Table 2 Reported rumours, institutional refusals, and management approaches

Reported rumours

Management approaches (preventative and reactionary)

 HPV vaccine is experimental/untested

 (Countries 3, 12, 24)

• Rumours resulted from opt-in consent, which was changed to opt-out;

• Government and experts immediately addressed rumours.

 HPV vaccination causes fertility problems

 (Countries 8, 17, 21, 24, 31, 16, 28)

• Mobilisation was started very early and messages built into parent-teacher meetings;

• High-level advocacy using parliamentarians from the beginning of the programme;

• Intense mobilisation targeted anti-vaccination lobbyists;

• A reactive crisis response was organised, including meeting with communities.

 Vaccine causes long-term adverse events, e.g., death, cancer

 (Countries 28, 33, 35, 26)

• Adverse events were investigated and guardians reassured that it was not due to vaccination.

 There is another cure for cervical cancer other than vaccination

 (Country 35)

• Rumours were tackled immediately with email newsletter and/or parent meetings.

Institutional refusals related to the vaccine

Management approaches

 Private/faith-based schools

 (Countries 23, 24, 31, 35, 37)

• Sensitization through the community and targeted mobilisation using influencers;

• Media access to correct information so communities could obtain HPV vaccine information from an independent source.

 Churches/religious groups

 (Countries 3, 28, 37)

• Increased face-to-face, community, and religious leaders’ meetings.

 Community/parent groups

 (Countries 1, 5, 6, 10, 14, 18, 23)

• Identified groups opposing vaccination were provided with more information;

• Frequent repetition of messages;

• Involved leaders and managed vaccination through government system;

• Provided additional training and information to health-workers and teachers.

 Anti-vaccination lobbyists, human rights groups, academics

 (Countries 12, 30)

• Provided additional media information and internet-based information campaigns.

 Teacher and health-worker reluctance to vaccinate girls

 (Countries 6, 23)

• Provided additional training to healthworkers and used peers to trace missing and out-of-school girls.