Introduction: India accounts for one-fifth of the global burden of cervical cancer cases and mortality. A
safe and effective vaccine to prevent human papillomavirus (HPV) infections, the primary cause of cervi-
cal malignancies, is available in India but multiple barriers lead to its low uptake in the country.
Physicians are a key stakeholder and communicator in the Indian health system and have the potential
to increase HPV vaccine uptake.
Objective: We undertook formative research to understand awareness, perceptions and choices of physi-
cians when recommending the HPV vaccine to parents of adolescent girls.
Methods: We conducted in-depth interviews with 32 physicians in two districts of West Bengal. Data col-
lection was carried out between July and August 2019. The data was transcribed, coded, and analyzed
using NVivo software using the thematic analysis technique.
Results: Our findings suggest that while physicians are generally aware about the burden of cervical can-
cer and its prevention by HPV vaccination, they face several barriers to recommending the HPV vaccine
routinely and strongly. These include the lack of national-level guidance on the age eligibility and dosage,
lack of practice-level opportunities such as well or non-sick visits and other routine adolescent vaccines,
practice-level barriers like out-of-pocket cost and vaccine availability, and perceived parental hesitancy
arising from reluctance to discuss cervical cancer, its prevention, and HPV vaccination.
Conclusions: Physicians in our study exhibited hesitancy when recommending the HPV vaccine. They also
faced logistical barriers. It is important that the barriers pertaining to when and how physicians recom-
mend the vaccine be tackled through further education, policy change, and development and implemen-
tation of interventions that are evidenced-based.