Religiosity, moral beliefs and HPV vaccine uptake among medical students in Serbia

Background

HPV vaccination prevents HPV-related cancers, yet uptake across the WHO European Region is uneven, with low coverage in South-Eastern Europe. In Serbia, the vaccine has been free for students since 2024 but coverage remains low. Medical students are future immunization advocates, so understanding value-based hesitancy in this group is critical. We examined whether religiosity and moral beliefs act as barriers to HPV vaccination among medical students in Serbia.

Methods

We conducted a cross-sectional study of all first- and second-year students at the Faculty of Medicine, University of Belgrade (N = 882) in early 2026. Participants completed an anonymous self-administered questionnaire with validated instruments. Religiosity was measured with a self-evaluation scale and 10 items on social and internal faith (4-point Likert). Moral beliefs were assessed with 9 statements (5-point Likert). We compared vaccinated and unvaccinated respondents using Mann–Whitney U and χ² tests in SPSS.

Results

Of 882 invited students, 715 (81.1%) completed the questionnaire; HPV vaccination coverage was 27.4%. Unvaccinated students reported higher religiosity than vaccinated peers (median score 72 vs 67, p = 0.003). They more often endorsed that vaccination is unnecessary if pre-marital abstinence is practised (only 43.7% disagreed vs 77.4% of vaccinated peers, p < 0.001). Across all 9 moral-belief statements, unvaccinated students showed significantly higher agreement and neutrality, while vaccinated peers predominantly strongly disagreed (p < 0.001).

Conclusions

In this future health workforce, religiosity and moral beliefs did not produce active vaccine refusal but generated ambivalence and a false sense of safety anchored in abstinence narratives. Tailored communication and partnerships with religious communities could strengthen HPV vaccination programmes across the WHO European Region, where similar value-based hesitancy persists.

Key messages

• Among 715 medical students in Belgrade, HPV vaccine coverage was 27.4%; unvaccinated students reported higher religiosity than vaccinated peers (median 72 vs 67, p = 0.003).

• Religiosity and moral beliefs did not drive outright refusal but fostered ambivalence and a false sense of safety; engaging religious communities could improve HPV vaccine acceptance.