OBJECTIVES

: Adding the vaccination against some cancerous types of HPV to the national vaccination program is questionable, as the other preventive alternatives are almost more cost-effective especially for countries with lower priority in cervical cancer prevention.

METHODS

: Articles contain “HPV” and “vaccination” in combination of “legislation” or “mandatory” words in titles, abstract, and keywords were rapidly reviewed in Scopus, Embase, Ovid, and google scholar in English language from 2002 to 2019.

RESULTS

: 43 articles were chosen to review and the challenges were extracted. Some concerns are frequent (non-trustable) claims about the side effects of HPV vaccines, non-confirmed age and sex groups targeted among population and uncertainty in interventions like dose adjustment of each 2-, 4- and 9-valent HPV vaccines and, some concerns related to the formulation and purification process of the product, in addition to some faults in choosing comparison arms, wrong inclusion criteria, short period of following administration of the vaccine to record the long-term positive/negative outcomes, and negative results demonstrated by cost-effectiveness studies of HPV vaccination for countries with low prevalence of HPV affliction make some challenges a head of policy makers around the world to legislate mandatory of HPV vaccination. This is why some countries are suspected in regulation of national vaccination.

CONCLUSIONS

To either have legislated HPV vaccination policies or not, multiple challenges to target population, adjusting the intervention, defects in choosing comparison arms and recording outcomes as well as negative results of some cost-effectiveness studies make some difficulties for evidence-based decision making especially in countries with low prevalence of HPV affliction. It raises the demand to run a network meta-analysis, especially for countries with low prevalence of cervical cancer. It is likely to take incremental substitution of the vaccination instead of categorical substitution among the other alternatives for cervical cancer prevention.