Beyond Vaccine Availability: Community Trust and Human Papillomavirus Vaccine Acceptance in Sub-Saharan Africa: A Narrative Review

Abstract

Even though most cases of cervical cancer are preventable with human papillomavirus (HPV) vaccines, cervical cancer continues to be a public health problem in sub-Saharan Africa. HPV vaccines have long been available, but vaccine coverage remains far below the global goal in the region. However, structural barriers contribute to this disparity, and they cannot fully explain a community's occasional failure to accept vaccines. This narrative review explored community trust as a determinant of HPV vaccine acceptance in sub-Saharan Africa. It examined evidence identified from PubMed, Scopus, Google Scholar, Web of Science, and the World Health Organisation (WHO) Institutional Repository. The literature search (May to July 2026) yielded around 180 records, of which 36 were included in the synthesis. All studies reviewed found strong community trust to underlie other factors that influence vaccine uptake. Where trust was lower, gaps in knowledge, misinformation, healthcare worker recommendations, attitudes of traditional and religious leaders, and family decisions had a greater impact; the opposite was true with heightened trust. This pattern was found in various contexts in Rwanda, Tanzania, Nigeria, Kenya, Uganda and Malawi. The results here indicate that simply bolstering HPV vaccine supply and service delivery is not enough. Ongoing, meaningful engagement to build and maintain community trust should be considered an essential element of HPV vaccination programmes in sub-Saharan Africa.