Lessons Learned From Bhutan on extending Girls-Only HPV Vaccination Program to Boys: A Qualitative Study

Area of Science:

• Public Health
• Vaccinology
• Social Sciences

Background:

• Bhutan initiated a school-based, gender-neutral human papillomavirus (HPV) vaccination program in 2020.
• The program achieved 96% coverage by 2021, demonstrating high uptake.
• Previous HPV vaccination programs were often girls-only.

Purpose of the Study:

• To evaluate the feasibility and acceptability of Bhutan's gender-neutral HPV vaccination program.
• To identify enablers and challenges in implementing school-based HPV vaccination for all genders.
• To provide insights for other countries considering similar programs.

Main Methods:

• Qualitative study using 49 in-depth interviews with diverse stakeholders.
• 12 focus group discussions conducted with vaccinated boys.
• Conventional content analysis applied to qualitative data.

Main Results:

• Key enablers included strong social mobilization, community engagement, school collaborations, effective program management, and digital tools.
• Challenges involved tracking and reaching eligible adolescents for vaccination.
• Vaccinated boys viewed school-based delivery as crucial for vaccine uptake.

Conclusions:

• Extending HPV vaccination programs to be gender-neutral is feasible and acceptable in the Bhutanese context.
• Lessons learned regarding enablers and challenges can inform global efforts to expand gender-neutral HPV vaccination.
• School-based delivery is a critical factor for successful HPV vaccine implementation.