Peer-reviewed article
Acceptability of human papillomavirus vaccination in the United Kingdom: a systematic review of the literature on uptake of, and barriers and facilitators to HPV vaccination.
Karakusevic A, Foss AM ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review examined factors affecting HPV vaccine uptake among adolescents and parents in the United Kingdom between 2017 and 2023. While HPV vaccination is generally well-accepted with over 80% coverage reported in studies, actual vaccine coverage in England has fallen below 80% and remains lower than pre-COVID levels. The review identified barriers including system-level issues with consent, concerns about HPV risk versus vaccine safety, and sociodemographic factors affecting both adolescents and parents. The authors highlight a significant gap in evidence regarding boys' vaccination rates and call for more research on facilitators to improve coverage.
Key points
- HPV vaccination coverage in England between 2020-2023 remains below 80% and is lower than pre-COVID levels, despite peer-reviewed literature reporting ≥80% coverage
- Barriers to vaccination operate at three levels: system-level (consent challenges), psychological/behavioural (risk perception), and sociodemographic factors
- Similar barriers are reported among both adolescents and parents
- Limited evidence exists specifically on HPV vaccination coverage and barriers for adolescent boys compared to girls
- Research gap identified: more evidence needed on facilitators to vaccination, particularly to address sociodemographic barriers
Limitations
This systematic review synthesises published literature and grey literature from 2017-2023 in English only, which may exclude relevant non-English studies and recent developments. The review identifies barriers and gaps in evidence but does not provide quantitative synthesis of the magnitude of different barriers or their relative importance in driving vaccination decisions.
Abstract
Background Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide, with HPV and HPV-related diseases representing a substantial disease burden. HPV vaccination has reduced HPV infections and HPV-related diseases; however, there is growing evidence of delayed or refused vaccination due to a lack of trust in vaccines. Understanding the factors that impact vaccine uptake will allow the development and implementation of successful vaccination programmes. Objectives This study aimed to evaluate the acceptability of HPV vaccination among adolescents and parents in the United Kingdom (UK). Design Systematic review. Methods Online databases (Embase, Medline and Cochrane) and grey literature sources were searched to identify publications pertaining to 'adolescents', 'parents', 'vaccine uptake', 'vaccine hesitancy' and 'barriers or facilitators to vaccination'. Searches were limited to English language and articles published specific to the United Kingdom between 2017 and 2023. Results Following a review of 152 abstracts, 24 publications met the inclusion criteria. While HPV vaccination is widely accepted in the UK, with coverage reported ⩾80% in peer-reviewed literature, the UK Health Security Agency report that vaccine coverage estimates in England between 2020-2023 remain below 80% and are lower than pre-COVID levels. Several important barriers were identified that may impact vaccine uptake, including system-level (challenges with obtaining consent), psychological/behavioural (perception of HPV risk vs vaccine risks), and sociodemographic factors, with similar factors reported among adolescents and parents. Conclusion HPV vaccination coverage remains below pre-COVID levels in the UK and common barriers among adolescents and parents have been identified that must be addressed to improve coverage rates. There is currently limited evidence among adolescent boys to fully evaluate any differences in vaccination coverage, or barriers, compared to girls. More research is required into facilitators to vaccination (especially to address sociodemographic barriers), to identify approaches to tackle the barriers that currently impede HPV vaccination uptake.