From: Global challenges of implementing human papillomavirus vaccines
INNOVATION | PROCUREMENT AND DELIVERY | POLICY FORMULATION | SOCIAL CHALLENGES (Knowledge, attitudes, beliefs) |
---|---|---|---|
Patent monopolies [19]. | Inadequate regulatory mechanisms, resources and infrastructure, i.e., for reporting of adverse events and post-market surveillance [23, 129]. | High vaccine costs [18]. | |
Scarcity of instruments and models for technology transfer of inexpensive biogenerics [19, 21]. | Cold chain issues, preventing quality- assured and controlled transportation and storage of vaccines [23, 129]. | Competing health priorities (e.g., HIV/AIDS, malaria) [105]. | Perceived low HPV/STI susceptibility. |
Gaps in multilateral funding for vaccine procurement [20]. |  | Controversies over HPV vaccine mandates [64–66, 86, 89–91]. | Unwillingness to discuss sex and STI. |
 |  | Inadequate knowledge exchange about STI risks and need for prevention [110, 113, 114]. | Perceived inappropriateness for pre-adolescents. |
 |  |  | Stigma, loss of privacy. |
 |  |  | Concerns about adolescent promiscuity and beliefs in moral education and marital monogamy. |
 |  |  | Suspicion of commercial motives and unethical vaccine trials. |
 |  |  | Worry about vaccine ingredients and adverse effects. |
 |  |  | Needle fears. |
 |  |  | Gaps in availability and access. Competing life priorities and pressures. |
 |  |  | Vaccine costs and duration of effectiveness. |
 |  |  | |
 |  |  | Unwillingness to endorse vaccine, discuss sex and STI, or to stock vaccine |
 |  |  | Lack of personnel and facilities for vaccination and heavy case loads in clinics. |