HPV vaccine: Difference between revisions

{{Short description|Class of vaccines against human papillomavirus}}

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{{Use dmy dates|date=July 2024}}

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{{Infobox drug

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<!-- Vaccine data -->

| target = [[Human papillomavirus infection|Human papillomavirus]] (HPV)

| vaccine_type = protein

<!-- Clinical data -->

| tradename = [[Gardasil]], others

| Drugs.com = {{drugs.com|monograph|human-papillomavirus-vaccine}}

| MedlinePlus = a615028

| DailyMedID = Human papillomavirus vaccine

| pregnancy_AU = B2

| pregnancy_AU_comment = <ref name="Drugs.com pregnancy">{{cite web | title=Human papillomavirus vaccine Use During Pregnancy | website=Drugs.com | date=11 February 2019 | url=https://www.drugs.com/pregnancy/human-papillomavirus-vaccine.html | access-date=3 April 2020 | archive-date=5 April 2020 | archive-url=https://web.archive.org/web/20200405152555/https://www.drugs.com/pregnancy/human-papillomavirus-vaccine.html | url-status=live }}</ref>

| pregnancy_category =

| routes_of_administration = [[Intramuscular]] injection

| ATC_supplemental = {{ATC|J07|BM02}} {{ATC|J07|BM03}}

<!-- Legal status -->

| legal_AU = S4

| legal_AU_comment = <ref>{{cite web | title=Gardasil HPV 6 L1 Protein / HPV 11 L1 Protein / HPV 16 L1 Protein / HPV 18 L1 Protein 20,40,40,20 micrograms/0.5mL sterile liquid syringe | website=Therapeutic Goods Administration (TGA) | url=https://search.tga.gov.au/s/search.html?collection=tga-artg&profile=record&meta_i=124410 | access-date=8 July 2022 | archive-date=8 July 2022 | archive-url=https://web.archive.org/web/20220708052620/https://search.tga.gov.au/s/search.html?collection=tga-artg&profile=record&meta_i=124410 | url-status=live }}</ref><ref>{{cite web | title=Gardasil 9 Human Papillomavirus 9-valent Vaccine, Recombinant, 30, 40, 60, 40, 20, 20, 20, 20, 20 micrograms/0.5mL, suspension for injection, syringe | website=Therapeutic Goods Administration (TGA) | url=https://search.tga.gov.au/s/search.html?collection=tga-artg&profile=record&meta_i=224092 | access-date=8 July 2022 | archive-date=8 July 2022 | archive-url=https://web.archive.org/web/20220708052623/https://search.tga.gov.au/s/search.html?collection=tga-artg&profile=record&meta_i=224092 | url-status=live }}</ref><ref>{{cite web | title=Gardasil 9 Human Papillomavirus 9-valent Vaccine, Recombinant, 30, 40, 60, 40, 20, 20, 20, 20, 20 micrograms / 0.5mL, suspension for injection, vial | website=Therapeutic Goods Administration (TGA) | url=https://search.tga.gov.au/s/search.html?collection=tga-artg&profile=record&meta_i=224093 | access-date=8 July 2022 | archive-date=8 July 2022 | archive-url=https://web.archive.org/web/20220708052623/https://search.tga.gov.au/s/search.html?collection=tga-artg&profile=record&meta_i=224093 | url-status=live }}</ref><ref>{{cite web | title=Gardasil (human papillomavirus vaccine) | website=Therapeutic Goods Administration (TGA) | date=24 June 2010 | url=https://www.tga.gov.au/alert/gardasil-human-papillomavirus-vaccine | access-date=8 July 2022 | archive-date=23 March 2022 | archive-url=https://web.archive.org/web/20220323081100/https://www.tga.gov.au/alert/gardasil-human-papillomavirus-vaccine | url-status=live }}</ref><ref>{{cite web | title=AusPAR: Human papillomavirus quadrivalent vaccine | website=Therapeutic Goods Administration (TGA) | date=24 February 2011 | url=https://www.tga.gov.au/auspar/auspar-human-papillomavirus-quadrivalent-vaccine | access-date=8 July 2022 | archive-date=18 June 2022 | archive-url=https://web.archive.org/web/20220618131328/https://www.tga.gov.au/auspar/auspar-human-papillomavirus-quadrivalent-vaccine | url-status=live }}</ref><ref>{{cite web | title=AusPAR: Human Papillomavirus 9 valent vaccine | website=Therapeutic Goods Administration (TGA) | date=16 January 2017 | url=https://www.tga.gov.au/auspar/auspar-human-papillomavirus-9-valent-vaccine | access-date=8 July 2022 | archive-date=4 April 2019 | archive-url=https://web.archive.org/web/20190404065603/https://www.tga.gov.au/auspar/auspar-human-papillomavirus-9-valent-vaccine | url-status=live }}</ref><ref>{{cite web | title=AusPAR: Human papillomavirus (Types 6, 11, 16 & 18) quadrivalent recombinant vaccine | website=Therapeutic Goods Administration (TGA) | date=7 June 2012 | url=https://www.tga.gov.au/auspar/auspar-human-papillomavirus-types-6-11-16-18-quadrivalent-recombinant-vaccine | access-date=8 July 2022 | archive-date=9 September 2017 | archive-url=https://web.archive.org/web/20170909223057/https://www.tga.gov.au/auspar/auspar-human-papillomavirus-types-6-11-16-18-quadrivalent-recombinant-vaccine | url-status=live }}</ref>

