Despite the availability of a safe and effective vaccination, uptake of human papillomavirus (HPV) vaccination remains low worldwide. We aimed to analyze the coverage of HPV immunization during the first year of the immunization program and the sociodemographic characteristics across different administrative units in Serbia and Montenegro. Coverage of HPV vaccination in Serbia for females aged 9–14 and 15–19 years was 5.5% and 5.9%, respectively. The coverage rate of immunization against HPV in Montenegro for girls aged 9–14 years was 22.1%. Within Serbia, only one administrative region (Moravica) had HPV immunization coverage in girls 9–19 years old above 10%, 11 districts had coverage from 5 to 10%, while 13 districts had coverage below 5%. As per Montenegro, two administrative units, Cetinje and Berane, reported the highest coverage, with 39% and 36.4% of vaccinated eligible girls, respectively. When we explored the coverage of HPV immunization among girls aged 9–19 years across different regions in Serbia, we observed that the level of coverage did not correlate with the number of pediatricians or with the population density. In Montenegro, we observed a similar situation. On the other hand, we noticed a statistically significant moderate negative correlation (r = −0.446; p = 0.026) between HPV immunization coverage and the percentage of illiterate women in the administrative units. Comparing the coverage between the two countries we found that the higher coverage in Montenegro corresponded with a smaller number of female populations aged 9–14 years, with higher average net monthly income, with smaller population density and smaller number of pediatricians, among divorced persons, and among those without formal education or incompletely primary education. Taking into account the experiences in Montenegro, increasing immunization coverage in Serbia could be achieved through a more vigorous educational campaign targeting schools, the general population, and healthcare workers as well as by additionally incentivizing those engaged in these activities.

Introduction: The Delta variant of SARS-CoV-2 dominated Montenegro from July 2020 until early 2022, when Omicron took over. COVID-19 vaccination began on 20 February 2021, two months later than in the EU. The study aimed to investigate the impact of vaccination on mortality rates in Montenegro during Delta’s predominance. Methods: A descriptive study was conducted using data from the Montenegrin Institute of Public Health COVID-19 database, the Population Electronic Immunization Register, which provides data for all administrated COVID-19 vaccines in Montenegro, and EUROSTAT mortality data. Results: COVID-19 accounted for 17.8% of total deaths in Montenegro during the period of study. Crude mortality rate among unvaccinated was almost four times higher compared to those who received at least one vaccine dose. Inactivated vaccines were predominantly administered to those aged 60 and over, while RNA vaccines were mainly given to those under 60. The median interval between the last vaccine dose and death was significantly higher for vector vaccines compared to inactivated vaccines. Discussion: The delayed start of vaccination and limited vaccine choices in Montenegro likely contributed to prolonged high mortality due to COVID-19. Our findings reveal disparities in vaccine distribution and effectiveness, highlighting the need for timely and equitable access to effective vaccines, especially for vulnerable populations. Conclusions: The study underscores the importance of prompt vaccine distribution and the option to choose vaccine types in building public trust and reducing mortality rates. It emphasizes the need for strengthening global mechanisms COVAX and continuing educational activities to address vaccine hesitancy and ensure equitable access to effective vaccines.