Prevalence and determinants of human papillomavirus vaccine refusal among adolescent girls in Morocco: a cross-sectional study

Vaccination against human papillomavirus (HPV) is an effective strategy for preventing cervical cancer. Morocco introduced the HPV vaccine into its National Immunization Program in 2022; however, vaccination coverage remains suboptimal. This study aimed to estimate the prevalence of HPV vaccine refusal among adolescent girls and to identify the factors associated with refusal. We conducted a cross-sectional study in Morocco among middle school girls aged 11 to 14 years. Data were collected using a structured questionnaire administered through individual face-to-face interviews. The questionnaire assessed sociodemographic characteristics, knowledge of HPV and its vaccine, perceptions and beliefs regarding HPV vaccination, trust in the healthcare system, social influences, and perceived susceptibility to HPV infection. A total of 1,099 adolescent girls participated in the study, with a mean age of 13.0 ± 0.8 years. The prevalence of HPV vaccine refusal was 31.6%. After multivariable adjustment, HPV vaccine refusal was independently associated with the belief that the vaccine could cause infertility, a monthly household income above USD 999, previous parental refusal of at least one routine vaccine, paternal illiteracy, limited knowledge of the vaccine target population, poor awareness of cervical cancer and its prevention, concerns about vaccine side effects, low perceived susceptibility to HPV infection, and negative societal norms. Conversely, a monthly household income between USD 150 and USD 199, fear of regretting not receiving the HPV vaccine, and limited knowledge of cervical cancer complications were associated with a lower likelihood of HPV vaccine refusal. HPV vaccine refusal among Moroccan adolescent girls was associated with inadequate knowledge, misconceptions about vaccine safety, low perceived susceptibility to HPV infection, socioeconomic characteristics, and sociocultural influences. These findings highlight the need for culturally tailored interventions that improve HPV-related knowledge, address misconceptions, and strengthen risk perception to increase HPV vaccine uptake in Morocco.