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| legal_BR_comment =

| legal_CA = Rx-only

| legal_CA_comment = /&nbsp;Schedule D<ref>{{cite web | title=Gardasil Product information | website=[[Health Canada]] | date=25 April 2012 | url=https://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=76882 | access-date=8 July 2022 | archive-date=8 July 2022 | archive-url=https://web.archive.org/web/20220708052622/https://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=76882 | url-status=live }}</ref><ref>{{cite web | title=Gardasil 9 Product information | website=[[Health Canada]] | date=25 April 2012 | url=https://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=92136 | access-date=8 July 2022 | archive-date=6 May 2021 | archive-url=https://web.archive.org/web/20210506190332/https://health-products.canada.ca/dpd-bdpp/info.do?lang=en&code=92136 | url-status=live }}</ref>

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| legal_UK = POM

| legal_UK_comment = <ref name="Gardasil 9 SmPC">{{cite web | title=Gardasil 9 suspension for injection - Summary of Product Characteristics (SmPC) | website=(emc) | date=24 January 2020 | url=https://www.medicines.org.uk/emc/product/7330 | access-date=3 April 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406051722/https://www.medicines.org.uk/emc/product/7330 | url-status=live }}</ref><ref>{{cite web | title=Gardasil suspension for injection - Summary of Product Characteristics (SmPC) | website=(emc) | date=7 May 2019 | url=https://www.medicines.org.uk/emc/product/261/ | access-date=3 April 2020 | archive-date=4 April 2020 | archive-url=https://web.archive.org/web/20200404064555/https://www.medicines.org.uk/emc/product/261/ | url-status=live }}</ref>

| legal_US_comment = <ref name="Gardasil FDA label">{{cite web | title=Gardasil- human papillomavirus quadrivalent- types 6, 11, 16, and 18 vaccine, recombinant injection, suspension | website=DailyMed | date=2 December 2020 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=30952400-0572-4431-9150-3a41affffb9a | access-date=31 March 2022 | archive-date=21 April 2022 | archive-url=https://web.archive.org/web/20220421112820/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=30952400-0572-4431-9150-3a41affffb9a | url-status=live }}</ref><ref name="Gardasil 9 FDA label">{{cite web | title=Gardasil 9- human papillomavirus 9-valent vaccine, recombinant injection, suspension | website=DailyMed | date=20 August 2021 | url=https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a21f4f4b-b891-4f25-b747-cb9ec7d865d6 | access-date=31 March 2022 | archive-date=5 April 2020 | archive-url=https://web.archive.org/web/20200405152553/https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=a21f4f4b-b891-4f25-b747-cb9ec7d865d6 | url-status=live }}</ref><ref>{{cite web | title=Cervarix | website=U.S. [[Food and Drug Administration]] (FDA) | date=4 October 2022 | url=https://www.fda.gov/vaccines-blood-biologics/vaccines/cervarix | access-date=9 October 2022 | id=STN:BL 125259 | archive-date=10 October 2022 | archive-url=https://web.archive.org/web/20221010032939/https://www.fda.gov/vaccines-blood-biologics/vaccines/cervarix | url-status=live }}</ref>

| legal_EU = Rx-only

| legal_EU_comment = <ref name="Silgard EPAR">{{cite web | title=Silgard EPAR | date=17 September 2018 | publisher=[[European Medicines Agency]] (EMA) | url=https://www.ema.europa.eu/en/medicines/human/EPAR/silgard | access-date=3 April 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406090611/https://www.ema.europa.eu/en/medicines/human/EPAR/silgard | url-status=live }}</ref><ref name="Gardasil 9 EPAR">{{cite web | title=Gardasil 9 EPAR | date=17 September 2018 | publisher=[[European Medicines Agency]] (EMA) | url=https://www.ema.europa.eu/en/medicines/human/EPAR/gardasil-9 | access-date=3 April 2020 | archive-date=6 April 2020 | archive-url=https://web.archive.org/web/20200406090607/https://www.ema.europa.eu/en/medicines/human/EPAR/gardasil-9 | url-status=live }} Text was copied from this source which is copyright European Medicines Agency. Reproduction is authorized provided the source is acknowledged.</ref><ref name="Gardasil EPAR">{{cite web | title=Gardasil EPAR | date=17 September 2018 | publisher=European Medicines Agency | url=https://www.ema.europa.eu/en/medicines/human/EPAR/gardasil | access-date=6 July 2022 | archive-date=11 June 2022 | archive-url=https://web.archive.org/web/20220611072549/https://www.ema.europa.eu/en/medicines/human/EPAR/gardasil | url-status=live }}</ref><ref name="Cervarix EPAR">{{cite web | title=Cervarix EPAR | website=European Medicines Agency (EMA) | date=20 September 2007 | url=https://www.ema.europa.eu/en/medicines/human/EPAR/cervarix | access-date=1 October 2024}}</ref>

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| legal_status = <!-- For countries not listed above -->

