Financing of Human Papillomavirus Vaccination in Africa: A Scoping Review

Human papillomavirus (HPV) vaccination is a critical intervention for cervical cancer prevention in Africa; however, program uptake and scale-up remain limited due to financing constraints. This scoping review mapped existing evidence on HPV vaccine financing in Africa, identifying prevailing funding mechanisms, cost estimates, delivery strategies, and challenges and opportunities for sustainable financing.

Guided by the Arksey and O'Malley framework and PRISMA-ScR guidelines, we systematically searched nine electronic databases for peer-reviewed studies. Retrieved records were deduplicated and screened against eligibility criteria. Eligible studies underwent data extraction, followed by collation, summarization, and thematic synthesis. All costs were standardized to United States (US) Dollars and further adjusted to a common reference year (2025US) using the US Consumer Price Index (CPI-U) to enable comparison across study years.

Twenty-seven peer-reviewed studies were included. The review found heavy dependence on donor support, particularly from Gavi, with limited domestic co-financing across most countries. Per-dose costs ranged from US$0.27-US$19.76 (financial) and US$1.31-US$45.00 (economic) as reported, or US$0.32-US$26.50 and US$1.63-US$60.36 after adjustment to 2025 US; per fully immunized girl, costs ranged from US$6.68-US$40.03 and US$17.31-US$91.19 as reported, or US$8.31-US$53.69 and US$21.53-US$122.31 adjusted. Primary cost drivers included service delivery, personnel, and outreach to out-of-school girls. School-based delivery was more cost-effective in several contexts, and the single-dose schedule consistently showed lower cost with comparable efficacy, enhancing cost-effectiveness and reducing programmatic burden. Willingness to pay exists among private individuals, but out-of-pocket models remain inequitable.

Donor funds, mainly Gavi, still drive HPV vaccination in most of Africa. The single-dose schedule cuts costs and logistics while remaining effective. For equitable, sustainable access, African countries must prioritize cost-effective vaccines, boost domestic funding, strengthen health systems, and adopt models that lessen reliance on external support.