HPV Vaccination Cuts Cervical Cancer Deaths: The Next Challenge Is Equitable Access
The HPV vaccine is saving lives from cervical cancer, but global elimination remains constrained by inequalities.
Human papillomavirus (HPV) vaccination is a key component of strategies to eliminate cervical cancer globally. A recent study published in The Lancet showed that deaths in England from cervical cancer have fallen sharply since school-age girls began being offered the vaccine in 2008.
The study analyzed population-based cervical cancer mortality data and found that between 2020–2024 no cervical cancer deaths were recorded in women aged 20 to 24. Without vaccination, around 23 deaths would have been expected based on historical mortality rates.
“The findings show for the first time that it is possible to substantially reduce the number of people dying from cervical cancer in a population by introducing HPV vaccination,” Prof. Peter Sasieni, the lead researcher at Queen Mary University of London, told Technology Networks.
Findings from Scotland, Sweden, and Denmark also support a substantial reduction in invasive cervical cancer following vaccination.
Population-level evidence like this shows that the tools to prevent most cervical cancers exist. Despite this, cervical cancer remains the fifth most commonly diagnosed cancer in women globally. The highest rates of cervical cancer are in low- and middle- income countries, reflecting major inequities driven by disparities in vaccine availability and uptake, cervical screening, and treatment services.
Access inequalities need to be addressed if the World Health Organization's 90-70-90 targets for cervical cancer are to be met by its 2030 deadline. Reaching this target would mean that 90% of girls are fully vaccinated with the HPV vaccine by age 15, 70% of women are screened by ages 35 and 45, and 90% of women with pre-cancer or invasive cancer receive appropriate treatment.
From a common infection to cancer
HPV is a large family of 200 known viruses, transmitted primarily by sexual intercourse. The immune system clears most infections, but persistent infection with certain HPV types can cause abnormal cells to develop that can progress to cancer.
“HPV only really appeared on the scene as being important in cancers when it was identified as being the cause of cervical cancer. The reason it was identified was that people could screen for cancer of the cervix using the Pap smear, and German virologist Dr. Harald zur Hausen identified HPV as the cause,” Dr. Tim Palmer, honorary senior lecturer at the University of Edinburgh, told Technology Networks.
“Once you could test for HPV, then people began to find it in other cancers,” he added.
HPV has since been linked to a subset of head and neck cancers arising in the oropharynx, unlike other head and neck cancers that are more closely related to alcohol and smoking. Additionally, HPV has been linked to cancers of the vagina and vulva in women, penile cancers in men, and anal cancers in both men and women.
It was the finding that almost all cervical cancers are caused by HPV that led to the development of the vaccines used today.
While the HPV vaccines used globally vary in the number of HPV strains they target, they all utilize virus-like particles to trigger an immune response. Palmer likens this technology to an “empty envelope”.
“HPV is a bit like a letter with its envelope, and the vaccine is made up of the envelope without the letter inside. When you post an envelope, all the postman cares about is the address on the front. All the immune system is interested in, concerning HPV, is that envelope,” explained Palmer.
In other words, the HPV vaccine reproduces the virus’s outer protein shell and contains no infectious viral genetic material. “The vaccine acts as a giant polymeric antigen, so it creates a very strong immune response,” Palmer continued.
The efficacy of the vaccine is one of the reasons for the success of cervical cancer elimination strategies. But equally important was the vaccine's marketing and deployment.
“HPV vaccination in the UK is school-based. When it was introduced, it achieved excellent uptake among 12–13-year-old girls. For several years, 88–90% of the target population were vaccinated,” stated Sasieni.
To reach this population, vaccine messaging was key. “You're dealing with children who are beginning to think for themselves. You're also dealing with parents who might be a bit worried because this is a vaccine against a virus that is intimately associated with sex. Most parents don't really think of their children having sex at the age of 12–13, but you've got to vaccinate before they begin having sex to get the maximum effect,” Palmer said. “In Scotland, we were putting literature out in hairdressers and nail parlors. There were adverts in the cinemas, on social media, and it was a big effort, but it has paid dividends because that sort of marketing is not something you get with the childhood or flu vaccines.”
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These efforts culminated in the success reported in England and other countries that have implemented these strategies.
Scientific success, unequal access
Despite the success seen in certain countries, the global picture is uneven. Cervical cancer rates reflect global inequalities; of the 350,000 women who died from cervical cancer in 2022, nearly 94% occurred in low- and middle- income countries.
A 2025 study found wide variation in HPV vaccine coverage between countries and income groups, with coverage far below the WHO target of 90% coverage for girls by age 15. “The greatest challenges are in China, India, Russia, and Central Africa,” explained Sasieni.
Numerous factors could be contributing to this disparity, “including the lack of public trust (social norms, information from social networking services, and mass media are important), physical barriers, logistical barriers, financial barriers, and so on,” Dr. Taito Kitano, physician scientist at Nara Prefecture General Medical Center, told Technology Networks.
Economic barriers, particularly in low-income countries, hinder vaccine introduction and scale-up, underscoring the need for increased international support. Implementing supportive national recommendations and policies, school-based HPV vaccination programs, increasing the supply of low-cost vaccines, and adopting single-dose vaccination schemes could significantly boost HPV vaccination rates.
