Coverage Performance and Lessons Learned from the Multi Age Cohort Campaign for HPV Vaccine Introduction in Phase One States of Nigeria

Background Nigeria introduced the quadrivalent HPV vaccine into its Expanded Programme on Immunization (EPI) in 2023 using a two-phase rollout. Phase one experienced several challenges underscoring the need to analyze vaccination coverage, identify factors influencing uptake and drawing lessons learned for future strategies. Methods We employed a mixed-method approach using call-in data from the multi-age cohort vaccination campaign and implementation reports from the 15 states and the Federal Capital Territory. We analyzed coverage rates and trends as well as thematic ally analyzed factors influencing uptake. Results Coverage varied across the 16 states; 12 (80%) achieved the national target of 80%. School-based vaccine delivery strategy proved the most effective approach. Factors that influenced coverage disparities across the implementing states include robust state technical working groups, timely financial support, leveraging local workforce, efficient vaccine distribution, real-time monitoring, comprehensive strategies, and rigorous ACSM activities engaging community influencers and mass media. Lessons learned revealed emphasizing the integration of the different working groups, ensuring the timely release of funds, adopting diverse service delivery strategies and sustained advocacy as central for future rollout. Conclusion The success of the phase one HPV vaccine introduction was linked to effective coordination, and diverse service delivery strategies. Lessons learned highlight the importance of early planning, early release of funding, involving community gatekeepers, and the integration of adolescents and civil society organizations in the promotion of vaccine uptake.