria. This study explored contextual interpretations of stakeholders regarding cervical cancer and HPV vaccines for adolescents in five selected communities in Ibadan, Nigeria. Qualitative Twenty focus group discussions and four key informant interviews were conducted. The study discovered widespread misconceptions that link cervical cancer to promiscuity, and found that cultural and moralistic beliefs negatively influenced the acceptance of HPV vaccination. Balogun and Omotade (2022) Facilitators and barriers of healthcare workers’ recommendation of HPV vaccine for adolescents in Nigeria: views through the lens of the theoretical domains framework This study therefore explored the facilitators and barriers for the recommendation of the HPV vaccine for adolescents by HCWs in Ibadan, Nigeria using the Theoretical Domain Framework (TDF). Qualitative 14 purposively selected HCWs who were in charge of vaccination. Barriers included a lack of training and an inadequate supply chain; facilitators involved trust in health authorities and professional responsibility. Hasahya et al. (2016) Beliefs, perceptions and health-seeking behaviours in relation to cervical cancer: a qualitative study among women in Uganda following completion of an HPV vaccination campaign This project explored beliefs, attitudes, perceptions, and health-seeking behaviours in relation to cervical cancer among women in Uganda after an HPV vaccination project was rolled out. Qualitative Six focus group discussions (FGDs) that included 36 women, aged 25-49 years, The study identified gaps in knowledge regarding the HPV and cervical cancer postvaccination campaign, along with persistent fears about vaccine safety and fertility. Islam et al. (2018) Acceptability of twoversus threedose human papillomavirus vaccination schedule among providers and mothers of adolescent girls: a mixed-methods study To assess acceptability of twovs. three-dose HPV vaccine schedules among mothers and healthcare providers. Mixed Methods Providers and mothers in 5 LMICs (including SSA countries) Found preference for two-dose schedule due to perceived lower logistical and financial burden; trust in healthcare systems was key to acceptability. Kamya et al. (2016) Evaluating Global Health Partnerships: A Case Study of a Gavi To evaluate Uganda’s experience with the Qualitative 7 in-depth interviews, 11 network surveys and document review Highlighted challenges in coordination and application World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 10 HPV Vaccine Application Process in Uganda Gavi HPV vaccine application process. processes; need for greater country-level engagement and ownership in global health partnerships. Kisaakye et al. (2018) Level and factors associated with uptake of Human papillomavirus infection vaccine among female adolescents in Lira District, Uganda This study assessed the level and the factors associated with uptake of HPV vaccine by female adolescents in Lira district, Uganda. mixed methods 460 female adolescents. 20 in-depth interviews The study revealed a low uptake rate of 17.6%, with factors such as parental consent, school-based delivery, and awareness of vaccine availability playing a significant role. Lubeya et al. (2023) “When you get the HPV vaccine, it will prevent cervical cancer; it will act as a shield”: adolescent girls’ knowledge and perceptions in Zambia This study aimed to understand adolescent girls’ knowledge and perceptions regarding the HPV vaccine and discuss its acceptability and uptake implications. Qualitative Interview 30 adolescent girls to reach saturation Revealed partial knowledge of vaccine benefits; misconceptions were common, but generally positive attitudes when informed; emphasised need for targeted educational interventions. Masika et al. (2015) Knowledge on HPV Vaccine and Cervical Cancer Facilitates Vaccine Acceptability among School Teachers in Kitui County, Kenya This study aims to assess primary school teachers’ knowledge and acceptability of the HPV vaccine and to explore facilitators and barriers of an ongoing Gavi Alliance-supported vaccination program in Kitui County, Kenya Mixed Methods 507 teachers in 37 schools, Demonstrated that higher knowledge significantly predicted acceptability of the HPV vaccine among educators, highlighting the role of teacher engagement in public health campaigns. Moucheraud et al. (2023) Malawian caregivers’ experiences with HPV vaccination for preadolescent girls: A qualitative study This study sought to understand attitudes about, and experiences with, the HPV vaccine among