Papillomavirus Vaccination Programs and Knowledge Gaps as Barriers to Implementation: A Systematic Review

Cangelosi, Giovanni; Sacchini, Francesco; Mancin, Stefano; Petrelli, Fabio; Amendola, Antonella; Fappani, Clara; Sguanci, Marco; Morales Palomares, Sara; Gravante, Francesco; Caggianelli, Gabriele

doi:10.3390/vaccines13050460

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Open AccessSystematic Review

Papillomavirus Vaccination Programs and Knowledge Gaps as Barriers to Implementation: A Systematic Review

by

Giovanni Cangelosi

^1,†

,

Francesco Sacchini

^2,†

,

Stefano Mancin

³

,

Fabio Petrelli

^1,*,

Antonella Amendola

^4,*

,

Clara Fappani

⁴

,

Marco Sguanci

⁵

,

Sara Morales Palomares

⁶

,

Francesco Gravante

^7,‡

and

Gabriele Caggianelli

^8,‡

¹

School of Pharmacy, Experimental Medicine and Public Health Unit, University of Camerino, 62032 Camerino, Italy

²

Department of Nursing, Polytechnic University of Ancona, 60121 Ancona, Italy

³

IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy

⁴

Department of Health Sciences, Università degli Studi di Milano, 20146 Milan, Italy

⁵

A.O. Polyclinic San Martino Hospital, 16132 Genova, Italy

⁶

Department of Pharmacy, Health and Nutritional Sciences (DFSSN), University of Calabria, 87036 Rende, Italy

⁷

Local Health Authority of Caserta, San Giuseppe Moscati Hospital, 81031 Aversa, Italy

⁸

Azienda Ospedaliera San Giovanni Addolorata, 00184 Rome, Italy

^*

Authors to whom correspondence should be addressed.

^†

Giovanni Cangelosi and Francesco Sacchini contributed equally as the first author of this work.

^‡

Francesco Gravente and Gabriele Caggianelli contributed equally as the last author of this work.

Vaccines 2025, 13(5), 460; https://doi.org/10.3390/vaccines13050460

Submission received: 27 February 2025 / Revised: 23 April 2025 / Accepted: 24 April 2025 / Published: 25 April 2025

(This article belongs to the Special Issue Advance Public Health Through Vaccination)

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Abstract

Background/Objectives: Human papillomavirus (HPV) is a leading cause of cervical cancer. Despite the proven effectiveness of vaccination programs, global coverage remains uneven, with significant disparities across regions due to various socioeconomic, cultural, and political factors. This study explores the primary barriers to HPV vaccination worldwide and proposes recommendations to improve access to screening and vaccination programs. Methods: A systematic literature review was conducted, analyzing studies published in the past ten years from databases such as PubMed, Scopus, and Embase, following the PRISMA methodology. Study selection involved multiple researchers, with discrepancies resolved through consultation. The quality of the included studies was assessed using CASP checklists. The protocol was registered on Open Science Framework (OSF). Results: Out of 2119 records, eight studies were included. The findings indicate that the main barriers to HPV vaccination include insufficient public awareness, cultural and religious resistance, financial constraints, and limited access in rural and underserved areas. Additionally, political factors, such as low prioritization of HPV vaccination and the absence of supportive policies, were identified as significant obstacles. Multidisciplinary and cross-cultural collaboration, along with the integration of HPV vaccination into existing health programs, was suggested as a strategic approach to improve vaccine uptake. Conclusions: Barriers to HPV vaccination, including limited awareness, inadequate healthcare infrastructure, and socioeconomic factors, vary across regions but must be addressed to improve global coverage. Targeted interventions such as health education, inclusive policies, and culturally sensitive campaigns can significantly boost vaccine uptake. Strengthening local health systems and fostering international collaboration are key strategies to overcoming these barriers and ensuring equitable access to HPV vaccination.

Keywords: human papillomavirus vaccination program; public health; health prevention; barriers; systematic review

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MDPI and ACS Style

Cangelosi, G.; Sacchini, F.; Mancin, S.; Petrelli, F.; Amendola, A.; Fappani, C.; Sguanci, M.; Morales Palomares, S.; Gravante, F.; Caggianelli, G. Papillomavirus Vaccination Programs and Knowledge Gaps as Barriers to Implementation: A Systematic Review. Vaccines 2025, 13, 460. https://doi.org/10.3390/vaccines13050460

AMA Style

Cangelosi G, Sacchini F, Mancin S, Petrelli F, Amendola A, Fappani C, Sguanci M, Morales Palomares S, Gravante F, Caggianelli G. Papillomavirus Vaccination Programs and Knowledge Gaps as Barriers to Implementation: A Systematic Review. Vaccines. 2025; 13(5):460. https://doi.org/10.3390/vaccines13050460

Chicago/Turabian Style

Cangelosi, Giovanni, Francesco Sacchini, Stefano Mancin, Fabio Petrelli, Antonella Amendola, Clara Fappani, Marco Sguanci, Sara Morales Palomares, Francesco Gravante, and Gabriele Caggianelli. 2025. "Papillomavirus Vaccination Programs and Knowledge Gaps as Barriers to Implementation: A Systematic Review" Vaccines 13, no. 5: 460. https://doi.org/10.3390/vaccines13050460

APA Style

Cangelosi, G., Sacchini, F., Mancin, S., Petrelli, F., Amendola, A., Fappani, C., Sguanci, M., Morales Palomares, S., Gravante, F., & Caggianelli, G. (2025). Papillomavirus Vaccination Programs and Knowledge Gaps as Barriers to Implementation: A Systematic Review. Vaccines, 13(5), 460. https://doi.org/10.3390/vaccines13050460

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

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