HPV vaccine uptake remains low in SG despite improved awareness

Knowledge of human papillomavirus (HPV) vaccination has improved in Singapore following government efforts to enhance cervical cancer awareness through national campaigns and policy changes. However, this has not translated to an increase in vaccine acceptance rates, according to a study.

“The decision for vaccine uptake is complex, and there are multiple factors that need to be addressed to ensure cost-effective implementation of strategies,” the researchers said. “These include concerns regarding cost and safety of the vaccines.”

Two cross-sectional surveys conducted in 2013 and 2019 in 639 female participants attending a general gynaecology clinic were compared in this study. Of the women, 597 completed the survey. Race, marital status, educational level, occupation, and monthly household income were similar among participants.

Knowledge scores for cervical cancer and HPV infection significantly improved from 2013 to 2019, but no significant difference was noted for HPV vaccination, which resulted in similar uptake of the HPV vaccine. [Singapore Med J 2025;66:596-600]

No statistically significant difference was observed in the intention to take the HPV vaccine between 2013 and 2019. Only 122 (44.0 percent) women in 2013 and 143 (44.7 percent) in 2019 expressed that they would consider receiving the HPV vaccine (p=0.874).

Furthermore, age (p=0.001), educational level (p=0.011), and knowledge of the HPV vaccine (p<0.001) significantly predicted the acceptance of HPV vaccination. Participants aged <30 years were more likely to be vaccinated than those aged ≥30 years, while a higher educational level also correlated with uptake of the vaccine.

On the other hand, the top two reasons for declining the HPV vaccine were cost and lack of knowledge, based on the results of the 2019 survey. Household monthly income and knowledge of cervical cancer and HPV infection were not significant predictors.

“Our study highlights the urgent need for effective dissemination of accurate vaccine information, allocation of additional subsidies for the target population, and consideration of a mandatory school-based vaccination programme with a switch to the nonvalent vaccine,” the researchers said.

Social media

An earlier study by Chirayil and colleagues suggested that social influence played a stronger role in improving vaccination uptake when compared with conventional awareness campaigns focusing of knowledge delivery. [SAGE Open 2014;doi:10.1177/2158244014554961]

“We suggest expanding campaigns using all forms of social media, incorporation of ambassadors and making campaigns multilingual to increase the target audience to all Singaporeans,” the researchers said.

Another effective approach to convey accurate information is from the physician to the patient or the parent. According to another study, a physician’s advice is more effective than government policies. [Ann Epidemiol 2009;19:531-538]

Previous longitudinal studies also found low coverage due to lack of recommendations from doctors. [J Womens Health 2009;18:1679-1686; Sex Transm Dis 2011;38:197-204]

“We propose that healthcare professionals should be proactive in recommending the HPV vaccine for all eligible patients as this has been shown to improve acceptance and vaccine uptake rates,” the researchers said. “At the primary care level, this should be considered at opportunistic consultations to increase the uptake.” [Prev Med 2007;45:107-114]