Countering Misinformation and Hesitancy, Tanzania Tripled HPV Vaccination in Three Years

About 14 million people in the United States contract human papillomavirus (HPV) annually, 47,000 of whom will go on to develop HPV-associated cancers . Cervical cancer is the most common, with HPV causing more than 90 percent of cases, killing 4,000 people a year . According to the Centers for Disease Control and Prevention, however, many of these deaths are preventable. About 93 percent of HPV-associated cancer cases could be prevented with measures like the nine-valent HPV vaccine, which protects against nine types of HPV.

In the U.S., widespread misinformation and pandemic-related disruptions to primary care have caused vaccine uptake to plateau. But in the East African country of Tanzania, vaccination rates are higher and growing. Even though the vaccine wasn’t widely introduced until 2018 — eight years later than in the U.S. — 60 percent of women and girls over age 15 in Tanzania had been fully immunized against HPV by 2022, compared to 50 percent in the U.S.

Successful Community Outreach in Tanzania

Tanzania successfully trialed the HPV vaccine in the Kilimanjaro region in 2014 by targeting girls enrolled in school. The government then expanded the program across the country, adding the vaccine to the national immunization schedule for 14-year-old girls. It was then integrated into the routine vaccines available through health facilities, community outreach sites, mobile clinics, and primary and secondary schools.

In line with World Health Organization recommendations, HPV vaccines are provided on an opt-out basis in schools, meaning students need parental sign-off or medical approval to be exempt. In the lead-up to the national launch of the vaccination program, more than 6,000 health workers and 22,000 school personnel were trained to administer or provide information about the shot.

Following the launch, however, misinformation began to spread. Rumors that the vaccine caused infertility were broadcast on religious radio, spawning concerns and hesitancy. In response, health communications specialists mobilized a crisis communication plan that involved using radio appeals to directly address the public, educating key community leaders and health specialists, and having physicians speak with concerned parents about the vaccine’s efficacy and safety.

The coordinated effort worked. Misinformation was effectively countered, and Tanzanians were resensitized to the importance of the vaccine and its benefits. In a 2019 survey, 97 percent of all respondents indicated that the vaccine was widely accepted in their community, despite more than half of respondents reporting hearing misinformation about its safety. Tanzania was able to triple its vaccination coverage among eligible women and girls from 18 percent in 2018 to 60 percent in 2022.

Vaccination rates everywhere slowed during the pandemic. Just like the U.S., Tanzania is struggling to ensure uptake of the full, two-dose vaccine schedule. Recently the Tanzanian government started reengaging the public in conversations about the HPV vaccine, including through TV, radio, and educational materials aimed at students and parents.

The U.S. Is Losing the Battle Over HPV Vaccine Misinformation

Online misinformation in the U.S., including false reports of the HPV vaccine’s inefficacy and “forced” vaccination programs for youths, has resulted in rising levels of vaccine hesitancy. Girls and women ages 14 to 19 and 20 to 24 are seeing the most significant declines in vaccination. Research shows that parents who are exposed to misinformation are less likely to want to vaccinate their children.

Alongside misinformation, a recent study found decreasing awareness about HPV and the HPV vaccine in the U.S., particularly in rural settings and among communities of color and people with low income. A national survey found that 48 percent of parents to an 11-to-17-year-old were not informed about the vaccine by their physician.

Several states and territories have taken steps to increase HPV vaccination rates in recent years. Rhode Island launched its “Vaccinate Before You Graduate ” program in 2021, giving students the chance to get vaccinated before transitioning from middle to high school or before graduating high school. The state now has the nation’s highest HPV vaccination rate , with 83 percent of its adolescents ages 13 to 17 vaccinated in 2021.

In nearly all states, as well as the District of Columbia and Puerto Rico, HPV vaccines are approved to be administered in pharmacies through the Vaccines for Children program. Pharmacies are a key way to expand access, but they must be enrolled in the program. And uptake has been slow: as of 2021, most enrolled pharmacies were concentrated in just a handful of states.

Tanzania teaches us that with strategic communication and vigorous outreach — encompassing mass media, school-based interventions, primary care physicians, and others — public perceptions can change quite dramatically. No one should be dying from HPV-related cancers in 2023 when there are effective interventions with the potential to prevent most cases.