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}}

'''Human papillomavirus''' ('''HPV''') '''vaccines''' are [[vaccine]]s intended to provide [[acquired immunity]] against [[Human papillomavirus infection|infection by certain types of human papillomavirus]] (HPV).<ref name="WHO2022">{{cite journal|vauthors=((World Health Organization))|title=Human papillomavirus vaccines: WHO position paper (2022 update)|journal=[[Weekly Epidemiological Record]]|volume=97|issue=50|pages=645–672|date=December 2022|hdl=10665/365351|author-link=World Health Organization|hdl-access=free}}</ref> The first HPV vaccine became available in 2006.<ref name="WHO2022" /><ref>{{cite book |vauthors=((World Health Organization))|title=The immunological basis for immunization series: module 19: human papillomavirus infection |date=May 2011 |hdl=10665/44604 |isbn=9789241501590 |publisher=World Health Organization |hdl-access=free}}</ref> Currently there are six licensed HPV vaccines: three bivalent (protect against two types of HPV), two quadrivalent (against four), and [[Gardasil|one nonavalent vaccine]] (against nine)<ref name=WHOcurrentdata/><ref>{{cite journal | vauthors = Kash N, Lee MA, Kollipara R, Downing C, Guidry J, Tyring SK | title = Safety and Efficacy Data on Vaccines and Immunization to Human Papillomavirus | journal = Journal of Clinical Medicine | volume = 4 | issue = 4 | pages = 614–633 | date = April 2015 | pmid = 26239350 | pmc = 4470159 | doi = 10.3390/jcm4040614 | s2cid = 14149551 | doi-access = free }}</ref> All have excellent safety profiles and are highly efficacious, or have met immunobridging standards.<ref name="WHO2022" />{{rp|p=668}} All of them protect against HPV types 16 and 18, which are together responsible for approximately 70% of [[cervical cancer]] cases globally.<ref name=WHOcurrentdata/> The quadrivalent vaccines provide additional protection against HPV types 6 and 11.<ref name=WHOcurrentdata/> The nonavalent provides additional protection against HPV types 31, 33, 45, 52 and 58.<ref name=WHOcurrentdata/> It is estimated that [[Cancer immunoprevention|HPV vaccines may prevent]] 70% of cervical cancer, 80% of [[anal cancer]], 60% of [[vaginal cancer]], 40% of [[vulvar cancer]], and show more than 90% [[Vaccine efficacy|effectiveness]] in preventing [[HPV-positive oropharyngeal cancer]]s.<ref>{{cite journal | vauthors = De Vuyst H, Clifford GM, Nascimento MC, Madeleine MM, Franceschi S | title = Prevalence and type distribution of human papillomavirus in carcinoma and intraepithelial neoplasia of the vulva, vagina and anus: a meta-analysis | journal = International Journal of Cancer | volume = 124 | issue = 7 | pages = 1626–1636 | date = April 2009 | pmid = 19115209 | doi = 10.1002/ijc.24116 | s2cid = 24197494 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Takes RP, Wierzbicka M, D'Souza G, Jackowska J, Silver CE, Rodrigo JP, Dikkers FG, Olsen KD, Rinaldo A, Brakenhoff RH, Ferlito A | title = HPV vaccination to prevent oropharyngeal carcinoma: What can be learned from anogenital vaccination programs? | journal = Oral Oncology | volume = 51 | issue = 12 | pages = 1057–1060 | date = December 2015 | pmid = 26520047 | doi = 10.1016/j.oraloncology.2015.10.011 | s2cid = 23356354 }}</ref><ref>{{cite journal | vauthors = Thaxton L, Waxman AG | title = Cervical cancer prevention: immunization and screening 2015 | journal = The Medical Clinics of North America | volume = 99 | issue = 3 | pages = 469–477 | date = May 2015 | pmid = 25841595 | doi = 10.1016/j.mcna.2015.01.003 | s2cid = 2828633 }}</ref><ref name="StatPearls 2020">{{cite book |vauthors=Anjum F, Zohaib J |chapter=Oropharyngeal Squamous Cell Carcinoma |date=4 December 2020 |chapter-url=https://www.ncbi.nlm.nih.gov/books/NBK563268/ | title = StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |edition=Updated |id=Bookshelf ID: NBK563268 |doi=10.32388/G6TG1L |pmid=33085415 |s2cid=229252540 |via=[[NCBI]] |access-date=7 February 2021 |archive-date=11 June 2021 |archive-url=https://web.archive.org/web/20210611150638/https://www.ncbi.nlm.nih.gov/books/NBK563268/ |url-status=live }}</ref> They also protect against [[penile cancer]].<ref>{{cite web|url=https://www.cancer.org/cancer/risk-prevention/hpv/hpv-vaccines.html|title=HPV Vaccines|date=30 April 2024|access-date=1 September 2024|publisher=[[American Cancer Society]]|archive-date=13 September 2024|archive-url=https://web.archive.org/web/20240913081035/https://www.cancer.org/cancer/risk-prevention/hpv/hpv-vaccines.html|url-status=live}}</ref> [[Vaccine-preventable disease|They additionally prevent]] [[genital wart]]s (also known as anogenital warts), with the quadrivalent and nonavalent vaccines providing virtually complete protection.<ref name=WHOcurrentdata/><ref name="WHO2022" /> The WHO recommends a one or two-dose schedule for girls aged 9–14 years, the same for girls and women aged 15–20 years, and two doses with a 6-month interval for women older than 21 years.<ref>{{Cite web|date=20 December 2022|title=WHO updates recommendations on HPV vaccination schedule|url=https://www.who.int/news/item/20-12-2022-WHO-updates-recommendations-on-HPV-vaccination-schedule|website=[[World Health Organization]]|access-date=6 October 2024}}</ref><ref name="WHO2022" /> The vaccines provide protection for at least five to ten years.<ref name="WHO2022" />

