Published in PLOS One on 2026-06-18, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Chidozie Ezechukwu, Esther Oluwayemisi Ayandipo, Demilade Osoteku, Raihanah Ibrahim, Oluwafunmilayo Raheem, Amy Boldosser-Boesch, Sarah Birse, Elizabeth Weinstein, Justice Nonvignon, Goodness Hadley, Eric Aigbogun, Uchenna Igbokwe
Source: PLOS One • DOI 10.1371/journal.pone.0350510
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
To lessen the burden of cervical cancer, Nigeria introduced the HPV vaccine to its national immunization program, but the program has faced operational and contextual problems during its early rollout. This study explored the systemic and community-level barriers affecting HPV vaccine delivery across selected Nigerian states.
This exploratory qualitative study employed key informant interviews with policymakers, immunization officers, government agencies, community-based organizations, and implementing partners across three states: Kaduna, Kano, and Lagos, from April 2025 to October 2025. Data were thematically analyzed using NVivo, with emphasis on identifying factors influencing the sustainability of HPV vaccination. The analysis focused on key domains such as policy implementation, financing, service delivery, supply chain systems, human resources, data management, and demand generation.
The study found that HPV vaccine implementation is hindered by limited state-level policy adaptation, reliance on donor funding, human resource shortages, supply chain weaknesses, data management gaps, and strong socio-cultural resistance driven by misinformation. These interconnected barriers reduce vaccine acceptance and disrupt service delivery.
The HPV vaccination program in Nigeria is constrained by systemic weaknesses and socio-cultural resistance. Addressing these challenges requires stronger state-level policy adaptation, sustainable financing, improved supply chain and data systems, and targeted community engagement to enhance acceptance and ensure effective service delivery.
Background
Human papillomavirus (HPV) is one of the most common sexually transmitted infections globally, and is a well-established cause of cervical cancer, as well as other anal, vulvar, and oropharyngeal cancers) [1,2]. The causal relationship between HPV and cervical cancer was first proposed by zur Hausen in the 1970s, leading to the identification of high-risk HPV genotypes 16 and 18 as the primary oncogenic strains responsible for approximately 70% of cervical cancer cases [3]. This discovery laid the foundation for HPV testing and the development of prophylactic vaccines, transforming cervical cancer prevention into a vaccine-preventable strategy aligned with the World Health Organization’s (WHO) cervical cancer elimination goals [4,5]. Beyond cervical cancer, HPV is also associated with other malignancies, including anal, vulvar, and oropharyngeal cancers [6].
Globally, cervical cancer ranks as the fourth most common cancer among women, with an estimated 660,000 new cases and 350,000 deaths reported in 2022 [7]. More than 80% of these cases occur in low- and middle-income countries (LMICs), where access to screening and preventive services remains limited [8]. Sub-Saharan Africa bears a disproportionate share of this burden, with the highest reported HPV prevalence globally, estimated at approximately 22.1%, although prevalence varies widely depending on study population and geographic context [9,10].
In Nigeria, HPV prevalence varies by region, population, and study year, with reported estimates ranging from approximately 12% to over 40% in some populations [11–13]. Cervical cancer is the second most frequent cancer among women in Nigeria and the leading cause of mortality and morbidity among women aged 15–44 years, with approximately 12,000 new cases and 8,000 deaths reported annually [14–16]. Despite this high burden, HPV vaccine uptake remains low. In a 2024 study in Northern Nigeria, [17]found that even if the HPV vaccine were free or subsidized, approximately one-third (32.7%) of parents would still choose not to vaccinate their children against the virus, highlighting a substantial gap between the implementation of national vaccination policies and actual population-level uptake [18,19].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Chidozie Ezechukwu, Esther Oluwayemisi Ayandipo, Demilade Osoteku, Raihanah Ibrahim, Oluwafunmilayo Raheem, Amy Boldosser-Boesch, Sarah Birse, Elizabeth Weinstein, Justice Nonvignon, Goodness Hadley, Eric Aigbogun, Uchenna Igbokwe. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Understanding factors influencing HPV vaccine uptake among caregivers in Kwara State, Nigeria: A qualitative study
- Evidence brief: Challenges, opportunities and best practices in routine childhood vaccination services delivery in urban slums and pastoralist regions of Ethiopia: An exploratory qualitative study in marginalized settings
- Evidence brief: Leveraging social media to mitigate HPV vaccine service disruptions in Abuja, Nigeria
