Resilience to HPV vaccine safety scares in seven countries.

Background: Resilience is the ability of a vaccination programme to return to high coverage after a disrupting event, such as a safety scare that undermines vaccine provision. To identify insights that can help countries achieve resilience in their vaccination programmes, we reviewed the experiences of countries that faced HPV vaccine safety scares. Methods: We developed case studies on HPV vaccine safety scares in three high-income (Denmark, Ireland, and Japan) and four middle-income countries (Brazil, Colombia, India, and Mongolia). The case studies included information on the safety scare, subsequent response, and impact on HPV vaccine uptake. Results: Reports of unfounded HPV vaccine safety concerns were amplified through traditional broadcast media coverage and perpetuated by parent groups and political leaders. After safety scares, five countries had widespread decreases in HPV vaccine coverage, one had regional drops in coverage, and two suspended introductions of the vaccine. Countries' strategies varied, but typically involved coalitions of government entities, healthcare providers, community leaders, and cancer prevention organisations. All the countries were able to increase their HPV vaccine coverage or restart vaccine introduction. Conclusions: Safety scares were often imported from other countries, gained momentum through traditional media coverage, and were abetted by political leaders, delays by some vaccination programmes, and the absence of effective crisis communication plans. To build resilient HPV vaccination programmes, leaders should respond quickly to safety scares, develop a broad coalition (providers, political and community), share credible messages that emphasise cancer prevention, and communicate across traditional and social media.