The primary target group in most of the countries recommending HPV [[vaccination]] is young adolescent girls, aged 9–14.<ref name=WHOcurrentdata/> The [[vaccination schedule]] depends on the age of the vaccine recipient.<ref name=WHOcurrentdata/> As of 2023, 27% of girls aged 9–14 years worldwide received at least one dose (37 countries were implementing the single-dose schedule, 45% of girls aged 9–14 years old vaccinated in that year).<ref name=WHO4October2024>{{Cite web|date=4 October 2024|title=WHO adds an HPV vaccine for single-dose use|url=https://www.who.int/news/item/04-10-2024-who-adds-an-hpv-vaccine-for-single-dose-use|website=[[World Health Organization]]|access-date=5 October 2024}}</ref><ref name=WHO15July2024>{{Cite web|title=Immunization coverage|url=https://www.who.int/news-room/fact-sheets/detail/immunization-coverage|website=[[World Health Organization]]|date=15 July 2024|access-date=6 October 2024}}</ref> As of September 2024, 57 countries are implementing the single-dose schedule.<ref name=WHO4October2024/> At least 144 countries (at least 74% of WHO member states) provided the HPV vaccine in their national immunization schedule for girls, as of November 2024.<ref name=WHO17November2024>{{Cite web|date=17 November 2024|title=WHO and partners rally cervical cancer elimination efforts|url=https://www.who.int/news/item/17-11-2024-who-and-partners-rally-cervical-cancer-elimination-efforts|author=<!--Not stated-->|publisher=[[World Health Organization]]|access-date=17 November 2024}}</ref><ref name=WHO15July2024/> As of 2022, 47 countries (24% of WHO member states) also did it for boys.<ref name="WHO2022" />{{rp|p=654}} Vaccinating a large portion of the population may also benefit the unvaccinated by way of [[herd immunity]].<ref name="Cervical cancer prevention in Austr">{{cite journal | vauthors = Saville AM | title = Cervical cancer prevention in Australia: Planning for the future | journal = Cancer Cytopathology | volume = 124 | issue = 4 | pages = 235–240 | date = April 2016 | pmid = 26619381 | doi = 10.1002/cncy.21643 | doi-access = free }}</ref>

The HPV vaccine is on the [[WHO Model List of Essential Medicines|World Health Organization's List of Essential Medicines]].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> The [[World Health Organization]] (WHO) recommends HPV vaccines as part of [[routine vaccinations]] in all countries, along with other prevention measures.<ref name="WHO2022" /> The WHO's priority purpose of HPV immunization is the [[Cancer prevention|prevention of cervical cancer]], which accounts for 82% of all HPV-related cancers and more than 95% of which are caused by HPV.<ref name="WHO2022" /><ref name=WHO4October2024 /> 88% (2020 figure) of cervical cancers and 90% of deaths occur in low- and middle-income countries and 2% (2020 figure) in high-income countries.<ref name="WHO2022" />{{rp|p=650}}<ref name=WHO4October2024 /> The WHO-recommended primary target population for HPV vaccination is girls aged 9–14 years before they become sexually active.<ref name="WHO2022" />{{rp|p=669}} It aims the introduction of the HPV vaccine in all countries and has set a target of reaching a coverage of 90% of girls fully vaccinated with HPV vaccine by age 15 years.<ref name=WHO15July2024/><ref>{{Cite web|title=Global strategy to accelerate the elimination of cervical cancer as a public health problem|url=https://www.who.int/publications/i/item/9789240014107|website=[[World Health Organization]]|date=17 November 2020|access-date=6 October 2024}}</ref> Females aged ≥15 years, boys, older males or [[men who have sex with men]] (MSM) are secondary target populations.<ref name="WHO2022" /> HPV vaccination is the most cost-effective public health measure against cervical cancer, particularly in resource-constrained settings.<ref name=WHOImmunizingagainstHPV>{{Cite web|title=Immunizing against HPV|url=https://www.who.int/activities/immunizing-against-hpv|website=[[World Health Organization]]|access-date=6 October 2024}}</ref><ref name="WHO2022" />{{rp|p=666}} [[Cervical cancer screening]] is still required following vaccination.<ref name="WHO2022" />

{{TOC limit}}

==Preventive vaccines==

A growing number of vaccine products initially prequalified for use in a 2-dose schedule can now be used in a single-dose schedule.<ref name=WHO4October2024 />

Cecolin (WHO prequalified HPV vaccine product, confirmed for use in a single-dose schedule), in the second edition of WHO's technical document on considerations for HPV vaccine product choice<ref name=WHO4October2024 />

[[Cervarix]] (bivalent)<ref name=WHO4October2024 />

[[Gardasil]] (quadrivalent) and Gardasil 9 nonavalent vaccine)<ref name=WHO4October2024 />

Walrinvax (WHO prequalified with a two-dose schedule on 2 August 2024)<ref name=WHO4October2024 />

==Medical uses==

[[File:HPV Vaccine Gardasil 9 box.jpg|thumb|Gardasil 9]]

[[File:HPV-vaccine- Gardasil2016JAPAN.jpg|thumb|A Gardasil Syringe]]

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HPV vaccines are used to prevent [[Human papillomavirus infection|HPV infection]] and therefore in particular [[cervical cancer]].<ref name="WHO2022" /> Vaccinating females between the ages of nine to thirteen is typically recommended, with many countries also vaccinating males in that age range.<ref name="WHO2022" /> In the United States, the [[Centers for Disease Control and Prevention]] (CDC) recommends that all 11- to 12-year-olds receive two doses of HPV vaccine, administered 6 to 12 months apart.<ref name="cdc-hpv-know">{{Cite web |date=6 May 2022 |title=HPV Vaccination: What Everyone Should Know |url=https://www.cdc.gov/vaccines/vpd/hpv/public/index.html |access-date=22 February 2023 |website=[[CDC]] |language=en-us |archive-date=13 May 2022 |archive-url=https://web.archive.org/web/20220513094542/https://www.cdc.gov/vaccines/vpd/hpv/public/index.html |url-status=live }}</ref> The vaccines require three doses for those ages 15 and above.<ref name="WHO2022" /> Gardasil is a three-dose (injection) vaccine. HPV vaccines are recommended in the United States for women and men who are 9–26 years of age and are also approved for those who are 27–45 years of age.<ref name="FDA 27-45" /><ref name=pmid31415491>{{cite journal | vauthors = Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE | title = Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 68 | issue = 32 | pages = 698–702 | date = August 2019 | pmid = 31415491 | pmc = 6818701 | doi = 10.15585/mmwr.mm6832a3 | url = https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6832a3-H.pdf | access-date = 15 October 2019 | url-status = live | archive-url = https://web.archive.org/web/20191013044039/https://www.cdc.gov/mmwr/volumes/68/wr/pdfs/mm6832a3-H.pdf | archive-date = 13 October 2019 }}</ref>

