Religion, Politics, and Vaccines: Elaborating the Integrative Public Policy Acceptance (IPAC) Framework Through HPV Vaccine Program Acceptance Among Religious Leaders in Bangladesh

Articles in Press

Document Type : Original Article

Authors

1 Government of Bangladesh, Ministry of Public Administration, Dhaka, Bangladesh

2 VaxPolLab, School of Social Sciences, The University of Western Australia, Perth, WA, Australia

3 ShuHaRi Health, Dhaka, Bangladesh

Abstract

Background 
In October 2023, Bangladesh introduced a free, single-dose human papillomavirus (HPV) vaccine for girls aged 9–14 through its national vaccination program to prevent cervical cancer, the second most common cancer among Bangladeshi females, caused by the HPV. Although vaccine hesitancy was not a significant issue before the COVID-19 pandemic, experiences from that pandemic and global literature suggest that the population’s uptake of this vaccine may face barriers due to concerns related to reproductive health, fertility, and cultural and religious beliefs. This is particularly relevant in a country where Islam is the state religion, 91% of the population is Muslim, and religious leaders hold significant influence over public opinion.
 
Methods 
Building upon the recently developed Integrative Public Policy Acceptance (IPAC) framework, this qualitative study explores the factors shaping religious leaders’ support for the HPV vaccine informing their potential role in promoting it. Semi-structured interviews with leaders from Bangladesh’s five main Islamic traditions were thematically analysed using NVivo 14 with inductive and deductive coding.
 
Results 
Islamic religious leaders’ varying support for HPV vaccinations in Bangladesh was influenced by their limited awareness of cervical cancer, as well as their religious and social concerns about ingredients, side effects and a fear of promoting promiscuity. Political ideologies also played a significant role, as leaders were less supportive of the program when they perceived the government as ideologically opposed to the beliefs or practices of their specific religious tradition.
 
Conclusion 
The study’s contribution to the IPAC framework highlights the importance of political consensus in policy acceptance, explaining how partisanship and ideological differences impact public policy compliance. The findings underscore the need for health systems in Muslim majority countries to engage with religious authorities, build political inclusivity and consensus, and align health policies with religious and cultural values.

