# Revisiting HPV vaccination post-COVID: geopolitical, sociocultural, and ethical disparities in global health

## TL;DR

This paper reviews recent HPV vaccine research post-COVID, highlighting gaps in addressing global equity, cultural factors, and vaccine accessibility.

## Contribution

The study identifies a lack of focus on geopolitical, sociocultural, and ethical factors in recent HPV vaccine research.

## Key findings

- Most post-pandemic HPV vaccine research focuses on implementation strategies rather than sociocultural or ethical factors.
- Few studies address the intersectionality of religion and HPV vaccine uptake.
- Low- and middle-income countries are underrepresented in vaccine development and manufacturing research.

## Abstract

HPV vaccines have been revolutionary in preventing HPV-related cervical cancer and reshaping the cervical cancer screening guidelines in the past decades. Yet, challenges persist in achieving universal accessibility and utilization. Since the COVID-19 pandemic, shifts have emerged in HPV vaccine research, implementation strategies, and the determinants shaping uptake and delivery, particularly from a global equity perspective.

This is a scoping review examining English-language, peer-reviewed articles published following the onset of the COVID-19 pandemic until the end of 2024. It focuses on the human papillomavirus (HPV) vaccine and factors influencing its uptake. Articles were retrieved from PubMed and Embase databases and screened for relevance using predefined search terms.

Out of 2755 articles, 349 were included. We identified that most peer-reviewed articles focus on interventions and implementation strategies more than acknowledging geopolitical affairs, gender specificity, religious and ethical dimensions, medical mistrust, or healthcare discrimination. Most of the articles were cross-sectional in nature and most were funded by the National Cancer Institute. Interestingly, we found no peer-reviewed articles on the intersectionality of Judaism and HPV vaccine uptake, with a limited number on Islamic, Christian, or other religious intersectionality. Articles addressing how low- and middle-income countries could be equipped to develop and manage their own vaccine programs and manufacturing were largely absent; instead, cost-effectiveness research focused primarily on the vaccine’s ability to reduce disease burden.

Post-pandemic research on HPV vaccination indicates that levels of hesitancy and uptake have remained relatively stable. However, the literature highlights persistent inconsistencies in how the vaccine is prioritized across communities, healthcare professionals, and health systems. Messaging regarding its importance for cancer prevention remains fragmented, while cost barriers and the absence of the vaccine from many national immunization schedules continue to limit access. Notably, ethical, religious, and cultural considerations receive limited attention in current research, despite the pandemic underscoring the global significance of these factors in shaping health behaviors. These findings suggest a need to re-examine how HPV vaccination is framed and advanced as a public health priority within diverse sociocultural and systemic contexts.