caregivers of eligible girls in Malawi. Qualitative 40 caregivers (parents or guardians) of preadolescent girls in Malawi Found mixed feelings; caregivers desired more consistent, transparent information from healthcare workers; mistrust in government and concerns World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 11 about side effects were barriers. Turiho et al. (2017) Perceptions of human papillomavirus vaccination of adolescent schoolgirls in western Uganda and their implications for acceptability: a qualitative study This study explored community member’s perceptions about HPV vaccination in Ibanda district and the implications of the perceptions for acceptability of HPV vaccination. Qualitative The FGDs of schoolgirls and of parents/guardians were conducted separately using pretested and translated FGD guides. The number of participants in FGDs ranged from 8 to 12 per group. Peer influence, misconceptions, and inadequate parental communication were critical factors affecting vaccination acceptability among adolescent girls. Venturas and Umeh (2017) Health professional feedback on HPV vaccination rollout in a developing country The study aims to investigate the perspectives of health professionals regarding the HPV vaccination program in Zambia. Qualitative 15 health professionals working in private, government, and missionary clinics/hospitals. Reported issues with programme communication, vaccine supply challenges, and the need for stronger stakeholder engagement in future roll-outs. WatsonJones et al. (2015) Access and Attitudes to HPV Vaccination amongst Hard-ToReach Populations in Kenya The study aimed to investigate access and attitudes towards the HPV vaccine among hard-to-reach populations. Qualitative Focus group discussions (n=14) and semi-structured interviews (n=28) with health workers, parents, youth, and community and religious leaders. The study identified significant geographical and socioeconomic barriers to access and emphasised tailored outreach strategies to improve uptake among underserved populations. 2.7. Critical Appraisal of Quality The quality of included studies was assessed using the Critical Appraisal Skills Programme (CASP) checklists, which are applicable across qualitative, quantitative, and mixed-methods designs (CASP, 2024). Appraisal focused on clarity of objectives, methodological relevance, participant recruitment, data collection and analysis, and validity of findings (table 2). No study was excluded based on appraisal outcomes; instead, a weighting approach was applied to ensure weaker studies did not disproportionately influence conclusions. CASP was chosen over alternatives, such as the JBI checklist, for its emphasis on reflexivity and ethical considerations, which are critical in culturally sensitive contexts like HPV vaccination (Long, French and Brooks, 2020). Each study was rated on a 0–2 scale across 10 criteria (Appendix B). Table 2 Critical Appraisal of the included articles using CASP checklist Author(s ) (Year) Cle ar Aim s Appropri ate Methodol ogy Resear ch Design Recruitm ent Strategy Data Collecti on Reflexiv ity Ethical Considerati ons Data Analy sis Findin gs Value of Resear ch Tot al Balogun and 2 2 2 2 2 1 2 2 2 2 19 World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 12 Omotade (2018) Balogun and Omotade (2022) 2 2 2 2 2 1 2 2 2 2 19 Hasahya et al. (2016) 2 2 2 2 2 1 2 2 2 2 19 Islam et al. (2018) 2 2 2 2 2 1 2 2 2 2 19 Kamya et al. (2016) 2 2 2 2 2 1 2 2 2 2 19 Kisaakye et al. (2018) 2 2 2 1 2 0 1 2 2 2 16 Lubeya et al. (2023) 2 2 2 2 2 1 2 2 2 2 19 Masika et al. (2015) 2 2 2 2 2 0 1 2 2 2 17 Mouchera ud et al. (2023) 2 2 2 2 2 1 2 2 2 2 19 Turiho et al. (2017) 2 2 2 2 2 1 2 2 2 2 19 Venturas and Umeh (2017) 2 2 2 2 2 1 2 2 2 2 19 WatsonJones et al. (2015) 2 2 2 2 2 1 2 2 2 2 19 Total 24 24 24 23 24 10 22 24 24 24 223 223/240*100= 92.91%. Applying the quality assessment formula: QA = (Total Score Obtained ÷ Total Maximum Score) by × 100 by Odubia, Akinrinade, et al. (2025). The overall quality score across studies was 92.9%, indicating strong methodological rigour. Exemplary alignment of objectives and design was noted in Balogun and Omotade (2018) and Moucheraud et al. (2023), although both, along with Masika et al. (2015) and Kisaakye et al. (2018), lost points due to limited reflexivity. This gap reduces transparency on how researchers’ positions may have influenced interpretation, particularly in culturally sensitive areas such as HPV vaccination. Kisaakye et al. (2018) also scored lower (16/20) for unclear recruitment strategies, limiting representation of adolescents. Islam et al. (2018) provided useful mixed-methods insights but underutilised qualitative contributions. Future studies should strengthen reflexive practice, adopt community advisory involvement, and integrate qualitative insights more fully to enhance cultural sensitivity and generalisability. Full details are presented in Appendix A. