PROCUREMENT AND DELIVERY
SOCIAL CHALLENGES (Knowledge, attitudes, beliefs)
Patent monopolies .
High vaccine costs .
Competing health priorities (e.g., HIV/AIDS, malaria) .
Perceived low HPV/STI susceptibility.
Gaps in multilateral funding for vaccine procurement .
Unwillingness to discuss sex and STI.
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.
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.