HPV vaccination in a context of public mistrust and uncertainty: a systematic literature review of determinants of HPV vaccine hesitancy in Europe

Hum Vaccin Immunother. 2019;15(7-8):1615-1627. doi: 10.1080/21645515.2018.1564436. Epub 2019 Feb 20.


Europe is increasingly described as the region in the world with the least confidence in vaccination, and particularly in the safety of vaccines. The aim of this systematic literature review was to gather and summarise all peer-reviewed and grey literature published about determinants of Human Papillomavirus (HPV) vaccine hesitancy in Europe. Ten thematic categories were identified across the 103 articles which were included in the review. Participants from European studies most commonly reported issues with the quantity and quality of information available about HPV vaccination; followed by concerns about potential side effects of the vaccine; and mistrust of health authorities, healthcare workers, and new vaccines. Comparative analyses indicated that confidence determinants differed by country and population groups. This evidence supports the need to develop context-specific interventions to improve confidence in HPV vaccination and design community engagement strategies aiming to build public trust.

Keywords: HPV; HPV vaccination; cervical cancer; vaccine confidence vaccination; vaccine hesitancy.

Publication types

  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Europe
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Papillomavirus Infections / prevention & control
  • Papillomavirus Vaccines / administration & dosage*
  • Patient Acceptance of Health Care*
  • Trust*
  • Uncertainty*
  • Uterine Cervical Neoplasms / prevention & control
  • Vaccination / psychology*
  • Vaccination Refusal / psychology
  • Vaccination Refusal / statistics & numerical data


  • Papillomavirus Vaccines

Grant support

This study was supported by the European Centre for Disease Prevention and Control (ECDC) under Service Contract OCS-2016-0UT-2050-MCTeFo.