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 13 2.8. Data Analysis Thematic content analysis was used to synthesise findings across heterogeneous study designs (Naeem et al., 2023). This approach was chosen because it enables the integration of qualitative and quantitative evidence, capturing both measurable factors and contextual insights relevant to HPV vaccine uptake in SSA (Ayre and McCaffery, 2022). An iterative coding process reduced subjectivity and ensured consistency (Ahmed et al., 2025). 2.9. Ethical Considerations This review did not require ethical approval since it relied exclusively on secondary data. All included studies were checked to confirm approval by appropriate ethics committees or institutional boards before inclusion. To uphold academic integrity, only publicly accessible sources were used, with full acknowledgement of intellectual contributions. The process followed PRISMA 2020 standards, ensuring accountability and methodological transparency. 3. Results and analysis What cultural beliefs, social norms, and community perceptions shape acceptance or resistance to HPV vaccination in Sub-Saharan Africa. Table 3 cultural beliefs, social norms, and community perceptions shape acceptance or resistance to HPV Subthemes Authors Verbatim Quotes Fear of infertility, death, or harm Venturas and Umeh (2017) ‘‘They were saying if they give those vaccines to young girls, maybe those young girls they won’t get pregnant in the future, it will pre vent them from getting pregnant, so those are beliefs that they have.” [Participant F (L: 16– 18)] Lubeya et al. (2023) “ Then there some who say you are not supposed to get the vaccine because you will never have children, you will be barren for the rest of your life. “ “They get wrong information from the community. Some say you may die after taking the vaccine (…) they are told that they have just come to kill us all because there are a lot of females in our population. A27,” Venturas and Umeh (2017) ‘‘They were saying if they give those vaccines to young girls, maybe those young girls they won’t get pregnant in the future, it will pre vent them from getting pregnant, so those are beliefs that they have.” [Participant F (L: 16– 18)] Balogun and Omotade (2018) FGD, Senior Girls Public school, participant 3 Said “I can't get vaccinated because most times when you get too much of anything it will have something it will damage in your body” In an FGD with out-of-school adolescents male, participant 3 said “Because that thing kills people... it is better to prevent it with this vaccine than the one you will spend later, if you prevent it now, it will be better” Hasahya et al. (2016) Some women used to have normal periods but after going there for screening, they start experiencing abnormal periods, some get itching, the signs. (FGD2:W5) Protection, prevention, and long-term health Moucheraud et al. (2023) ‘I think this vaccine is very important because women are losing their lives because of this dangerous disease of cervical cancer.” (Woman, 31 years old, daughter who received 1 dose) Turiho et al. (2017) “Our girls are lucky to have this chance… They have peace of mind because they are confident that their future is free of the cervical cancer disease… We are happy about the vaccination because it saves our money that would be spent treating cervical cancer in future” (FGD of parents) World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 14 As highlighted in Table 3, one of the most prominent subthemes emerging from the qualitative studies is the widespread fear of infertility, death, or bodily harm linked to HPV vaccination. These fears, often rooted in misinformation and community-based rumours, played a critical role in shaping vaccine hesitancy. Venturas and Umeh (2017) illustrate this concern through a participant’s testimony: “They were saying if they give those vaccines to young girls, maybe those young girls, they will not get pregnant in the future, it will prevent them from getting pregnant, so those are beliefs that they have.” This statement captures broader community suspicions that the vaccine could jeopardize fertility, reflecting cultural anxieties about reproduction and