Barriers to and drivers of vaccination – insights and recommended actions: targeting low uptake of human papillomavirus vaccination and vaccination inequities in Georgia

In Georgia, despite maintaining high national coverage for measles, mumps and rubella (MMR) vaccination and for diphtheria, tetanus and pertussis vaccinations through 2019, the country has yet to recover from a decline which began prior to the coronavirus disease pandemic with 86% coverage for MMR and 88% coverage for DTP3 reported in 2023. The human papillomavirus (HPV) vaccination was introduced into the national childhood immunization schedule in Georgia in 2019 and is administered to girls aged 10–12 in primary health care facilities. Nationally, HPV vaccination uptake is only 24% of the target population, with some regions as low as 16%. A qualitative study gathering behavioural insights was conducted in low-coverage areas of Georgia between February and July 2023 and aimed to identify barriers and drivers of routine vaccination uptake. Findings revealed that health workers face numerous challenges including opposition from colleagues and the media, knowledge gaps, specific challenges in rural areas, fear of legal repercussions from adverse events and mixed attitudes towards HPV vaccines. Caregivers are influenced by the negative perceptions of health workers, poor facility conditions, knowledge gaps and safety concerns, especially with regard to HPV vaccination.