Determinants of HPV vaccine hesitancy in South Asia: a systematic review

Human papillomavirus (HPV) vaccine hesitancy is a pronounced issue in low- and middle-income countries, including South Asia. The current systematic review focuses on examining vaccine hesitancy determinants, among South Asian countries. A comprehensive literature search was conducted across 2 data bases; PubMed and Scopus, using appropriate search strings, from the years 2018-2025. Articles were screened on the basis of a predefined inclusion criteria. After assessing for these criteria, a total of 29 articles were eligible for inclusion. The data extraction was carried out by 2 independent reviewers, who assessed the study for relevance, scientific rigor, and potential biases, while a third reviewer resolved discrepancies. Findings reported low HPV vaccine uptake across different South Asian countries. It was associated with lack of awareness regarding cervical cancer, HPV, and HPV vaccine, socio- cultural taboos, and religious beliefs, fear of ill effects, and inadequate healthcare guidance and recommendations. Limited access, high vaccination costs, and lack of integration of HPV vaccination within the national immunization programs, further contributed to decreased vaccine acceptance. A multi-pronged strategy, focusing on promoting community level awareness, health professional HPV vaccine training, culturally relevant health education, and policy support, is required to increase HPV vaccine uptake.