womanhood. In the same vein, Lubeya et al. (2023) reported similar views from participants, such as: “Then there some who say you are not supposed to get the vaccine because you will never have children, you will be barren for the rest of your life.” Such expressions reinforce the widespread perception that vaccination could cause barrenness. Lubeya et al. (2023) also emphasize that fears surrounding vaccines are fuelled by international distrust, with some groups believing such interventions might be designed to harm women in particular. Echoing this, Balogun and Omotade (2018) and Hasahya et al. (2016) highlight additional concerns that the vaccine may cause physical harm or unusual health problems, including malfunctions of the reproductive system. Taken together, these findings demonstrate that fears of infertility and bodily harm are pervasive, sustained by misinformation, cultural beliefs, and deep-rooted distrust of health communication. Contrasting with the negative narratives of harm and infertility, another important theme that surfaced was that of protection, prevention, and long-term health as motivating factors for HPV vaccine acceptance (see Table 4.2). This counter-narrative demonstrates that, when individuals are properly informed, they tend to view the vaccine as a protective measure safeguarding girls against future health risks. Moucheraud et al. (2023) capture this perspective through a participant who affirmed: “I think this vaccine is very important because women are losing their lives because of this dangerous disease of cervical cancer.” This response reflects awareness of the serious threat posed by cervical cancer and highlights a proactive attitude towards prevention standing in direct opposition to the fear-based concerns discussed earlier. Similarly, Turiho et al. (2017) found that some community members regarded vaccination as both emotionally fulfilling and financially beneficial. Participants expressed relief and gratitude for the opportunity to protect girls from cervical cancer, noting that prevention not only preserves health but also reduces future medical expenses. “Individuals indicated their gratitude that they had the chance to save girls against cancer of the cervix, which is relieving and saves future costs.” Such sentiments portray vaccination as the most sensible option to avoid illness and unnecessary financial strain. However, these positive perspectives were comparatively less frequent across the reviewed studies, suggesting the need for stronger educational interventions to amplify these views and counterbalance the persistence of misinformation. World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 21 2023); parental disapproval (Lubeya et al., 2023; Turiho et al., 2017); religious prohibitions (Masika et al., 2015; Moucheraud et al., 2023); misinformation (Turiho et al., 2017; Lubeya et al., 2023); as well as cost and access challenges (Balogun and Omotade, 2022; Kisaakye et al., 2018; Venturas and Umeh, 2017). These challenges cannot be understood in isolation, as they are embedded in wider histories of marginalisation and uneven development. While prior studies often frame spiritual concerns as superstition and supply issues as technical, our analysis highlights their interconnection. For instance, fears of satanism are not merely irrational beliefs but express anxieties over autonomy, sovereignty, and the hidden agendas of global health actors (Wilson et al., 2023; Moucheraud et al., 2023). Likewise, parental resistance is frequently linked to educational inequalities, which reveal generational gaps in health knowledge. While most interventions focus on young people, they overlook the gatekeeping power of parents and older adults with limited information (Lubeya et al., 2023). Although logistical problems are often blamed for issues of cost and supply (Prem et al., 2024), Kutz et al. (2023) and Asempah and Ikpebe (2024) argue that the deeper issue lies in global inequities, with vaccine distribution favouring high-income countries and structurally disadvantaging SSA. This reflects a larger flaw in global health governance, where inequitable allocation perpetuates disadvantage in the region. The constant reference to “rumoured side effects” in communities also reflects not simply misinformation, but a collective trauma shaped by past medical neglect and coercion. In such contexts, information alone cannot overcome suspicion. Instead, transformation requires visible, lived demonstrations of vaccine safety as Turiho et al. (2017) observed, seeing peers vaccinated without harm significantly shifted parental perceptions. Overcoming barriers, therefore, demands a move away from top-down information delivery and toward co-created, community-grounded approaches to health, where trust is built relationally and collectively rather than assumed. 