Awareness of HPV vaccination increased significantly among children and parents in Roma communities in Slovakia, following a five-year research project that examined barriers to vaccine uptake. The RIVER EU initiative worked with Roma health mediators to design and deliver training and interventions for a community that often experiences limited access to healthcare.
As well as increasing levels of knowledge, the proportion of participants that intended to vaccinate against HPV increased from 29% before the initiative to 49% afterwards.
So, how did they do it?
Researchers worked with an existing network of Roma health mediators who have high levels of trust in the community. Together, they adapted health information to address the community’s needs, taking account of cultural and language barriers.
Discussions with 23 stakeholders, including healthcare professionals, schools, local authorities and community members, helped increase education and access to services. The health mediators incorporated HPV vaccine information into their ongoing community outreach work, and guided people through the steps involved in the HPV vaccination process.
Speaking at the final RIVER-EU conference in Brussels, František Turták, a coordinator of Roma health mediators in Slovakia, described what it takes to talk to people you know about something as sensitive as HPV. The mediator’s role, he said, is not to know everything, it is to know how to guide people toward the right sources.
Low vaccine uptake leaves marginalised groups unprotected
HPV vaccine uptake in Slovakia is below target across the population. It was not until 2019 that the bivalent HPV vaccine became fully reimbursed through public health insurance for 12-year-olds. From 2022, full reimbursement was extended to the nonavalent vaccine, accompanied by vaccination campaigns.
Against this policy backdrop, the proportion of 12-year-olds who had received at least one dose of an HPV vaccine reached 30.8% in 2022 and increased to 38.4% in 2023. However, it fell to 27.9% in 2024, before rising slightly to 30.1% in 2025. ‘One possible explanation for the decline among 12-year-olds is the extension of full reimbursement to children aged 13 and 14 years from December 2023, which may have led some families to postpone vaccination until a later age,’ explains Dr. Daniela Fiľakovská, from the Pavol Jozef Safarik University (UPJŠ).
No specific data are available for HPV uptake in Roma communities. However, vaccine uptake in areas with significant Roma communities is generally lower than the national average, suggesting that HPV vaccination rates are likely to be very low. The European target is 90% uptake among girls, with ongoing efforts to increase vaccination among boys.
One of the main barriers to vaccination was the lack of information about HPV in marginalised Roma communities and limited capacity of primary paediatricians, particularly in rural regions with significant Roma populations. With large patient lists and little time, doctors were often unable to introduce HPV vaccination, explain an unfamiliar topic in accessible language and respond to concerns or misinformation.
‘The project did not seek to replace the paediatrician, but to move the first stage of education into the community,’ Dr Fiľakovská tells Vaccines Today. ‘Through educational sessions, together with Roma health mediators, we provided simple, culturally sensitive information, addressed common concerns and helped families navigate the vaccination process.’
Participants were reassured that nobody would be vaccinated or pressured during the sessions: the aim was to enable an informed decision. When parents later visited the paediatrician, they were already familiar with HPV vaccination, allowing the doctor to confirm the information, answer remaining questions and administer the vaccine.
Making an impact
In the 16 marginalised Roma communities where the project was active, knowledge about HPV rose from 15% to 65% among Roma parents, and from 30% to 70% among Roma school children. Intention to vaccinate rose significantly in both groups. Among 257 eligible children aged 12–14 whose parents were reached at follow-up, 20.6% had received at least one dose of the HPV vaccine, exceeding the corresponding 2024 coverage of 13.1% among 12–14-year-olds in the same region.
Dr. Daniela Fiľakovská says establishing trust with the community was the key to the project. The main challenge was overcoming low levels of confidence in the safety and effectiveness of vaccines. Roma health mediators played a central role.
‘They are already trusted and credible community members themselves, trained to bridge community members with healthcare providers,’ she says. ‘But with that trust, comes a responsibility. We were very careful to protect their credibility.’
New guidelines on reaching marginalised communities
The RIVER-EU project studied determinants of high and low vaccine uptake in eight marginalised communities. These included Ukrainian families in Poland, British Bangladeshis, migrants and refugees in Greece, Somali communities in Finland, Arabs in Israel, and Turkish and Moroccan communities in the Netherlands.
In each case, researchers collected evidence on barriers to uptake and devised interventions to increase trust and, ultimately, vaccination rates. The consortium involved in the five-year EU-funded project have used their experiences to develop a guideline for future work with underserved communities.
