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The World Health Organization (WHO) estimates that 94% of global cervical cancer deaths occur in low- and middle-income countries, with sub-Saharan Africa heavily affected
HPV is fuelling high cervical cancer rates in sub-Saharan Africa despite the availability of effective vaccines. Yet uptake remains low, driven largely by vaccine hesitancy. In South Africa alone, most participants (71%) were hesitant to receive at least one of the vacines in the country, according to the Vaccine Confidence Report by MSD (www.MSD.co.za) and Prof. Hannelie Meyer, Head of the South African Vaccination and Immunisation Centre. [1] The report was launched at the European Society of Clinical Microbiology and Infectious Diseases and during the SSA HPV Media Roundtable held during World and Africa Immunisation Week (24–30 April 2025).
Cervical cancer, caused by persistent infection of HPV, is one of the leading causes of cancer-related deaths among women in sub-Saharan Africa. The World Health Organization (WHO) estimates that 94% of global cervical cancer deaths occur in low- and middle-income countries, with sub-Saharan Africa heavily affected. [2]
Studies indicate that, globally, about 12% of women with normal cervical cytology are found to have an HPV infection. This prevalence doubles to around 24% in sub-Saharan Africa. Young women under 25 are particularly vulnerable, with an HPV prevalence rate of 43.9% in Africa compared to the global rate of 19.2%. [3]
A 2023 report indicated that cervical cancer ranks as the 13th most frequent cancer among women in Egypt and the 9th most frequent among women aged 15 to 44 years. [4] In Kigali, Rwanda, before the national HPV vaccination programme, 54% of women aged 19 years and younger were found to have received an HPV-positive result. [5] The high mortality rate in Ghana further demonstrates the burden, with approximately 3,000 women diagnosed with cervical cancer annually, resulting in around 2,000 deaths each year. [6]
Vaccine hesitancy, defined as a delay in acceptance or refusal of vaccines despite their availability, remains a challenge in the fight against preventable diseases such as cervical cancer. Misinformation, cultural beliefs, and accessibility issues further compound the low uptake of HPV vaccines. As global health organisations and local health authorities strive to eliminate preventable diseases, understanding and addressing vaccine hesitancy has never been more urgent. [1]
Understanding vaccine hesitancy
The Vaccine Confidence Report highlights several drivers of HPV vaccine hesitancy, including safety concerns, mistrust in healthcare systems, and misinformation on social media. According to Prof. Meyer, despite clear scientific evidence, many still believe vaccines are harmful. [1] “This reluctance is troubling,” she said, “given the direct link between HPV and cervical cancer. Addressing these fears with credible information is vital to reducing the burden in sub-Saharan Africa.”
We must work together to share accurate information, address concerns, and make vaccines truly accessible
An external study titled ‘Vaccine Hesitancy and Trust in sub-Saharan Africa’ published in Scientific Reports in May 2023 examined vaccination behaviours and attitudes across six sub-Saharan African countries: Ghana, Kenya, Nigeria, South Africa, Tanzania, and Uganda. The study found that only about 10% of respondents reported receiving at least one HPV vaccination. Vaccine hesitancy rates varied across countries, with South Africa exhibiting the highest rate at 17.15% and Kenya the lowest at 8.3%. [7]
Impact of misinformation, funding gaps and immunisation disruption Misinformation remains a major driver of vaccine hesitancy in Africa, especially through online platforms. It has shaped public attitudes and eroded trust in immunisation programmes. At the same time, shifting global priorities and economic pressures have led to reduced funding for vaccination efforts, limiting access in low-income communities. [8] “Routine immunisation has saved millions of lives,” said Dr Alima Essoh, Regional Director of the Preventive Medicine Agency for Africa (AMP Africa). “When misinformation and resource constraints disrupt these efforts, we risk undoing decades of progress.” Expanding HPV vaccination is critical to reducing cervical cancer, but it requires tackling misinformation head-on and improving access across the continent.
Broader implications for public health
While HPV vaccination remains a key focus, vaccine hesitancy extends to other preventable diseases. The World Health Organization (WHO) has set a target to eliminate cervical cancer as a public health concern by 2030, which includes ensuring that 90% of girls are fully vaccinated against HPV by age 15. [9] According to Prof Meyer, vaccine hesitancy threatens to derail this goal and broader efforts to achieve high immunisation rates for other preventable illnesses such as measles, polio, and influenza.
