Roles of stakeholders in the decision-making and health advocacy of human papillomavirus vaccination among children aged 9–14 years

In China, the human papillomavirus (HPV) vaccine has not yet been included in the national immunization program (NIP). Nevertheless, several provinces and municipalities have launched pilot HPV vaccination programs targeting female adolescents in secondary schools since 2021. This study aimed to explore the roles of key stakeholders in the decision-making process regarding HPV vaccination and to provide recommendations for future promotional strategies. Semi-structured interviews were conducted with stakeholders from Shanghai, Jiangsu, Zhejiang, and Anhui, including public health professionals, school teachers, and parents of adolescent girls. The interview framework comprised both fixed-choice and open-ended questions. Key topics addressed included: (1) the support for prioritizing HPV vaccination within NIP, (2) the influence of stakeholders on vaccination decisions, and (3) suggestions for enhancing vaccination promotion. Eighty-three people participated in the study. Only 30 % of respondents believed HPV vaccination should be prioritized in the NIP, citing concerns about public perception, cultural values, and financial feasibility. Health and class teachers were found to have a substantial impact on the vaccination choices of parents and their daughters. To boost vaccination uptake, a comprehensive approach that includes stakeholder collaboration, educational campaigns, digital technology, and improved access to immunization services was proposed. This research provides valuable insights into the decision-making processes surrounding HPV vaccination and advocacy efforts aimed at girls aged 9–14 years. The findings serve as important references for future initiatives aimed at promoting awareness and uptake of the vaccine. • Stakeholder influence on HPV vaccination decision-making in the Yangtze River Delta is analyzed for the first time. • Class and health teachers significantly influence parental and girls' HPV vaccination decisions. • Financial constraints, low public acceptance, and cultural taboos hinder the inclusion of the HPV vaccine in China's national immunization program. • A multi-sectoral strategy emphasizes education-healthcare collaboration to enhance HPV vaccine coverage.