Prevalence and determinants of human papillomavirus vaccine hesitancy among parents of young girls in Morocco

The vaccination against Human papillomavirus (HPV) effectively prevents cervical cancer, nevertheless, parental hesitancy limits coverage and reduces the impact of prevention programs. This study sought to estimate the prevalence of parental hesitancy toward HPV vaccination in Morocco and to identify the factors associated with it. A multicenter cross-sectional survey was conducted between March and September 2025 among parents of girls aged 11-14 years attending healthcare centers in Morocco. Trained interviewers administered a structured questionnaire to collect data on socioeconomic characteristics, knowledge of cervical cancer and HPV vaccination, trust in the healthcare system, social influences, and perceptions of HPV infection. We then applied multivariate logistic regression to identify factors associated with vaccine hesitancy. Data were analyzed using Epi Info™ software, version 7.2.0.1. A total of 2,088 parents with an average age of 37.9 ± 6.3 years were surveyed. Among these parents, 1,771 stated that they were hesitant to have their daughters vaccinated, representing a prevalence of 84.8% (1,771/2,088). Factors significantly associated with hesitancy included lack trust in the healthcare system (Adjusted Odds Ratio (AOR) 17.23; 95% CI [4.31-68.8]; p-value = 0.0001), low trust in the healthcare system (AOR 1.91; 95% CI [1.21-3.02]; p = 0.004), absence of recommendation from healthcare professionals (AOR 6.8; CI [2.99-15.47]; p < 0.001), not having ever heard of cervical cancer (AOR 2.94; CI [1.71-5.07]; p = 0.0001), negative media influences (AOR 2.68; CI [1.53-4.68]; p = 0.0005), societal norms (AOR 2.68; CI [1.68-4.30]; p < 0.01), low perception of HPV severity (AOR 2.58; CI [1.22-5.43]; p = 0.01), concerns about adverse reactions (AOR 2.34; CI [1.39-3.94]; p = 0.01), walking to the health center (AOR 2.23; CI [1.54-3.23]; p < 0.001), rural residence (AOR 2.01; CI [1.37-2.95]; p = 0.0004), and limited knowledge of cervical cancer complications (AOR1.88; CI [1.15-3.07]; p = 0.01). Higher monthly income was protective against hesitancy (AOR 0.39; CI [0.25-0.62]; p = 0.0001). Parental hesitancy toward HPV vaccination in Morocco is shaped by social, knowledge, and access factors. Addressing these barriers requires a comprehensive approach, including education and awareness campaigns, bolstering healthcare trust, improving access to vaccination services, and community mobilization to promote vaccine adoption.