Health system determinants of delivery and uptake of HPV vaccination services among involuntary migrant populations

Githaiga, Jennifer Nyawira

Health system determinants of delivery and uptake of HPV vaccination services among involuntary migrant populations

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Migrant populations are commonly under-immunised relative to general populations in host countries. Under-immunisation has been linked to upsurges of vaccine preventable diseases. The evidence base on routine vaccination among migrant children suggests higher priority is given to infants and younger children compared to adolescents. Though migrants are often classified as a homogenous group, different sub-populations of migrants exist, including voluntary migrants who choose to move versus involuntary migrants forcibly displaced by humanitarian crises. The human papillomavirus (HPV) vaccine, a relatively recent addition to global routine immunisation schedules for adolescents, serves as a useful proxy for understanding vaccine equity for this under-prioritised group. This qualitative systematic review explores health system determinants of delivery and uptake of HPV vaccination services among involuntary migrants. A literature search was conducted across ten electronic databases. An analytical framework tailored to the migrant context aided in capturing the complexity and magnitude of systemic factors that determine vaccine delivery and uptake among involuntary migrants. Of the 600 records retrieved, 25 studies were included in this review. Key determinants of vaccine delivery include adaptation of immunisation policies for migrant inclusiveness, implementation of migrant-targeted interventions, health provider recommendations, electronic health records and free vaccines. Uptake determinants include access dependent on legal status, awareness-related determinants akin to culturally appropriate health messaging, and acceptance-related determinants associated with sociocultural beliefs, misinformation and distrust. Prioritising vaccination programmes linked with non-outbreak-related childhood diseases is challenging in the disruptive context of humanitarian crises given fragile health systems, limited resources, loss of health infrastructure and deployment of health personnel to emergency care, all of which sideline preventative services like HPV vaccination programs. We strongly advocate for global actors at all health systems levels to actively restructure national HPV vaccination programs to enhance inclusivity of adolescent girls in crises settings or resettled in host countries.

Keywords

HPV vaccination

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