Keywords

References

  1. International Agency for Research on Cancer (IARC). Bangladesh, Human Papillomavirus and Related Cancers, Factsheet 2023. IARC; 2023. https://hpvcentre.net/statistics/reports/BGD_FS.pdf?t=1661333484494#:~:text=However%2C%20in%20Southern%20Asia%2C%20the,to%20HPVs%2016%20or%2018. Accessed August 30, 2023.
  2. UNICEF. Government Launches Nationwide Human Papillomavirus (HPV) Vaccination Campaign. UNICEF; 2023. https://www.unicef.org/bangladesh/en/press-releases/government-launches-nationwide-human-papillomavirus-hpv-vaccination-campaign. Accessed October 11, 2023.
  3. Brabin L, Roberts SA, Stretch R, et al. Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. BMJ. 2008;336(7652):1056-1058. doi:1136/bmj.39541.534109.BE
  4. Forster A, Wardle J, Stephenson J, Waller J. Passport to promiscuity or lifesaver: press coverage of HPV vaccination and risky sexual behavior. J Health Commun. 2010;15(2):205-217. doi:1080/10810730903528066
  5. Ogilvie GS, Remple VP, Marra F, et al. Parental intention to have daughters receive the human papillomavirus vaccine. CMAJ. 2007;177(12):1506-1512. doi:1503/cmaj.071022
  6. Touyz SJ, Touyz LZ. The kiss of death: HPV rejected by religion. Curr Oncol. 2013;20(1):e52-e53. doi:3747/co.20.1186
  7. Dailey PM, Krieger JL. Communication and US-Somali immigrant human papillomavirus (HPV) vaccine decision-making. J Cancer Educ. 2017;32(3):516-521. doi:1007/s13187-015-0959-0
  8. Salad J, Verdonk P, de Boer F, Abma TA. "A Somali girl is Muslim and does not have premarital sex. Is vaccination really necessary?" A qualitative study into the perceptions of Somali women in the Netherlands about the prevention of cervical cancer. Int J Equity Health. 2015;14:68. doi:1186/s12939-015-0198-3
  9. Loke AY, Chan AC, Wong YT. Facilitators and barriers to the acceptance of human papillomavirus (HPV) vaccination among adolescent girls: a comparison between mothers and their adolescent daughters in Hong Kong. BMC Res Notes. 2017;10(1):390. doi:1186/s13104-017-2734-2
  10. Wong LP. Young multiethnic women's attitudes toward the HPV vaccine and HPV vaccination. Int J Gynaecol Obstet. 2008;103(2):131-135. doi:1016/j.ijgo.2008.07.005
  11. Wong LP. HPV information needs, educational messages and channel of delivery preferences: views from developing country with multiethnic populations. Vaccine. 2009;27(9):1410-1415. doi:1016/j.vaccine.2008.12.045
  12. Wong LP. An exploration of knowledge, attitudes and behaviours of young multiethnic Muslim-majority society in Malaysia in relation to reproductive and premarital sexual practices. BMC Public Health. 2012;12:865. doi:1186/1471-2458-12-865
  13. Sheikh N, Sultana M, Ali N, et al. Coverage, timelines, and determinants of incomplete immunization in Bangladesh. Trop Med Infect Dis. 2018;3(3):72. doi:3390/tropicalmed3030072
  14. Ali M, Hossain A. What is the extent of COVID-19 vaccine hesitancy in Bangladesh? A cross-sectional rapid national survey. BMJ Open. 2021;11(8):e050303. doi:1136/bmjopen-2021-050303
  15. Hossain MB, Alam MZ, Islam MS, et al. COVID-19 vaccine hesitancy among the adult population in Bangladesh: a nationwide cross-sectional survey. PLoS One. 2021;16(12):e0260821. doi:1371/journal.pone.0260821
  16. Kanozia R, Arya R. “Fake news,” religion, and COVID-19 vaccine hesitancy in India, Pakistan, and Bangladesh. Media Asia. 2021;48(4):313-321. doi:1080/01296612.2021.1921963
  17. Fesshaye B, Wade SA, Lee C, et al. Sources of COVID-19 vaccine promotion for pregnant and lactating women in Bangladesh. Vaccines (Basel). 2023;11(8):1387. doi:3390/vaccines11081387