Rethinking the fight against HPV-related cervical cancer: Community action and vaccine confidence
Efforts to eliminate HPV and reduce HPV-related cervical cancer in Africa necessitate innovative, community-driven solutions. Dr Sabrina Kitaka, Senior Lecturer at Makerere University, states that engaging and accessible tools, such as comic books and school-based vaccination, have significantly enhanced vaccine uptake among young people. She adds that reminder systems, such as SMS and automated phone calls, help ensure adolescents complete the HPV vaccine schedule. If implemented on a large scale, these strategies could strengthen vaccine coverage across the region. She further states that, tackling vaccine hesitancy will require a coordinated approach involving governments, healthcare workers, civil society, and the private sector. This means improving health communication, building trust through local partnerships, and tailoring outreach to meet communities where they are.
“There is no time to waste,” says Prof. Meyer. “We must work together to share accurate information, address concerns, and make vaccines truly accessible. Only then can we protect future generations from preventable diseases.”
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Lusaka — African health ministers and partners are calling for increased investment in integrated health services to address the growing burden of severe noncommunicable diseases (NCDs), particularly those affecting women and underserved populations across the region. At a high-level side event during the Seventy-fifth session of the WHO Regional Committee for Africa, delegates emphasized the urgent need for equitable access to prevention, screening, treatment, and rehabilitation across the continuum of care for NCDs. Disparities are especially pronounced in rural areas, where health infrastructure and services remain inadequate. Breast and cervical cancers are among the leading causes of cancer-related deaths among women in sub-Saharan Africa—particularly cervical cancer, which is both preventable and treatable. It remains the most common cause of cancer death for women in the region. In 2022, Africa accounted for nearly a quarter (23%) of the 76 000 global cervical cancer deaths. Meanwhile, severe NCDs such as Type 1 diabetes, sickle cell disease, and heart conditions claim more than half a million lives annually, including among children, adolescents, and young adults in some of the continent’s poorest communities. Inequitable access to health services continues to hinder efforts to reduce this burden. To improve cervical and breast cancer care in the region, urgent investment is needed in leadership, governance, and financing. Strengthening these foundations is critical in the current funding landscape. Advancements in strategic planning, healthcare infrastructure, workforce training, and—most importantly—equitable access to screening, diagnostic, and treatment services are essential. To address these challenges, WHO and its partners showcased successful integrated models such as the Women’s Integrated Care for Cancer Services (WICS), the BEAT Breast Cancer Project, and the PEN-Plus Strategy. WICS strengthens early detection, treatment, and integration of women’s cancer services into primary health care systems in Côte d’Ivoire, Kenya, and Zimbabwe. The BEAT Breast Cancer Project is a transformative multi-year initiative aimed at reducing breast cancer mortality among women in Tanzania and Ghana through early detection, timely diagnosis, and comprehensive treatment access. “PEN-Plus, WICS and the BEAT Breast Cancer Initiative are models for a new standard of care, rooted in equity, access and health justice. I urge countries to prioritize policies that embed these models into broader health system strengthening, said Dr Mohamed Janabi, WHO Regional Director for Africa”. Côte d’Ivoire offers a compelling example of progress, combining high HPV vaccination coverage—reaching over three million girls (91.4%)—with WICS-supported community-based screening campaigns to strengthen cervical cancer prevention. In Kenya, cervical cancer screening has been successfully integrated into national health services. “This gathering marks a pivotal moment to accelerate action for breast cancer prevention in Africa. We deeply value the leadership of the Ministries of Health of Ghana and Tanzania, and the steadfast support of the Pfizer Foundation in helping us achieve this milestone. The side event builds momentum for the policy prioritization of women’s cancers, partnerships to strengthen the broader women’s cancer ecosystem, and advance a health-systems approach to breast cancer prevention and management”, said Dr Somesh Kumar, Senior Director, Jhpiego. PEN-Plus expands access to care for severe NCDs at the district hospital level. Since its implementation, 20 countries in Africa have increased access to services for severe NCDs. Over 15 000 people are currently receiving treatment for chronic conditions such as sickle cell disease and Type 1 diabetes through PEN-Plus clinics.
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