5. Conclusion This study explored the complex interplay between perceptions, facilitators, and barriers influencing HPV vaccine uptake across Sub-Saharan Africa. Findings reveal a sharp contrast between negative perceptions often driven by fears of infertility, bodily harm, and mistrust rooted in misinformation and positive views of the vaccine as a preventive measure against cervical cancer. While facilitators such as trusted educators, government initiatives, and public vaccination campaigns play an important role, their impact remains uneven and inconsistently applied across contexts. On the other hand, barriers extend beyond access and logistics to include deeply embedded socio-cultural, spiritual, and systemic challenges. These findings underscore that vaccine uptake in SSA is less about technical delivery and more about building trust in information, institutions, and health systems. Improving HPV vaccine coverage will therefore require more than campaigns; it calls for long-term, context-sensitive interventions that address historical mistrust and socio-cultural realities. Recommendations Based on these insights, practice and policy must prioritise grassroots education campaigns co-designed with local leaders, religious figures, and youth advocates to dismantle myths and translate scientific information into relatable contexts. Vaccination delivery models should also expand beyond schools to include mobile clinics and home-based outreach targeting rural and out-of-school populations. Strengthening institutional trust through permanent awareness units, empathetic frontline training, and embedding HPV vaccination in national immunisation policies with clear budget allocations is essential to reduce donor dependency. Additionally, communication strategies must be genderinclusive and intergenerational, directly engaging parents and adolescents in patriarchal and low-literacy settings. For future research, there is a need for country-specific ethnographic studies, deeper exploration of male influencers’ roles, and long-term studies on recipients’ health behaviours and reproductive decisions. Furthermore, developing frameworks for co-designing vaccine strategies with communities will be vital in ensuring sustainable and equitable uptake across SSA. Compliance with ethical standards Disclosure of conflict of interest The authors declare that there are no conflicts of interest related to the preparation and publication of this manuscript. No financial, personal, academic, or institutional relationships have influenced the conduct, interpretation, or reporting of this study. All authors confirm that the research was carried out objectively and independently, with no competing interests to disclose.. . World Journal of Biology Pharmacy and Health Sciences, 2025, 23(03), 006-024 22 References [1] Agimas, M.C., Adugna, D.G., Derseh, N.M., Kassaw, A., Kassie, Y.T., Abate, H.K. and Mekonnen, C.K. (2024) ‘Uptake of human papilloma virus vaccine and its determinants among females in East Africa: a systematic review and meta-analysis’, BMC public health, 24(1). Available at: https://doi.org/10.1186/s12889-024-18141-5. [2] Ahmed, S.K., Mohammed, R.A., Nashwan, A.J., Ibrahim, R.H., Abdalla, A.Q., Ameen, B.M.M. and Khidhir, R.M. 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[38] World Health Organisation (2025) Microsoft Power BI - HPV Vaccine Included in National Immunisation Programme, app.powerbi.com. Available at: https://app.powerbi.com/view?r=eyJrIjoiNDIxZTFkZGUtMDQ1Ny00MDZkLThiZDktYWFlYTdkOGU2NDcwIiwi dCI6ImY2MTBjMGI3LWJkMjQtNGIzOS04MTBiLTNkYzI4MGFmYjU5MCIsImMiOjh9. [39] World Health Organisation Africa (2024) Accelerating action for HPV vaccination in Africa, WHO | Regional Office for Africa. Available at: https://www.afro.who.int/news/accelerating-action-hpv-vaccination-africa. [40] World Health Organization (2024) Immunization Coverage, World Health Organization. Available at: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage. Authors short Biography Odubia, James Success is a renowned research addict with a passion for solving public health issues through health promotion and research. His vision stems from the understanding that research is a vital tool that allows us to reflect on the past, sustain the present, and project into the future.