  18. Chowdhury Z. No Steps Yet to Stop ‘Islamic Scholars’ from Spreading Disinformation on COVID-19: Having Been Misguided by Their Misleading Speeches, a Large Number of People Are Also Spreading COVID-19 Falsehoods on Social Media. The Business Standard; 2020.
  19. Rafe R. Misinformation Mars Bangladesh Vaccination Drive. Deutsche Welle; 2021.
  20. Khan YH, Mallhi TH, Alotaibi NH, et al. Threat of COVID-19 vaccine hesitancy in Pakistan: the need for measures to neutralize misleading narratives. Am J Trop Med Hyg. 2020;103(2):603-604. doi:4269/ajtmh.20-0654
  21. Religious Leaders Play Key Role in Battle Against COVID-19. UNICEF; 2020. https://www.unicef.org/rosa/stories/religious-leaders-play-key-role-battle-against-covid-19. Accessed October 2, 2024.
  22. Melillo S, Strachan R, O’Brien CJ, Wonodi C, Bormet M, Fountain D. Effects of local faith-actor engagement in the uptake and coverage of immunization in low-and middle-income countries: a literature review. Christian Journal for Global Health. 2022;9(1):2-32.
  23. Ali Sheikhi R, Heidari M, Doosti P. The role of religious leaders in the acceptance of COVID-19 vaccinations: a systematic review. BMC Public Health. 2025;25(1):2683. doi:1186/s12889-025-23947-y
  24. Trangerud HA. "What is the problem with vaccines?" A typology of religious vaccine skepticism. Vaccine X. 2023;14:100349. doi:1016/j.jvacx.2023.100349
  25. Kibongani Volet A, Scavone C, Catalán-Matamoros D, Capuano A. Vaccine hesitancy among religious groups: reasons underlying this phenomenon and communication strategies to rebuild trust. Front Public Health. 2022;10:824560. doi:3389/fpubh.2022.824560
  26. Mike JH. The influence of religious leaders and faith-based organizations on health observance, behaviors and public health policies. Indonesian Journal of Religion and Society. 2025;7(1):25-42.
  27. World Population Review. Bangladesh. 2022. https://worldpopulationreview.com/countries/bangladesh. Accessed January 1, 2025.
  28. Hoq MN, Hossain ME, Sultana I. Determinants of sterilization birth control method in Bangladesh. Open J Soc Sci. 2019;7(9):31-43. doi:4236/jss.2019.79003
  29. Sarker BK, Rahman M, Rahman T, Hossain J, Reichenbach L, Mitra DK. Reasons for preference of home delivery with traditional birth attendants (TBAs) in rural Bangladesh: a qualitative exploration. PLoS One. 2016;11(1):e0146161. doi:1371/journal.pone.0146161
  30. Esposito JL. Islam: The Straight Path. 3rd ed. London: Oxford University Press; 2004.
  31. Valdez A, Stewart SL, Tanjasiri SP, Levy V, Garza A. Design and efficacy of a multilingual, multicultural HPV vaccine education intervention. J Commun Healthc. 2015;8(2):106-118. doi:1179/1753807615y.0000000015
  32. Reiter PL, Katz ML, Paskett ED. Correlates of HPV vaccination among adolescent females from Appalachia and reasons why their parents do not intend to vaccinate. Vaccine. 2013;31(31):3121-3125. doi:1016/j.vaccine.2013.04.068
  33. Tiwana MH, Smith J. Faith and vaccination: a scoping review of the relationships between religious beliefs and vaccine hesitancy. BMC Public Health. 2024;24(1):1806. doi:1186/s12889-024-18873-4
  34. Namoos A, Sheppard V, Abdelkarim M, et al. Exploring factors influencing cervical cancer prevention behaviors: unveiling perspectives of conservative Muslim American women in Virginia. J Relig Health. 2023; 62(5):3453-3465. doi:1007/s10943-023-01886-5
  35. Kisa S, Kisa A. Religious beliefs and practices toward HPV vaccine acceptance in Islamic countries: a scoping review. PLoS One. 2024;19(8):e0309597. doi:1371/journal.pone.0309597
  36. Alsuwaidi AR, Hammad HA, Elbarazi I, Sheek-Hussein M. Vaccine hesitancy within the Muslim community: Islamic faith and public health perspectives. Hum Vaccin Immunother. 2023;19(1):2190716. doi:1080/21645515.2023.2190716