HPV vaccination of a large percentage of people within a population has been shown to decrease rates of HPV infections, with part of the benefit from [[herd immunity]].<ref name="WHO2022" /><ref>{{cite journal | vauthors = Drolet M, Bénard É, Pérez N, Brisson M | title = Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis | journal = Lancet | volume = 394 | issue = 10197 | pages = 497–509 | date = August 2019 | pmid = 31255301 | pmc = 7316527 | doi = 10.1016/S0140-6736(19)30298-3 }}</ref> Since the vaccines only cover some high-risk types of HPV, [[cervical cancer screening]] is recommended even after vaccination.<ref name="WHO2022" /><ref name="National Cancer Institute HPV Q&A">{{cite web |url=http://www.cancer.gov/cancertopics/factsheet/risk/HPV-vaccine |title=Human Papillomavirus (HPV) Vaccines: Q & A |work=Fact Sheets: Risk Factors and Possible Causes |publisher=[[National Cancer Institute]] (NCI) |date=22 October 2009 |access-date=18 July 2008 |url-status=live |archive-url=https://web.archive.org/web/20080621065557/http://www.cancer.gov/cancertopics/factsheet/risk/HPV-vaccine |archive-date=21 June 2008}}</ref> In the US, the recommendation is for women to receive routine Pap smears beginning at age 21.<ref>{{Cite web |url=https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening2?ds=1&s=PAP |title=Cervical Cancer: Screening |website=[[United States Preventive Services Task Force]] (USPSTF) |date=August 2018 |access-date=7 November 2018 |archive-url=https://web.archive.org/web/20181107185546/https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/cervical-cancer-screening2?ds=1&s=PAP |archive-date=7 November 2018 |url-status=live}}</ref> In Australia, the national screening program has changed from the two yearly cytology (pap smears) to being based on tests for HPV DNA,<ref name="Cox_2018">{{cite journal | vauthors = Cox B, Sneyd MJ | title = HPV screening, invasive cervical cancer and screening policy in Australia | journal = Journal of the American Society of Cytopathology | volume = 7 | issue = 6 | pages = 292–299 | date = 2018 | pmid = 31043298 | doi = 10.1016/j.jasc.2018.07.003 | s2cid = 58548623 }}</ref> based on work by [[Karen Canfell]] and others.<ref name="Lew_2017">{{cite journal | vauthors = Lew JB, Simms KT, Smith MA, Hall M, Kang YJ, Xu XM, Caruana M, Velentzis LS, Bessell T, Saville M, Hammond I, Canfell K | title = Primary HPV testing versus cytology-based cervical screening in women in Australia vaccinated for HPV and unvaccinated: effectiveness and economic assessment for the National Cervical Screening Program | journal = The Lancet. Public Health | volume = 2 | issue = 2 | pages = e96–e107 | date = February 2017 | pmid = 29253402 | doi = 10.1016/S2468-2667(17)30007-5 | doi-access = free }}</ref> As of 2021, the World Health Organization recommends HPV DNA testing as the preferred screening method.<ref>{{cite web | title=WHO recommends DNA testing as a first-choice screening method for cervical cancer prevention | website=World Health Organization (WHO) | date=11 September 2021 | url=https://www.who.int/europe/news/item/11-09-2021-who-recommends-dna-testing-as-a-first-choice-screening-method-for-cervical-cancer-prevention | access-date=1 October 2024}}</ref><ref>{{cite book | title=WHO guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention | publisher=[[World Health Organization]] (WHO) | date=6 July 2021 | url=https://www.who.int/publications/i/item/9789240030824 | access-date=1 October 2024 | edition= 2nd | isbn=978-92-4-003082-4 }}</ref>

[[File:HPV Vaccination and Cervical Cancer Incidence A Global Perspective (2021).png|thumb|HPV adolescent girls vaccination rates (2023 estimated figures) and cervical cancer cases per 100,000 people across global regions (2021 figures).]]

