New Study Uncovers Key Drivers of HPV Vaccine Uptake in Sierra Leone as Coverage Fluctuates

New Study Uncovers Key Drivers of HPV Vaccine Uptake in Sierra Leone as Coverage Fluctuates In a meeting, organized by the Research Innovation and Support Office (RISO), COMAHS at Radisson Blu, on 6 May 2026, Freetown to communicate the results of ICARIA trail, the participants were informed about the Post-Introduction Evaluation of the Social Dimensions of the Human Papilloma virus Vaccine Uptake for improved​ sustained coverage in Sierra Leone.

​​ The document sates, anew mixed-methods formative research evaluation, known as the SHARE study, is shedding light on the dramatic fluctuations in human papillomavirus (HPV) vaccine uptake across Sierra Leone, offering critical insights to stabilize the national immunization program. Introduced nationwide in October 2022 with support from Gavi, the HPV vaccination program initially achieved a promising coverage rate of 74%. However, coverage plunged to just 24% in 2023, before partially recovering to61% in 2024. This persistent variability has prompted urgent action, with researchers from ISGlobal and local partners conducting an in-depth evaluation across Bombali, Tonkolili, and Port Loko districts from August 2024 to July 2025. Awareness High, But Knowledge Gaps Remain The study reveals that while awareness of HPV and cervical cancer is growing, driven largely by schools and radio, knowledge remains fragmented. Many caregivers, adolescents, and community members are unfamiliar with cervical cancer or confuse it with other illnesses like breast cancer. Persistent misconceptions include the belief that HPV spreads through public toilets or shared objects. Although some recognize HPV as a

sexually transmitted infection, it is still widely perceived as a “woman’s disease,” largely due to its visible impact on the female reproductive system. What Drives a Caregiver from Intent to Action?

One of the most striking findings is that perceived benefit is the strongest behavioral

driver. Caregivers who believe the vaccine reduces HPV risk are 5.51 times more likely to vaccinate their daughters. Additionally, a direct recommendation from a healthcare worker increases uptake odds by 4.74 times. Overall willingness among caregivers is moderate to high, with41% reporting that their daughters had already received the HPV vaccine—mostly through school-based delivery. Trust and Concerns Coexist Despite broadly positive attitudes toward vaccination, specific concerns continue to hinder uptake. Fear of infertility and lingering mistrust stemming from past health crises remain major barriers. Many caregivers and adolescents adopt a “wait and see” approach, choosing to observe vaccinated peers before committing to the vaccine. Endorsement from traditional and religious leaders provides essential local legitimacy, while prior notification to parents and teachers is critical for facilitating acceptance. Encouragingly, adolescent girls and young women are showing growing awareness of cervical cancer and a strong sense of responsibility toward their own reproductive health. Operational Barriers Persist Health providers face recurring logistical challenges, including geographic distance, transportation difficulties, vaccine stock shortages, and cold chain limitations, particularly in remote areas. School-based delivery has emerged as the most accepted and effective channel, with teachers playing a key role in building caregiver trust. However, researchers emphasize that decentralized community outreach is essential to reach out-of-school girls and ensure equitable coverage. Recommendations for a Sustainable Program

Based on the findings, the SHARE study outlines several operational recommendations:

• · Conduct Community, Technical Advisor (CTA) meetings before any school-based vaccination

• · Engage men and boys as active participants in HPV communication efforts.
• · Develop decentralized outreach strategies to reach out-of-school girls and remote communities.

• · Train previously vaccinated adolescents as peer communicators in school-based activities.

• · Address fertility concerns using locally resonant framings in sensitization materials.

“Understanding contextual drivers of vaccination is key to developing culturally sensitive strategies that enhance HPV program sustainability,” the study’s authors note. With Gavi’s support expected to transition in the coming years, these insights arrive at a critical moment for Sierra Leone to strengthen its national HPV program, meet WHO targets, and protect future generations from cervical cancer. Dr. Tonya Musa Director of Communications and International Relations University of Sierra Leone