  37. Pratt R, Njau SW, Ndagire C, et al. "We are Muslims and these diseases don't happen to us": a qualitative study of the views of young Somali men and women concerning HPV immunization. Vaccine. 2019;37(15):2043-2050. doi:1016/j.vaccine.2019.03.006
  38. Al Zaabi O, Heffernan OA, Lazarus ER, Al Farsi H. Muslim parents’ knowledge, attitudes, willingness, and barriers toward HPV vaccination for their children: a qualitative study. Res Sq [Preprint]. April 1, 2025. Available from: https://www.researchsquare.com/article/rs-6338663/v1.
  39. Shaikh MY, Hussaini MF, Narmeen M, et al. Knowledge, attitude, and barriers towards human papillomavirus (HPV) vaccination among youths of Karachi, Pakistan. Cureus. 2019;11(11):e6134. doi:7759/cureus.6134
  40. Mohd Sopian M, Shaaban J, Mohd Yusoff SS, Wan Mohamad WM. Knowledge, decision-making and acceptance of human papilloma virus vaccination among parents of primary school students in Kota Bharu, Kelantan, Malaysia. Asian Pac J Cancer Prev. 2018;19(6):1509-1514. doi:22034/apjcp.2018.19.6.1509
  41. Grelle S, Hofmann W. When and why do people accept public-policy interventions? An integrative public-policy-acceptance framework. Perspect Psychol Sci. 2024;19(1):258-279. doi:1177/17456916231180580
  42. Roy S, Huq S, Rob AB. Faith and education in Bangladesh: a review of the contemporary landscape and challenges. Int J Educ Dev. 2020;79:102290. doi:1016/j.ijedudev.2020.102290
  43. Al Hussain A. State, Qawmi Madrasas and Children in Bangladesh: From a Social Protection Perspective [dissertation]. The Netherlands: International Institute of Social Studies (ISS), Erasmus University Rotterdam; 2018. doi:13140/rg.2.2.31891.30245
  44. Momen A. Understanding the Qawmi madrasah system in Bangladesh and its educational framework: understanding the Qawmi madrasah system in Bangladesh. J Asiat Soc Bangladesh Humanit. 2025;70(1):65-87. doi:3329/jasbh.v70i1.82655
  45. Al-Hasani SM. Madrasah education in Bangladesh: a comparative study between Aliya and Qawmi. Journal of Creative Writing. 2020;4(2):111-132.
  46. Islamic Foundation Bangladesh (IFB). Introduction of IFB. 2024. https://islamicfoundation.gov.bd/site/page/c0054950-5b2b-4d6d-af24-9a5f1aea918e/. Accessed November 10, 2025.
  47. Pieri Z. Tablīghī Jamāʿat. Handbook of Islamic Sects and Movements. Brill; 2021:49-72.
  48. Ahmad M. Islamic Fundamentalism in South Asia: The Jamaat-i-Islami and the Tablighi Jamaat of South Asia. Fundamentalisms Observed. 1991;1:457-530.
  49. Al Masud A, Abdullah MF, Amin MR. The contributions of Sufism in promoting religious harmony in Bangladesh. Jurnal Usuluddin. 2017;45(2):105-122. doi:22452/usuluddin.vol45no2.5
  50. Halim W. The Sufi Sheikhs and their socio-cultural roles in the Islamization of Bengal during the Mughal period (1526-1858). Journal of Islamic Civilization in Southeast Asia. 2018;7(2):175-194. doi:24252/jicsa.v7i2.7045
  51. Göktaş V, Chowdury S. Districts of Bangladesh named after Sufis manifesting the great impact of Sufism on Bengal civilization: a qualitative study. Journal of Islamic Thought and Civilization. 2023;13(1):320-327. doi:32350/jitc.131.22
  52. Alam S. Sufism without boundaries: pluralism, coexistence, and interfaith dialogue in Bangladesh. Comparative Islamic Studies. 2013;9(1):67-90. doi:1558/cis.v9i 1.26765
  53. May T, Perry B. Social Research: Issues, Methods and Process. London: McGraw-Hill Education; 2022.
  54. World Health Organization (WHO). Behavioural and Social Drivers of Vaccination: Tools and Practical Guidance for Achieving High Uptake. Geneva: WHO; 2022.
  55. World Health Organization (WHO). Cervical Cancer. WHO; 2024. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer. Accessed November 10, 2025.