===Efficacy===

The HPV vaccine has been shown to prevent [[cervical dysplasia]] from the high-risk HPV types 16 and 18 and provide some protection against a few closely related high-risk HPV types.<ref name="WHO2022" /><ref name=Arbyn2018>{{cite journal | vauthors = Arbyn M, Xu L, Simoens C, Martin-Hirsch PP | title = Prophylactic vaccination against human papillomaviruses to prevent cervical cancer and its precursors | journal = The Cochrane Database of Systematic Reviews | volume = 5 | issue = 3 | pages = CD009069 | date = May 2018 | pmid = 29740819 | pmc = 4176676 | doi = 10.1002/14651858.CD009069.pub3 | id = CD009069 }}</ref> However, other high-risk HPV types are not affected by the vaccine.<ref name="Lancet" /> The protection against HPV 16 and 18 has lasted at least eight years after vaccination for Gardasil<ref name="De_Vincenzo">{{cite journal | vauthors = De Vincenzo R, Conte C, Ricci C, Scambia G, Capelli G | title = Long-term efficacy and safety of human papillomavirus vaccination | journal = International Journal of Women's Health | volume = 6 | pages = 999–1010 | date = 3 December 2014 | pmid = 25587221 | pmc = 4262378 | doi = 10.2147/IJWH.S50365 | doi-access = free }}</ref> and more than nine years for Cervarix.<ref name=De_Vincenzo /> It is thought that booster vaccines will not be necessary.<ref>{{cite journal | vauthors = | title = Committee opinion no. 467: human papillomavirus vaccination | journal = Obstetrics and Gynecology | volume = 116 | issue = 3 | pages = 800–803 | date = September 2010 | pmid = 20733476 | doi = 10.1097/AOG.0b013e3181f680c8 | doi-access = free }}</ref>

As of September 2024, 57 countries are implementing the single-dose schedule.<ref name=WHO4October2024/> A growing number of vaccine products initially prequalified for use in a 2-dose schedule can now be used in a single-dose schedule.<ref name=WHO4October2024 /> Before, it was unsure whether two doses of the vaccine may work as well as three doses.<ref>{{cite journal | vauthors = Jit M, Brisson M, Laprise JF, Choi YH | title = Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model | journal = BMJ | volume = 350 | pages = g7584 | date = January 2015 | pmid = 25567037 | pmc = 4285892 | doi = 10.1136/bmj.g7584 }}</ref> The US [[Centers for Disease Control and Prevention]] (CDC) recommends two doses in those less than 15 years and three doses in those over 15 years.<ref>{{cite web |title=Meeting of the Advisory Committee on Immunization Practices (ACIP) |url=https://www.cdc.gov/vaccines/acip/meetings/downloads/agenda-archive/agenda-2016-10.pdf |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=21 October 2016 |date=14 October 2016 |url-status=live |archive-url=https://web.archive.org/web/20161021070110/http://www.cdc.gov/vaccines/acip/meetings/downloads/agenda-archive/agenda-2016-10.pdf |archive-date=21 October 2016}}</ref> A single dose might be effective.<ref>{{cite journal | vauthors = Sonawane K, Nyitray AG, Nemutlu GS, Swartz MD, Chhatwal J, Deshmukh AA | title = Prevalence of Human Papillomavirus Infection by Number of Vaccine Doses Among US Women | journal = JAMA Network Open | volume = 2 | issue = 12 | pages = e1918571 | date = December 2019 | pmid = 31880792 | pmc = 6986697 | doi = 10.1001/jamanetworkopen.2019.18571 }}</ref><ref name="Zou 2023">{{cite journal | vauthors = Zou Z, Zhang L | title = The one-dose schedule opens the door to rapid scale-up of HPV vaccination | journal = BMC Medicine | volume = 21 | issue = 1 | pages = 387 | date = October 2023 | pmid = 37807059 | doi = 10.1186/s12916-023-03097-x | pmc = 10561457 | doi-access = free }}</ref><ref name="Markowitz 2023">{{cite journal | vauthors = Markowitz LE, Unger ER | title = Human Papillomavirus Vaccination | journal = The New England Journal of Medicine | volume = 388 | issue = 19 | pages = 1790–1798 | date = May 2023 | pmid = 37163625 | doi = 10.1056/NEJMcp2108502 | pmc = 11567082 | s2cid = 264642213 }}</ref><ref name="WHO 2022">{{cite web |title=One-dose Human Papillomavirus (HPV) vaccine offers solid protection against cervical cancer |url=https://www.who.int/news/item/11-04-2022-one-dose-human-papillomavirus-(hpv)-vaccine-offers-solid-protection-against-cervical-cancer |website=www.who.int |language=en |access-date=31 October 2023 |archive-date=16 May 2022 |archive-url=https://web.archive.org/web/20220516014759/https://www.who.int/news/item/11-04-2022-one-dose-human-papillomavirus-(hpv)-vaccine-offers-solid-protection-against-cervical-cancer |url-status=live }}</ref>

A study with 9vHPV, a 9-valent HPV vaccine that protects against HPV types 6, 11, 16, 18, 31, 33, 45, 52, and 58, came to the result that the rate of high-grade cervical, vulvar, or vaginal disease was the same as when using a quadrivalent HPV vaccine.<ref name="pmid25693011">{{cite journal | vauthors = Joura EA, Giuliano AR, Iversen OE, Bouchard C, Mao C, Mehlsen J, Moreira ED, Ngan Y, Petersen LK, Lazcano-Ponce E, Pitisuttithum P, Restrepo JA, Stuart G, Woelber L, Yang YC, Cuzick J, Garland SM, Huh W, Kjaer SK, Bautista OM, Chan IS, Chen J, Gesser R, Moeller E, Ritter M, Vuocolo S, Luxembourg A | title = A 9-valent HPV vaccine against infection and intraepithelial neoplasia in women | journal = The New England Journal of Medicine | volume = 372 | issue = 8 | pages = 711–723 | date = February 2015 | pmid = 25693011 | doi = 10.1056/NEJMoa1405044 | doi-access = free }}</ref> A lack of a difference may have been caused by the study design of including women 16 to 26 years of age, who may largely already have been infected with the five additional HPV types that are additionally covered by the 9-valent vaccine.<ref>{{cite journal | vauthors = Schuchat A | title = HPV "coverage" | journal = The New England Journal of Medicine | volume = 372 | issue = 8 | pages = 775–776 | date = February 2015 | pmid = 25693018 | pmc = 6009818 | doi = 10.1056/NEJMe1415742 }}</ref>

