Children vaccinated as part of the 2025 human papillomavirus (HPV) vaccine big catch-up campaign, Tamlan School, Rove, Solomon Islands.

Towards eliminating cervical cancer – tracking HPV vaccination progress in LMICs

As the world strives to eliminate cervical cancer, a new scoping review on the implementation of human papillomavirus (HPV) vaccine in low- and middle-income countries (LMICs) provides clear insights into what is working, and what challenges may remain.

The review, published in The Lancet Regional Health – Western Pacific, examined national HPV vaccination programs in 84 LMICs.  

Its findings reveal significant progress in adopting HPV vaccination globally but also highlight a persistent gap between policy ambition and vaccination coverage.
 

Global HPV vaccination – where things stand

Vaccination against HPV, the virus responsible for 99.7% of cervical cancer cases, has been shown to be highly effective. Yet, cervical cancer remains one of the world's leading causes of cancer-related illness and death for women, particularly in LMICs, where more than 85% of cervical cancer cases and deaths occur.

To help fight the disease’s ongoing impact, the World Health Organization (WHO) launched its global strategy to eliminate cervical cancer as a public health problem in 2020.

The strategy includes a 2030 target for 90% of girls to be fully vaccinated against HPV by age 15.
 

An evolving policy landscape

Most countries target adolescents aged between 9 and 14 years and provide vaccination free of charge. School-based delivery is the most common model across both lower- and upper-middle-income countries, and across the 84 countries overall – but it is less common (41.6%) in low-income countries.

Significantly, nearly half of the 84 countries reviewed have moved to a single-dose HPV vaccination schedule, reflecting recent WHO recommendations and emerging evidence that this approach provides strong protection against HPV infection.

Vaccination programs for boys remain largely limited to upper-middle-income countries, while lower-income settings continue to focus primarily on girls.

Vaccine types, funding arrangements and delivery approaches also vary considerably between countries and regions.
 

Progress has not yet translated into high coverage

Despite widespread policy adoption, vaccination coverage remains below global targets in most countries.

Of the 62 countries that reported data on first-dose coverage, 21% achieved the WHO target of 90% complete HPV vaccination coverage among girls by 15 years of age, while 30.6% recorded complete vaccination coverage below 50%.

The review also found substantial variation – some low-income countries achieved high coverage rates, while many upper-middle-income countries continued to struggle, despite having established vaccination programs.

These findings suggest that introducing an HPV vaccination program is only the first step – strong implementation is critical for achieving population-level protection.
 

What is working?

Across the countries reviewed, several common factors emerged among successful HPV vaccination programs.

School-based delivery with mixed-model adaptability provides a strong foundation

School-based programs consistently demonstrated more stable performance over time than those delivered through health facilities. School-based programs are able to reach large numbers of adolescents, reduce travel and costs for families, and can be integrated into existing education systems. However, countries achieving the strongest results often supplemented school-based programs with community outreach, health-facility delivery or mobile services to target ‘out-of-school’ adolescents.

Simpler vaccine schedules support HPV vaccination program implementation

The shift toward single-dose vaccination represents an important opportunity for many countries. Researchers found no substantial difference in first-dose coverage between single-dose and 2-dose programs, with single-dose schedules offering practical benefits including reduced costs, simplified logistics and eased cold-chain requirements.  

'The move towards single-dose HPV vaccination is particularly promising for countries working with limited resources,' said Dr Shu Chen, Senior Research Officer, NCIRS Global Health and co-author of the study. 'It could reduce procurement and delivery costs and logistical barriers, while making it easier for health systems to reach more adolescents and sustain high coverage over time.’

Collaboration matters

Successful programs frequently relied on strong partnerships between ministries of health, health care providers and international partners, ensuring strong vaccine education across schools and communities.

Communication and community engagement are essential

Countries reporting strong performance invested in tailored communication strategies, including school engagement, community outreach, social media campaigns and culturally appropriate messaging. These approaches helped address concerns about vaccine safety and improve community confidence.
 

Challenges remain

In lower-income countries, financing and health system capacity – including vaccine supply, transport and logistics, workforce shortages and infrastructure limitations – remain challenges.

In contrast, in upper middle-income settings, social and behavioural barriers were often more prominent. Vaccine hesitancy, misinformation, concerns about vaccine safety and misconceptions relating to fertility or sexual behaviour were identified as recurring issues.

The review also highlighted equity concerns, particularly in terms of out-of-school adolescents, rural populations, ethnic minorities and other vulnerable groups who may find it more difficult to access vaccine services.
 

Key lessons for HPV vaccine policy and practice

The authors conclude that, alongside expanding access to HPV vaccines, achieving cervical cancer elimination will require practical and equitably designed programs that are adapted to local contexts.

School-based vaccination programs, complemented by targeted strategies for hard-to-reach populations and supported by simplified single-dose schedules, may offer one of the most effective pathways for increasing coverage in many LMICs.

The review also reinforces the importance of strong leadership, cross-sector collaboration, effective communication and ongoing investment in health system capacity.  

Overall. it provides valuable guidance for strengthening HPV vaccination programs and ensuring more adolescents are protected against HPV-related cancers as countries continue working towards the WHO's 2030 cervical cancer elimination targets.

Access the study