Barriers and Facilitators to the Acceptance and Utilization of the Human Papillomavirus Vaccine in Anambra State: A Qualitative Analysis

Abstract

Human Papillomavirus (HPV) vaccination is recognized as a highly effective strategy and preventive measure against cervical cancer globally. Despite the introduction of the HPV vaccine (Gardasil-9) into Nigeria Expanded Program on Immunization Schedule in 2023 and health facilities providing routine immunization services across Anambra state in May 2024, uptake remains suboptimal. This study employed a qualitative descriptive survey design to explore the barriers and facilitators to the acceptance and utilization of the HPV vaccine in six Local Government Areas across the three senatorial zones of Anambra State. Data were collected from 360 participants, including parents, adolescents, community members and healthcare workers, using focus group discussions and key informant interviews, and analyzed thematically. Findings revealed that healthcare workers demonstrated high knowledge and strong advocacy for vaccination, while parents and adolescents showed moderate awareness and conditional acceptance influenced by safety concerns, cultural and religious beliefs. Misconceptions on the safety of the vaccine and trust in misinformation including rumors were highlighted as a major barrier to vaccine utilization among the community members. Systemic factors such as inconsistent vaccine supply, cold chain limitations, and uneven distribution further constrained vaccine utilization. Facilitators identified included trust in healthcare providers, prior exposure to health education campaigns, and perceived preventive benefits of vaccination. The study concludes that improving HPV vaccine uptake in Anambra State requires targeted educational interventions, culturally sensitive communication, strengthened vaccine supply chains, and active engagement of healthcare workers as trusted community advocates. These findings provide evidence-based guidance for policy and programmatic strategies to enhance HPV vaccination coverage and reduce HPV-related disease burden in the region.