Neither Cervarix nor Gardasil prevent other sexually transmitted infections, and they do not treat existing HPV infections or cervical cancer.<ref name=pmid_17380109>{{cite journal | vauthors = Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER | title = Quadrivalent Human Papillomavirus Vaccine: Recommendations of the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Recommendations and Reports | volume = 56 | issue = RR-2 | pages = 1–24 | date = March 2007 | pmid = 17380109 | url = https://www.cdc.gov/mmwr/pdf/rr/rr5602.pdf | url-status = live | archive-url = https://web.archive.org/web/20150924044909/http://www.cdc.gov/mmwr/pdf/rr/rr5602.pdf | archive-date = 24 September 2015 }}</ref><ref name=CDC-HPV>{{cite web |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |url=https://www.cdc.gov/hpv/parents/vaccine.html |title=HPV Vaccines |date=15 October 2010 |access-date=27 February 2011 |url-status=live |archive-url=https://web.archive.org/web/20151004003353/http://www.cdc.gov/hpv/parents/vaccine.html |archive-date=4 October 2015}}</ref>

====Gardasil====

When Gardasil was first introduced, it was recommended as a prevention for cervical cancer for women 25 years old or younger.<ref name=pmid31415491 /> Evidence suggests that HPV vaccines are effective in preventing cervical cancer for women up to 45 years of age.<ref name="FDA 27-45">{{cite press release |title=FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old |website=U.S. [[Food and Drug Administration]] (FDA) |date=5 October 2018 |url=https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old |archive-url=https://web.archive.org/web/20191014194303/https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old |archive-date=14 October 2019 |url-status=live |access-date=14 October 2018}}</ref>

[[Gardasil|Gardasil and Gardasil 9]] protect against HPV types 6 and 11 which can cause [[genital wart]]s, with the quadrivalent and nonavalent vaccines providing virtually complete protection.<ref name=WHOcurrentdata/><ref name="Gardasil FDA label" /><ref name="Gardasil 9 FDA label" /><ref name="WHO2022" />

====Adenocarcinoma====

HPV types 16, 18, and 45 contribute to 94% of cervical [[adenocarcinoma]] (cancers originating in the glandular cells of the cervix).<ref name=Tay /> While most cervical cancer arises in the squamous cells, adenocarcinomas make up a sizable minority of cancers.<ref name=Tay /> Further, [[Pap smears]] are not as effective at detecting [[adenocarcinomas]], so where Pap screening programs are in place, a larger proportion of the remaining cancers are adenocarcinomas.<ref name=Tay /> Trials suggest that HPV vaccines may also reduce the incidence of adenocarcinoma.<ref name=Tay />

===Males===

As of 2022, 47 countries (24% of WHO member states) have introduced HPV vaccine in their national immunization programme for boys.<ref name="WHO2022" />{{rp|p=654}} For instance, it is the case in Switzerland, Portugal, Canada, Australia, Ireland, South Korea, Hong Kong, the United Kingdom, New Zealand, the Netherlands, and the United States.<ref name="FDA2018">{{cite web |title=FDA approves expanded use of Gardasil 9 to include individuals 27 through 45 years old |url=https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old |publisher=U.S. [[Food and Drug Administration]] (FDA) |access-date=9 November 2019 |archive-url=https://web.archive.org/web/20191014194303/https://www.fda.gov/news-events/press-announcements/fda-approves-expanded-use-gardasil-9-include-individuals-27-through-45-years-old |archive-date=14 October 2019 |url-status=live}}</ref><ref name="CanadaHPV">{{cite web |title=Human Papillomavirus (HPV) Prevention and HPV Vaccines: Questions and Answers |url=https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/hpv-prevention-vaccines-questions-answers.html#a3 |publisher=Public Health Agency of Canada |access-date=9 November 2019 |archive-url=https://web.archive.org/web/20190926001324/https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/hpv-prevention-vaccines-questions-answers.html#a3 |archive-date=26 September 2019 |url-status=live |date=18 June 2007}}</ref>

