{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,25]],"date-time":"2026-07-25T17:59:38Z","timestamp":1785002378698,"version":"3.55.0"},"reference-count":28,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"unspecified","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R25MH083620"],"award-info":[{"award-number":["R25MH083620"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-046461"],"award-info":[{"award-number":["INV-046461"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV-057603"],"award-info":[{"award-number":["INV-057603"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2026,1,27]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Emerging evidence of durable immunogenicity from mono-dose human papillomavirus vaccination (HPVV) prompted the WHO to recommend a single-dose HPVV schedule in December 2022. There is, however, limited understanding of processes and considerations influencing country adoption of the updated HPVV dosing schedule recommendation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified four archetypes characterising countries\u2019 progress along the HPVV introduction and single-dose adoption continua. From September 2023 to February 2024, we purposefully sampled and conducted semistructured interviews with immunisation stakeholders representing Ministries of Health, Gavi-funded technical assistance partners, civil society organisations and multilateral agencies from African and Asian low-income and middle-income countries. Using multicycle, iterative thematic analysis, we identified factors enabling the adoption of the HPVV single-dose recommendation, as well as constraints to rendering a decision on the HPVV dosing schedule.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We interviewed 66 stakeholders across 19 countries with mature HPVV programmes (n=11) or forthcoming national HPVV introductions (n=8), as well as countries adopting (n=10) or undecided about (n=9) the single-dose schedule. Stakeholders conveyed enthusiasm for single-dose HPVV, citing the following anticipated benefits: higher HPVV schedule completion and coverage, especially in underimmunised populations; costs saved from operational reconfigurations and reduced vaccine procurement demands, particularly for countries transitioning out of Gavi co-financing in a vaccine supply-constrained environment; and optimised vaccine stock management capacity, importantly for countries pursuing new vaccine introductions for multiple antigens simultaneously. Factors demotivating HPVV single-dose schedule adoption or delaying decision-making included: limited localised evidence of long-term immunologic protection from single-dose HPVV; off-label product use liabilities; costs\/resources required for retraining the health workforce in countries with mature HPVV programmes; and potential for widening HPVV coverage inequities, notably in countries with elevated HIV burdens.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Coupled with the WHO\u2019s endorsement, the perceived benefits of single-dose HPVV consistently outweighed the anticipated risks, even when these risks delayed country-level HPVV schedule-related decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjgh-2024-018779","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:45:14Z","timestamp":1771253114000},"page":"e018779","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Decision-making considerations for single-dose HPV vaccination, including drivers of schedule adoption or switch: insights from immunisation stakeholders in 19 low-income and middle-income countries"],"prefix":"10.1136","volume":"11","author":[{"given":"Erica N.","family":"Rosser","sequence":"first","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ishani","family":"Sheth","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan D.","family":"Wysong","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sunny","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey","family":"Geddes","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rupali J.","family":"Limaye","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"},{"name":"Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4991-4033","authenticated-orcid":false,"given":"Joseph G.","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"key":"2026021606450463000_11.2.e018779.1","unstructured":"World Health Organization . Cervical cancer. 2024. Available: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/cervical-cancer"},{"key":"2026021606450463000_11.2.e018779.2","unstructured":"World Health Organization . A cervical cancer-free future: first-ever global commitment to eliminate a cancer. 2020."},{"key":"2026021606450463000_11.2.e018779.3","unstructured":"GAVI The Vaccine Alliance . Human papillomavirus vaccine support. 2024. Available: https:\/\/www.gavi.org\/types-support\/vaccine-support\/human-papillomavirus"},{"key":"2026021606450463000_11.2.e018779.4","unstructured":"World Health Organization . Human papillomavirus vaccines: who position paper (2022 update). World Health Organization; 2022."