Published in PLOS One on 2026-06-16, 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: Abdulmujeeb Opeyemi Muhammad-Olodo, Laura Asher
Source: PLOS One • DOI 10.1371/journal.pone.0351659
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Human papillomavirus (HPV) vaccine prevents over 90% of cervical cancers. In October 2023, Nigeria launched a free HPV vaccination campaign targeting girls aged 9–14 years. Despite removing cost barriers, misinformation about fertility impacts and population control contributed to variable uptake across states. Understanding caregiver decision-making is crucial for improving coverage. This study aimed to explore factors influencing caregivers’ HPV vaccination decisions during Nigeria’s 2023 campaign in Ilorin East Local Government Area, Kwara State.
A qualitative study using focus group discussions (FGDs) was conducted using purposive and snowball sampling. We recruited 41 caregivers (mean age 47 years; 71% female) of eligible girls from urban and rural communities. Five FGDs were conducted: four with vaccine acceptors (n = 35) and one with decliners (n = 6). Discussions were conducted in Yoruba, audio-recorded, transcribed verbatim, and analysed using Braun and Clarke’s reflexive thematic analysis. Ethical approval was obtained from two institutional review boards.
Four themes emerged from the analysis. Trust operated at multiple levels: institutional (government programmes), interpersonal (healthcare worker competence), and community (religious/traditional leader endorsement). Historical medical mistrust, intensified by COVID-19 experiences, may have manifested as fertility and population control fears. Personal cancer experiences strongly motivated acceptance, whilst concerns about childhood sexuality influenced timing preferences. Despite free provision, barriers included geographic inequities (remote Fulani-Hausa communities were excluded), language barriers (no Hausa translators), school-based delivery gaps, and indirect costs (transport, time). Caregivers recommended house-to-house campaigns, multilingual services, traditional leader engagement, and permanent vaccination centres.
Free vaccine provision is necessary but not sufficient to ensure uptake. Successful HPV vaccination requires rebuilding trust through community engagement, addressing historical medical exploitation concerns, and ensuring equitable access. Integrating these findings into Nigeria’s National Programme on Immunisation could improve coverage from current estimates of 54% to targeted 90%, protecting more girls from cervical cancer whilst respecting community values.
Introduction
Cervical cancer is the fourth leading cause of death amongst women globally, with more than 342,000 deaths in 2020 [1]. Nigeria has the highest cervical cancer mortality rate in sub-Saharan Africa, with more than 8000 women dying from this disease in 2020 [2]. Since the discovery of Human Papillomavirus (HPV) as a cause of cervical cancer, HPV vaccination has emerged as a crucial preventive measure, with HPV vaccines such as Gardasil-9 preventing more than 90% of cases [3].
Before 2023, the high cost of HPV vaccines in Nigeria posed significant access barriers, particularly for individuals from lower socioeconomic backgrounds [4]. This disparity in access represented a critical healthcare inequity in cervical cancer prevention. To address this inequity, in October 2023 the Federal Government of Nigeria, through the Ministry of Health and National Primary Health Care Development Agency (NPHCDA), partnered with multilateral organisations including the Global Alliance for Vaccines and Immunization (Gavi), International Finance Facility for Immunisation (IFFIm), and World Health Organization (WHO) to launch a nationwide HPV vaccination campaign targeting female children aged 9–14 years [2]. Crucially, the vaccine was made free to access. However, there were reports that the campaign was met with public hesitancy; rumours included claims that the vaccine would cause infertility or premature death [5–7].
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 public health 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 Abdulmujeeb Opeyemi Muhammad-Olodo, Laura Asher. 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: Geographic inequities in human papillomavirus vaccine non-uptake and its determinants among adolescent girls in Ethiopia: Evidence from the National Immunization Survey
- Evidence brief: Gaps and barriers preventing sustained delivery of HPV vaccination in Kano, Kaduna, and Lagos states: An exploratory qualitative study
- Evidence brief: Strengthened HPV vaccination among adolescents living with HIV, – Findings of a Pilot QI project in Kampala Metropolitan, Uganda
