Global HPV vaccination programs and coverage rates: a systematic review

Jingjing Han; Li Zhang; Yuqing Chen; Yuelun Zhang; Le Wang; Ruyu Cai; Minge Li; Yuxin Dai; Le Dang; Hongda Chen; Lan Zhu

doi:10.1016/j.eclinm.2025.103290

Global HPV vaccination programs and coverage rates: a systematic review

EClinicalMedicine. 2025 Jun 9:84:103290. doi: 10.1016/j.eclinm.2025.103290. eCollection 2025 Jun.

Authors

Jingjing Han^{1

2

3}, Li Zhang¹, Yuqing Chen³, Yuelun Zhang³, Le Wang⁴, Ruyu Cai⁵, Minge Li⁵, Yuxin Dai², Le Dang², Hongda Chen³, Lan Zhu^{1

2}

Affiliations

¹ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100730, China.
² Department of Obstetrics and Gynecology, National Clinical Research Center for Obstetric and Gynaecological Diseases, State Key Laboratory of Common Mechanism Research for Major Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
³ Center for Prevention and Early Intervention, National Infrastructures for Translational Medicine, Institute of Clinical Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, 100730, China.
⁴ Department of Cancer Prevention, Zhejiang Cancer Hospital, Hangzhou, 310022, China.
⁵ Department of Gynecology, Shenzhen People's Hospital (The Second Clinical Medical College, Jinan University; The First Affiliated Hospital, Southern University of Science and Technology), Shenzhen, Guangdong, 518020, China.

Abstract

Background: Many countries have included the human papillomavirus (HPV) vaccine in their national immunization programs. However, comprehensive studies on global HPV vaccination coverage remain scarce. This study aims to provide an in-depth overview of the current status of global HPV immunization programs and assess HPV vaccination coverage worldwide.

Methods: In this study, we performed a comprehensive search of the PubMed and Embase databases (from their inception to February 28, 2025), websites, the WHO database, to identify HPV vaccination policies and coverage rate data from all 194 WHO member states. Studies included in our analysis reported population-based HPV vaccination coverage rates. Additionally, we analyzed trends in HPV vaccination coverage from 2010 to 2023 and evaluated cervical cancer incidence rates during the same period in 15 early-adopter countries of HPV vaccines. Subgroup analyses were conducted by sex and age. The systematic review was prospectively registered in PROSPERO (registration number: CRD42023488463).

Findings: As of February 28, 2025, 148 WHO member states have incorporated the HPV vaccine into their national immunization programs. 132 countries reported HPV vaccination coverage estimates for the first dose and 129 countries reported full doses in 2023, and the weighted average coverage of the first and full dose of HPV vaccination in girls aged 9-14 years were 61.6% (95% CI: 50.9%-71.8%) and 47.6% (39.7%-57.4%) respectively. Among 132 countries, fifteen countries (11%) achieved 90% coverage for the first dose. Upper-middle income countries presented the highest coverage, with 71.7% (95% CI: 59.1%-78.6%) for the first dose. Age-specific analysis revealed that vaccination coverage of China peaked in women in 20-24 age group and was lowest in 9-14. Time trend analysis demonstrated that in most assessed countries, cervical cancer incidence is showing a declining trend.

Interpretation: Global HPV vaccination coverage remains significantly below the target of 90%. Strategies to effectively enhance HPV vaccination coverage must be identified, developed, and implemented to address this gap.

Funding: CAMS Innovation Fund for Medical Sciences (2021-I2M-1-004, 2023-I2M-3-019); National High Level Hospital Clinical Research Funding (2022-PUMCH-D-003); Supported by Sanming Project of Medicine in Shenzhen (SZSM202311011).

Keywords: Cervical cancer; Human papillomavirus; Vaccination coverage; Vaccination program.