},{"key":"2026021606450463000_11.2.e018779.5","unstructured":"World Health Organization . WHO immunization data portal: introduction of HPV (human papilloma virus) vaccine. n.d. Available: https:\/\/immunizationdata.who.int\/global\/wiise-detail-page\/introduction-of-hpv-(human-papilloma-virus)-vaccine?ISO_3_CODE=&YEAR="},{"key":"2026021606450463000_11.2.e018779.6","unstructured":"Zaidi A . Four things to know about the single-dose HPV vaccine for cervical cancer, 2024. Available: https:\/\/www.gatesfoundation.org\/ideas\/articles\/hpv-single-dose-vaccine-explained"},{"key":"2026021606450463000_11.2.e018779.7","doi-asserted-by":"crossref","DOI":"10.1056\/EVIDoa2100056","article-title":"Efficacy of single-dose HPV vaccination among young African women","volume":"1","author":"Barnabas","year":"2022","journal-title":"NEJM Evid"},{"key":"2026021606450463000_11.2.e018779.8","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00453-8"},{"key":"2026021606450463000_11.2.e018779.9","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djaa011"},{"key":"2026021606450463000_11.2.e018779.10","unstructured":"Strategic advisory group of experts (sage) working group on potential contribution of hpv vaccines and immunization towards cervical cancer elimination. 2022."},{"key":"2026021606450463000_11.2.e018779.11","doi-asserted-by":"crossref","first-page":"e1473","DOI":"10.1016\/S2214-109X(22)00309-6","article-title":"Immunogenicity and safety of one-dose human papillomavirus vaccine compared with two or three doses in Tanzanian girls (DoRIS): an open-label, randomised, non-inferiority trial","volume":"10","author":"Watson-Jones","year":"2022","journal-title":"Lancet Glob Health"},{"key":"2026021606450463000_11.2.e018779.12","unstructured":"Graham M . Will a single dose of hpv vaccine prevent cervical cancer. 2022. Available: https:\/\/www.path.org\/our-impact\/articles\/single-dose-hpv-vaccine-cervical-cancer"},{"key":"2026021606450463000_11.2.e018779.13","unstructured":"World Health Organization . Wave of new commitments marks historic step towards the elimination of cervical cancer. 2024."},{"key":"2026021606450463000_11.2.e018779.14","doi-asserted-by":"publisher","DOI":"10.1007\/s10488-013-0528-y"},{"key":"2026021606450463000_11.2.e018779.15","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315588501"},{"key":"2026021606450463000_11.2.e018779.16","unstructured":"Saldana J . The Coding Manual for Qualitative Researchers. 4th edn. 2021."},{"key":"2026021606450463000_11.2.e018779.17","first-page":"ii5","article-title":"New vaccine adoption: qualitative study of national decision-making processes in seven low- and middle-income countries","volume":"27 Suppl 2","author":"Burchett","year":"2012","journal-title":"Health Policy Plan"},{"key":"2026021606450463000_11.2.e018779.18","unstructured":"Yin RK . Qualitative Research from Start to Finish. 2nd edn. The Guilford Press, 2016."},{"key":"2026021606450463000_11.2.e018779.19","unstructured":"World Health Organization . Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020."},{"key":"2026021606450463000_11.2.e018779.20","doi-asserted-by":"crossref","first-page":"328","DOI":"10.2471\/BLT.18.218370","article-title":"Fractional-dose inactivated poliovirus vaccine, India","volume":"97","author":"Haldar","year":"2019","journal-title":"Bull World Health Organ"},{"key":"2026021606450463000_11.2.e018779.21","doi-asserted-by":"crossref","first-page":"e8","DOI":"10.1016\/S2468-2667(16)30001-9","article-title":"Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models","volume":"1","author":"Brisson","year":"2016","journal-title":"Lancet Public Health"},{"key":"2026021606450463000_11.2.e018779.22","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(20)30860-4"},{"key":"2026021606450463000_11.2.e018779.23","doi-asserted-by":"crossref","first-page":"799984","DOI":"10.3389\/fpubh.2022.799984","article-title":"Human Papillomavirus Vaccination in South Africa: Programmatic Challenges and Opportunities for Integration With Other Adolescent Health Services?","volume":"10","author":"Amponsah-Dacosta","year":"2022","journal-title":"Front Public Health"},{"key":"2026021606450463000_11.2.e018779.24","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0285031","article-title":"Leveraging health infrastructure to optimize HPV vaccination for adolescents in Zambia: Protocol for an implementation study","volume":"18","author":"Miti","year":"2023","journal-title":"PLoS One"},{"key":"2026021606450463000_11.2.e018779.25","doi-asserted-by":"crossref","DOI":"10.1136\/bmjgh-2023-012580","article-title":"Health and economic effects of introducing single-dose or two-dose human papillomavirus vaccination in India","volume":"8","author":"M de Carvalho","year":"2023","journal-title":"BMJ Glob Health"},{"key":"2026021606450463000_11.2.e018779.26","doi-asserted-by":"crossref","first-page":"1673","DOI":"10.1016\/j.vaccine.2024.01.097","article-title":"Implications of information heard about Dengvaxia on Filipinos\u2019 perception on vaccination","volume":"42","author":"Mabale","year":"2024","journal-title":"Vaccine (Auckl)"},{"key":"2026021606450463000_11.2.e018779.27","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1080\/21645515.2018.1522468","article-title":"Vaccine confidence plummets in the Philippines following dengue vaccine scare: why it matters to pandemic preparedness","volume":"15","author":"Larson","year":"2019","journal-title":"Human Vaccines & Immunotherapeutics"},{"key":"2026021606450463000_11.2.e018779.28","doi-asserted-by":"crossref","DOI":"10.1136\/bmjmed-2023-000726","article-title":"Covid-19 pandemic and equity of global human papillomavirus vaccination: descriptive study of World Health Organization-Unicef vaccination coverage estimates","volume":"3","author":"Casey","year":"2024","journal-title":"BMJ Med"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2024-018779","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T14:45:18Z","timestamp":1771253118000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2024-018779"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":28,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,16]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjgh-2024-018779"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2024-018779","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}