  56. Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. Thousand Oaks: SAGE Publications; 1994.
  57. Banik R, Naher S, Rahman M, Gozal D. Investigating Bangladeshi rural women's awareness and knowledge of cervical cancer and attitude towards HPV vaccination: a community-based cross-sectional analysis. J Cancer Educ. 2022;37(2):449-460. doi:1007/s13187-020-01835-w
  58. Bhuiyan A, Sultana F, Islam JY, Chowdhury MA, Nahar Q. Knowledge and acceptance of human papillomavirus vaccine for cervical cancer prevention among urban professional women in Bangladesh: a mixed method study. Biores Open Access. 2018;7(1):63-72. doi:1089/biores.2018.0007
  59. Islam JY, Khatun F, Alam A, et al. Knowledge of cervical cancer and HPV vaccine in Bangladeshi women: a population based, cross-sectional study. BMC Womens Health. 2018;18(1):15. doi:1186/s12905-018-0510-7
  60. Rahman ME, Moonajilin MS, Bishwas MS, Banik R, Pinky GN, Alin SI. Awareness, knowledge about human papillomavirus and attitude towards its vaccine among university students: a Bangladeshi pilot study. Asian J Health Sci. 2019;5(2):11. doi:15419/ajhs.v5i2.458
  61. Ali K. Sexual Ethics and Islam: Feminist Reflections on Qur'an, Hadith, and Jurisprudence. Simon and Schuster; 2016.
  62. Seoud M. Burden of human papillomavirus-related cervical disease in the extended middle east and north Africa-a comprehensive literature review. J Low Genit Tract Dis. 2012;16(2):106-120. doi:1097/LGT.0b013e31823a0108
  63. Hamdi S. The impact of teachings on sexuality in Islam on HPV vaccine acceptability in the Middle East and North Africa region. J Epidemiol Glob Health. 2018;7(Suppl 1):S17-S22. doi:1016/j.jegh.2018.02.003
  64. Shelton RC, Snavely AC, De Jesus M, Othus MD, Allen JD. HPV vaccine decision-making and acceptance: does religion play a role? J Relig Health. 2013;52(4):1120-1130. doi:1007/s10943-011-9553-x
  65. Lahijani AY, King AR, Gullatte MM, Hennink M, Bednarczyk RA. HPV vaccine promotion: the church as an agent of change. Soc Sci Med. 2021;268:113375. doi:1016/j.socscimed.2020.113375
  66. Guidry JPD, Naavaal S, Laestadius LI, et al. Health, beliefs, and faith: HPV vaccine uptake intent among Catholic, Evangelical, and mainline protestant parents. Hum Vaccin Immunother. 2024;20(1):2425142. doi:1080/21645515.2024.2425142
  67. Hittson H, McAleer L, Saucedo L, et al. Association between religious beliefs and HPV vaccination attitudes among college students. Vaccines (Basel). 2023;11(10):1623. doi:3390/vaccines11101623
  68. Marlow LA, Wardle J, Forster AS, Waller J. Ethnic differences in human papillomavirus awareness and vaccine acceptability. J Epidemiol Community Health. 2009;63(12):1010-1015. doi:1136/jech.2008.085886
  69. Wong LP, Wong PF, Megat Hashim M, et al. Multidimensional social and cultural norms influencing HPV vaccine hesitancy in Asia. Hum Vaccin Immunother. 2020;16(7):1611-1622. doi:1080/21645515.2020.1756670
  70. Ahmed A, Lee KS, Bukhsh A, et al. Outbreak of vaccine-preventable diseases in Muslim majority countries. J Infect Public Health. 2018;11(2):153-155. doi:1016/j.jiph.2017.09.007
  71. Grabenstein JD. What the world's religions teach, applied to vaccines and immune globulins. Vaccine. 2013;31(16):2011-2023. doi:1016/j.vaccine.2013.02.026
  72. Khoo YS, Ghani AA, Navamukundan AA, Jahis R, Gamil A. Unique product quality considerations in vaccine development, registration and new program implementation in Malaysia. Hum Vaccin Immunother. 2020;16(3):530-538. doi:1080/21645515.2019.1667206
  73. Larson HJ. Commentary: the uptake of human papillomavirus vaccination: the power of belief. Int J Epidemiol. 2013;42(3):908-910. doi:1093/ije/dyt096
