# HPV vaccination hesitancy and acceptance among parents in Saxony-Anhalt, Germany: the role of gender, awareness and fear

## TL;DR

A survey in Germany found that mothers are more aware of HPV and more willing to vaccinate their children than fathers, with gender dynamics and fear influencing vaccination decisions.

## Contribution

This study identifies gender-specific patterns in HPV vaccine acceptance and highlights the need for targeted strategies to engage fathers and address misperceptions.

## Key findings

- Mothers were significantly more aware of HPV and more willing to vaccinate than fathers.
- Parents of daughters expressed greater fear of HPV-associated disease than parents of sons.
- Logistic regression identified awareness, fear of disease, and higher education as determinants of vaccination willingness.

## Abstract

Despite national recommendations in Germany for universal HPV vaccination, uptake remains suboptimal—particularly among boys. Parental awareness, gender dynamics, and hesitancy play key roles in vaccination decisions.

A cross-sectional survey was conducted among 406 parents of children aged 9–14 years in Magdeburg, Saxony-Anhalt. An anonymized online questionnaire assessed HPV-associated awareness, attitudes, willingness to vaccinate, and conditions under which hesitant parents might reconsider. Statistical analyses included chi-square tests and logistic regression. Parent–child gender dyads were examined to explore interaction effects. Vaccine hesitancy was conceptualized along a continuum from acceptance to refusal, although for analysis we contrasted parents willing to vaccinate with those refusing vaccination.

Mothers were significantly more aware of HPV than fathers (86.8% vs. 68.0%; p < 0.001) and more willing to vaccinate their children (90.4% vs. 74.8%; p < 0.001). Parents of daughters expressed greater fear of HPV-associated disease than parents of sons (67.5% vs. 37.4%; p < 0.001), although willingness to vaccinate did not differ by child gender. Dyadic analysis highlighted gender-specific patterns, with father–daughter pairs reporting high perceived disease risk yet comparatively lower willingness to vaccinate. Father–son pairs showed the lowest awareness and engagement overall. Logistic regression identified three determinants of willingness to vaccinate: prior awareness of HPV (OR = 3.77; p = 0.006), fear of disease (OR = 3.69; p = 0.006), and higher education (OR = 1.60; p = 0.032). Among parents who refused HPV vaccination, 80% reported that their decision would not change under any of the proposed conditions.

Gender disparities in HPV vaccine awareness and acceptance persist. Emphasizing the role of male vaccination in reducing transmission and protecting both sexes could improve uptake. Targeted strategies should strengthen engagement of all parents, with particular efforts to involve fathers and correct gendered misperceptions.

The online version contains supplementary material available at 10.1186/s12889-025-26061-1.