Abstract
The pace of progress of HPV vaccine introduction in Sub-Saharan francophone African countries has been limited, particularly in conflict-affected countries. To better understand the barriers affecting the introduction and sustainability of the HPV vaccine, we conducted a qualitative study from January - April 2024 informed by insights from a multi-country HPV symposium. Our study explored perspectives from stakeholders across six countries through key-informant interviews: four in the pre-introduction phase (Chad, Central African Republic, Gabon, Republic of Congo) and two seeking to sustain HPV vaccination program (Senegal and Côte d'Ivoire), alongside regional and global partners. We identified shared and context-specific barriers using semi-structured interviews and abductive thematic analysis, which included weak health system capacity, competing vaccine priorities, human resource constraints, political and conflict instability, and logistical challenges that limited countries' ability to introduce the HPV vaccine. For countries with existing programs, challenges included coordination between Ministries of Health and Education, insufficient funding for communication, misinformation, and gaps in teacher engagement. Despite policy commitment, financial sustainability, including co-financing and transition from Gavi support, remains a core concern. The study findings emphasize the importance of strengthening health systems, promoting cross-sectoral coordination, allocating finance for communication plan, and planning for sustainable financing to support both the introduction and long-term sustainability of HPV programs in low-resource settings.