  74. Banerjee AV, Duflo E, Glennerster R, Kothari D. Improving immunisation coverage in rural India: clustered randomised controlled evaluation of immunisation campaigns with and without incentives. BMJ. 2010;340:c2220. doi:1136/bmj.c2220
  75. Banerjee P, Seth R, Dhaliwal BK, et al. Vaccine acceptance in rural India: engaging faith leaders as vaccine ambassadors. Front Public Health. 2022;10:979424. doi:3389/fpubh.2022.979424
  76. Viskupič F, Wiltse DL. The messenger matters: religious leaders and overcoming COVID-19 vaccine hesitancy. PS Polit Sci Polit. 2022;55(3):504-509. doi:1017/s104909652200004x
  77. Hicken A, Jones P, Menon A, Rozek LS. Can endorsement by religious leaders move the needle on vaccine hesitancy? Vaccine. 2024;42(4):918-923. doi:1016/j.vaccine.2024.01.009
  78. Ruijs WL, Hautvast JL, van Ijzendoorn G, van Ansem WJ, van der Velden K, Hulscher ME. How orthodox protestant parents decide on the vaccination of their children: a qualitative study. BMC Public Health. 2012;12:408. doi:1186/1471-2458-12-408
  79. Streefland PH. Public doubts about vaccination safety and resistance against vaccination. Health Policy. 2001;55(3):159-172. doi:1016/s0168-8510(00)00132-9
  80. Franklin MD, Schlundt DG, Wallston KA. Development and validation of a religious health fatalism measure for the African-American faith community. J Health Psychol. 2008;13(3):323-335. doi:1177/1359105307088137
  81. Schieman S. Socioeconomic status and beliefs about God's influence in everyday life. Sociol Relig. 2010;71(1):25-51. doi:1093/socrel/srq004
  82. Schieman S, Pudrovska T, Milkie MA. The sense of divine control and the self-concept: a study of race differences in late life. Res Aging. 2005;27(2):165-196. doi:1177/0164027504270489
  83. Rumetta J, Abdul-Hadi H, Lee YK. A qualitative study on parents' reasons and recommendations for childhood vaccination refusal in Malaysia. J Infect Public Health. 2020;13(2):199-203. doi:1016/j.jiph.2019.07.027
  84. DiGregorio BD, Corcoran KE, Scheitle CP. 'God will protect us': belief in God/higher power's ability to intervene and COVID-19 vaccine uptake. Rev Relig Res. 2022;64(3):475-495. doi:1007/s13644-022-00495-0
  85. Padoginog RG, Flor BP. Vaccine hesitancy as lived experience among members of a Christian community in the Philippines. Religion and Social Communication. 2023;21(1):119-142.
  86. Krupenkin M. Does partisanship affect compliance with government recommendations? Polit Behav. 2021;43(1):451-472. doi:1007/s11109-020-09613-6
  87. Iyengar S, Westwood SJ. Fear and loathing across party lines: new evidence on group polarization. Am J Pol Sci. 2015;59(3):690-707. doi:1111/ajps.12152
  88. Bianco W. Trust: Representatives and Constituents. University of Michigan Press; 1994.
  89. Blair RA, Morse BS, Tsai LL. Public health and public trust: survey evidence from the Ebola virus disease epidemic in Liberia. Soc Sci Med. 2017;172:89-97. doi:1016/j.socscimed.2016.11.016
  90. Citrin J, Stoker L. Political trust in a cynical age. Annu Rev Polit Sci (Palo Alto). 2018;21(1):49-70. doi:1146/annurev-polisci-050316-092550
  91. Druckman JN, Lupia A. Preference change in competitive political environments. Annu Rev Polit Sci (Palo Alto). 2016;19(1):13-31. doi:1146/annurev-polisci-020614-095051
  92. Chowdhury NS. Bangladesh in 2022 and 2023: democracy and disillusionment. Asian Survey. 2024;64(2):321-329. doi:1525/as.2024.64.2.321
  93. Hassaan HM, Bloch F, Rashid M. Analyzing the institutional and socio-political impacts of Sheikh Hasina’s departure on Bangladesh’s democracy. Bull Bus Econ. 2024;13(3):171-177. doi:61506/01.00459
  94. Attwell K, Duong H, Morris A, Roberts L, Navin M. Drivers of noncompliance with vaccine mandates—the interplay between distrust, rationality, morality, and social motivation. Regul Gov. 2025. doi:1111/rego.70018