“In regions with suboptimal coverage, a multidisciplinary approach is important. That is not something we can achieve in a day, but we need to continuously improve to make the situation better.” — Dr. Taito Kitano.
“Studies have shown that if you look at dose-response and the clinical protection afforded by one dose, it is more than adequate,” said Palmer. “When you combine that with the fact that with high uptake over about 70–80% you start getting herd protection, then you can envisage a situation where one dose is given, and you aim to get high uptake of vaccine, so that there's a degree of herd protection. In the West and in developed countries, we're now vaccinating boys as well as girls at the same age, and that strengthens that herd protection.”
One-dose vaccines also have logistical advantages. Setting up a program for adolescents is much easier with one-dose vaccines, making school vaccination more feasible. “School vaccination is much better than trying to persuade people to go to their doctor. If you do it in school, you get much higher uptake rates,” explained Palmer.
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As new vaccine programs are introduced, systems should be in place to measure the program's effectiveness. “You don't have to have individual-level data to do that, as England has shown. You can compare before and after cohorts of the population, but you need to know your vaccine uptake to do that,” said Palmer.
Expanding HPV vaccinations to males
Many vaccination programs historically prioritized females, given the burden of cervical cancer and its strong ties to HPV. “According to the World Health Organization, in 2019, HPV caused 620,000 cancers in women and 70,000 in men. More recent estimates are consistent—88–90% of HPV-related cancers (and deaths) are in women,” Sasieni stated.
While the disease burden in males is lower, it is still significant given HPV's ties to many cancers beyond cervical cancer. “It's been known for some time that men who have sex with men have a higher rate of cancer of the anus, and this is related to HPV, which is why across the UK we vaccinate men who have sex with men up to the age of 45 because they are at high risk of developing HPV-related anal disease,” said Palmer.
Vaccinating males can not only prevent certain cancers later in life, but by vaccinating both girls and boys, it may be possible to eliminate the virus, so everyone benefits, even those not vaccinated.
“Male vaccination is critical not only from a public health perspective but from an individual benefit perspective.” — Dr. Taito Kitano.
Despite the significant burden on males and the potential benefits of herd immunity, many countries have not started male vaccination. Expanding male eligibility should complement efforts to reach females to better protect the entire population.
In a double-blind controlled trial, oral HPV prevalence four years after vaccination with a bivalent HPV 16/18 vaccine was much lower among women who received the vaccine vs a hepatitis A control vaccine. This suggests that the vaccine protects against oral HPV 16/18 infection and has implications for the prevention of increasingly common HPV-associated oropharyngeal cancer. While the study didn’t include male participants, the researchers concluded that “it is likely that the protection we observed among women will also be present in men, as VE [vaccine efficacy] of both vaccines has been demonstrated against HPV infections among men and women at all mucosal sites evaluated.”
Towards global cervical cancer elimination
Current HPV vaccines don’t cover every cancer-associated HPV type, and older cohorts who were never offered routine vaccination remain at risk. Screening is therefore still necessary to detect precancerous changes and prevent cancers among unvaccinated people or those infected with non-vaccine HPV types.
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To help improve screening uptake, at-home self-sampling is now being offered across some countries, including England, Scotland, and Wales, for people who are overdue for a screening appointment by six months or more. This has the potential to reach people who avoid clinician-collected cervical screening because of discomfort, embarrassment, previous negative experiences, or practical barriers.
In a study of self-sampling for cervical screening, researchers showed what can be achieved in under-screened women using a combination of opportunistic personal offers of kits by GPs and systematic sending out of kits to those who are overdue for screening.
GP practices were randomized to either offer self-sampling kits during consultations or usual care. Additionally, never-screened women and those overdue for screening by 15 or 27 months were individually randomized to receive one of three interventions:
- Usual care (no intervention)
- A letter inviting them to order a self-sampling kit
- A letter including a self-sampling kit and how to use it
Half of women offered a kit in the GP's surgery were screened, compared with 12.3% of those sent a kit in the post, and just 4.8% of those sent a letter. However, over an average of 11 months, only 7.3% of eligible women were offered a kit during a primary care appointment. The findings suggest that introducing self-sampling for those overdue for cervical screening will increase participation, with one-to-one offers of self-sampling in primary care likely to have the biggest impact.
While self-sampling has the potential to engage otherwise hesitant people, Palmer warns that “other studies have shown that, yes, there's a good uptake of screening. But actually, you're diverting some of the people who would have gone, albeit with reluctance, to their practitioner. So, there's some doubt about the precise uplift you get in the uptake from self-sampling.”
“However, if you're catching the people who have never been or are reluctant to go, then you're catching the highest risk group, because over half of cancers are found in people who've either never been screened or have poorly attended screening appointments,” he added.
Evidence from England shows what is possible when vaccine technology, screening programs, public funding, and high uptake align. As a result of these efforts, up until the end of 2024, an estimated 200 cervical cancer deaths were avoided in England because of the HPV vaccination.
The remaining obstacles to eliminating cervical cancer are no longer a lack of scientific tools, but whether health systems can deliver protection equitably.
“To have the biggest impact over the next decade, we need to focus on cervical screening for women aged 45–65, particularly those not screened over the last 10 years. But for sustained progress towards reducing the burden of HPV-related cancers long-term, we need concerted efforts to achieve very high HPV vaccine coverage in all countries,” Sasieni concluded.
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