Perceptions of a Gender-Neutral Approach to Human Papillomavirus (HPV) Vaccination in Cameroon: A Qualitative Study

Cameroons Expanded Program on Immunization (EPI) introduced the HPV vaccine into the routine immunization schedule in Cameroon in October 2020. However, HPV vaccine coverage has remained low, reaching only 20% by December 2022. In response, a gender-neutral vaccination (GNV) approach was adopted and implemented from January 2023 to increase acceptance, reduce stigma, and improve vaccine coverage. This study aimed to assess the perceptions of key immunization stakeholders in Cameroon on the GNV approach to HPV vaccination. A cross-sectional study was conducted from June to September 2024 using an in-depth and semi-structured interviews to explore the perspectives of key stakeholders (policymakers, community leaders, and parents of girls aged 9-13 years) across three regions (South-West, North, and Centre) and the central level. Data was analyzed using traditional content analysis, via manual and NVivo coding to identify key themes. The research team ensured reliability through consensus discussions, and key quotes illustrating central findings were identified. A total of 51 participants were interviewed. Participants observed that the inclusion of boys in the HPV vaccination program contributed to a positive shift in community perceptions, dispelled misconceptions, and enhanced overall vaccine acceptance. However, challenges related to limited resources, lingering misinformation, and hesitancy from parents, religious leaders, and healthcare workers hindered the effective implementation of the GNV approach. Participants emphasized the need for improved partnerships, sensitization strategies, integration with existing health programs, and sustained funding to enhance community understanding and increase vaccination uptake. Overall, stakeholders viewed the GNV approach as effective for improving HPV vaccine acceptability and promoting equity, but emphasized the need for continuous investments and stronger community engagement to address challenges like limited resources, misinformation, and hesitancy.