  95. Attwell K, Leask J, Meyer SB, Rokkas P, Ward P. Vaccine rejecting parents' engagement with expert systems that inform vaccination programs. J Bioeth Inq. 2017;14(1):65-76. doi:1007/s11673-016-9756-7
  96. Denemark D, Harper T, Attwell K. Vaccine hesitancy and trust in government: a cross-national analysis. Aust J Polit Sci. 2022;57(2):145-163. doi:1080/10361146.2022.2037511
  97. Cao A, Ueta M, Uchibori M, et al. Trust in governments, public health institutions, and other information sources as determinants of COVID-19 vaccine uptake behavior in Japan. Vaccine. 2024;42(17):3684-3692. doi:1016/j.vaccine.2024.04.081
  98. Thornton J. COVID-19: trust in government and other people linked with lower infection rate and higher vaccination uptake. BMJ. 2022;376:o292. doi:1136/bmj.o292
  99. Viskupič F, Wiltse DL, Meyer BA. Trust in physicians and trust in government predict COVID-19 vaccine uptake. Soc Sci Q. 2022;103(3):509-520. doi:1111/ssqu.13147
  100. Nicholls N, Pleace M, Yitbarek E. Trust in government, social media and willingness to vaccinate. Soc Sci Med. 2024;360:117302. doi:1016/j.socscimed.2024.117302
  101. Jamo IA. Vaccine preventable diseases and the challenges of immunization exercise in Nigeria. Jalingo Journal of Social and Management Sciences. 2020;2(2):117-127.
  102. Smith TC, Gorski DH. Infertility: a common target of antivaccine misinformation campaigns. Vaccine. 2024;42(4):924-929. doi:1016/j.vaccine.2024.01.043
  103. Wilson RJ, Leigh L, Bah H, Larson HJ, Clarke E. HPV vaccination acceptance and perceptions related to fertility and population control in the Gambia: an anthropological analysis. Vaccine. 2023;41(24):3647-3654. doi:1016/j.vaccine.2023.04.072
  104. Gietel-Basten S. Depopulation or population decline? Demographic nightmares and imaginaries. Vienna Yearb Popul Res. 2023;21:57-68. doi:1553/p-ak37-74ha
  105. Bastani R, Glenn BA, Tsui J, et al. Understanding suboptimal human papillomavirus vaccine uptake among ethnic minority girls. Cancer Epidemiol Biomarkers Prev. 2011;20(7):1463-1472. doi:1158/1055-9965.Epi-11-0267
  106. Bingham A, Drake JK, LaMontagne DS. Sociocultural issues in the introduction of human papillomavirus vaccine in low-resource settings. Arch Pediatr Adolesc Med. 2009;163(5):455-461. doi:1001/archpediatrics.2009.50
  107. Hopfer S, Clippard JR. College women's HPV vaccine decision narratives. Qual Health Res. 2011;21(2):262-277. doi:1177/1049732310383868
  108. Watson M, Shaw D, Molchanoff L, McInnes C. Challenges, lessons learned and results following the implementation of a human papilloma virus school vaccination program in South Australia. Aust N Z J Public Health. 2009;33(4):365-370. doi:1111/j.1753-6405.2009.00409.x
  109. Ault KA. Long-term efficacy of human papillomavirus vaccination. Gynecol Oncol. 2007;107(2 Suppl 1):S27-S30. doi:1016/j.ygyno.2007.07.078
  110. De Vincenzo R, Conte C, Ricci C, Scambia G, Capelli G. Long-term efficacy and safety of human papillomavirus vaccination. Int J Womens Health. 2014;6:999-1010. doi:2147/ijwh.s50365
  111. Ellingson MK, Sheikha H, Nyhan K, Oliveira CR, Niccolai LM. Human papillomavirus vaccine effectiveness by age at vaccination: a systematic review. Hum Vaccin Immunother. 2023;19(2):2239085. doi:1080/21645515.2023.2239085
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 07 January 2026

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  • Received Date: 24 April 2025
  • Revised Date: 05 December 2025
  • Accepted Date: 06 January 2026
  • First Published Date: 07 January 2026
  • Published Date: 07 January 2026

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