Misconceptions leading to human papillomavirus vaccination hesitancy in Nigeria: Findings from a modified Delphi panel with stakeholders of the immunization ecosystem

Abstract

Background

Human papilloma virus (HPV) is a significant contributor to various cancers, notably cervical cancer, which poses a major health challenge in sub-Saharan Africa (SSA), including Nigeria. Despite the availability and effectiveness of HPV vaccines, many SSA countries have yet to reach the World Health Organization's vaccination goals. Nigeria introduced the HPV vaccine for girls (9–14 years) as part of the national immunization program in October 2023. This was heralded with certain misconceptions among both healthcare workers and the general populace. This study aimed to identify and rank these misconceptions via the modified Delphi technique to increase HPV vaccination coverage in Nigeria.

Objectives

The primary objective of this study was to identify and rank predominant HPV vaccine misconceptions in Nigeria, summarize the stability of expert judgments across rounds and to translate the prioritized list into communication and training recommendations.

Methods

We conducted desk review, expert validation and a two-round modified Delphi with immunization stakeholders from across Nigeria's 36 states and the Federal Capital Territory. Thirteen candidate misconceptions were generated from desk review and validation meetings, then rated on a five-point Likert “criticality” scale reflecting perceived prevalence, barrier importance, and likely impact on uptake if unaddressed. Descriptive statistics summarized item rankings and round-to-round changes; a paired t-test assessed aggregate stability.

Results

Forty-nine panelists completed both rounds. Rank order at the top was stable: the infertility/population-control misconception consistently ranked first, followed by the belief that vaccination promotes adolescent promiscuity, safety/“Western conspiracy” and “unknown long-term side-effects” clustered next. Aggregate ratings did not change significantly between rounds (paired t-test t (8) = 0.39, p = 0.71).

Conclusion

The stability of ratings between rounds indicate that observed differences were compatible with random variation rather than systematic shifts in opinion. A decision-ready prioritization of HPV vaccine misconceptions highlights a set of high-level misconceptions, like infertility, promiscuity, and safety/conspiracy narratives that should anchor first-wave communication in Nigeria.

Programs can translate these findings into audience-specific strategies like caregiver and community‑leader engagement with clear, safety-affirming messages, brief provider scripts and micro-training for school and clinic encounters and concise briefs for local decision-makers. Future iterations should pre-specify formal consensus thresholds and incorporate public prevalence measures to refine priority setting.