In males also, [[Gardasil|Gardasil and Gardasil 9]] protect against HPV types 6 and 11 which can cause [[genital wart]]s, with the quadrivalent and nonavalent vaccines providing virtually complete protection.<ref name=WHOcurrentdata/><ref name="Gardasil FDA label" /><ref name="Gardasil 9 FDA label" /><ref name="WHO2022" /> They reduce their risk of [[precancerous]] lesions caused by HPV. This reduction in precancerous lesions is predicted to reduce the rates of penile and anal cancer in men. Gardasil has been shown to also be effective in preventing high-risk HPV types 16 and 18 in males.<ref name=FDA-male-aprove>{{cite press release |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm |title=FDA Approves New Indication for Gardasil to Prevent Genital Warts in Men and Boys |publisher=U.S. [[Food and Drug Administration]] (FDA) |access-date=30 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20091024164856/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm187003.htm |archive-date=24 October 2009}}</ref><ref name=pmid_20508594>{{cite journal | title = FDA licensure of quadrivalent human papillomavirus vaccine (HPV4, Gardasil) for use in males and guidance from the Advisory Committee on Immunization Practices (ACIP) | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 59 | issue = 20 | pages = 630–632 | date = May 2010 | pmid = 20508594 | url = https://www.cdc.gov/mmwr/pdf/wk/mm5920.pdf | url-status = live | archive-url = https://web.archive.org/web/20150924044945/http://www.cdc.gov/mmwr/pdf/wk/mm5920.pdf | archive-date = 24 September 2015 | author1 = Centers for Disease Control and Prevention (CDC) }}</ref><ref>{{cite journal | vauthors = Chow EP, Carter A, Vickers T, Fairley CK, McNulty A, Guy RJ, Regan DG, Grulich AE, Callander D, Khawar L, Machalek DA, Donovan B | title = Effect on genital warts in Australian female and heterosexual male individuals after introduction of the national human papillomavirus gender-neutral vaccination programme: an analysis of national sentinel surveillance data from 2004-18 | journal = The Lancet. Infectious Diseases | volume = 21 | issue = 12 | pages = 1747–1756 | date = December 2021 | pmid = 34339639 | doi = 10.1016/S1473-3099(21)00071-2 | hdl = 1959.4/unsworks_81211 | s2cid = 236884872 | url = https://unsworks.unsw.edu.au/bitstreams/43a94475-416d-4eb3-99ee-9b6a24460197/download }}</ref><ref>{{cite journal | vauthors = Chow EP, Read TR, Wigan R, Donovan B, Chen MY, Bradshaw CS, Fairley CK | title = Ongoing decline in genital warts among young heterosexuals 7 years after the Australian human papillomavirus (HPV) vaccination programme | journal = Sexually Transmitted Infections | volume = 91 | issue = 3 | pages = 214–219 | date = May 2015 | pmid = 25305210 | doi = 10.1136/sextrans-2014-051813 | s2cid = 24549759 }}</ref><ref>{{cite journal | vauthors = Chow EP, Tabrizi SN, Fairley CK, Wigan R, Machalek DA, Garland SM, Cornall AM, Atchison S, Hocking JS, Bradshaw CS, Balgovind P, Murray GL, Chen MY | title = Prevalence of human papillomavirus in young men who have sex with men after the implementation of gender-neutral HPV vaccination: a repeated cross-sectional study | journal = The Lancet. Infectious Diseases | volume = 21 | issue = 10 | pages = 1448–1457 | date = October 2021 | pmid = 34043963 | doi = 10.1016/S1473-3099(20)30687-3 | s2cid = 235230838 }}</ref><ref>{{cite journal | vauthors = Chow EP, Machalek DA, Tabrizi SN, Danielewski JA, Fehler G, Bradshaw CS, Garland SM, Chen MY, Fairley CK | title = Quadrivalent vaccine-targeted human papillomavirus genotypes in heterosexual men after the Australian female human papillomavirus vaccination programme: a retrospective observational study | journal = The Lancet. Infectious Diseases | volume = 17 | issue = 1 | pages = 68–77 | date = January 2017 | pmid = 27282422 | doi = 10.1016/S1473-3099(16)30116-5 }}</ref> While Gardasil and the Gardasil 9 vaccines have been approved for males, a third HPV vaccine, [[Cervarix]], has not. Unlike the Gardasil-based vaccines, Cervarix does not protect against genital warts.<ref>{{Cite web |title=Vaccine Information Statement |url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-cervarix.html |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=20 November 2015 |url-status=dead |archive-url=https://web.archive.org/web/20151121014704/http://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv-cervarix.html |archive-date=21 November 2015}}</ref>

Since penile and anal cancers are much less common than cervical cancer, HPV vaccination of young men is likely to be much less cost-effective than for young women.<ref name=NYTIMES0808>{{cite news | vauthors = Rosenthal E |work=[[The New York Times]] |date=19 August 2008 |url=https://www.nytimes.com/2008/08/20/health/policy/20vaccine.html |title=Drug Makers' Push Leads to Cancer Vaccines' Fast Rise |access-date=20 August 2008 |quote=Said Dr. Raffle, the British cervical cancer specialist: 'Oh, dear. If we give it to boys, then all pretense of scientific worth and cost analysis goes out the window.' |url-status=live |archive-url=https://web.archive.org/web/20090409005806/http://www.nytimes.com/2008/08/20/health/policy/20vaccine.html |archive-date=9 April 2009 }}</ref>

Gardasil is also used among [[men who have sex with men]] (MSM), who are at higher risk for genital warts, penile cancer, and anal cancer.<ref>{{cite web |url=http://info.cancerresearchuk.org/news/archive/cancernews/2007-02-23-gay-men-seeking-hpv-vaccine |work=[[Cancer Research UK]] |title=Gay men seeking HPV vaccine |date=23 February 2007 |access-date=30 October 2009 |url-status=dead |archive-url=https://web.archive.org/web/20100324231910/http://info.cancerresearchuk.org/news/archive/cancernews/2007-02-23-gay-men-seeking-hpv-vaccine |archive-date=24 March 2010}}</ref>

====Recommendations by national bodies====

=====Australia=====

Australia introduced HPV vaccination for boys in 2013.<ref>{{Citation |title=Karen Canfell: The road to cervical cancer elimination | date=25 March 2021 |url=https://www.youtube.com/watch?v=NvpcofhdIIE |language=en |access-date=14 April 2022 |archive-date=17 December 2021 |archive-url=https://web.archive.org/web/20211217005308/https://www.youtube.com/watch?v=NvpcofhdIIE&feature=youtu.be |url-status=live }}</ref>

===== Ireland =====

Ireland introduced HPV vaccination for boys aged 13 as part of their National Immunization Plan in 2019.<ref>{{Cite news |vauthors=Ní Aodha G |date=11 August 2019 |title=Explainer: The HPV vaccine is free for boys from next month - here's why that's important |language=en |work=thejournal.ie |url=https://www.thejournal.ie/hpv-vaccine-for-boys-immunity-4757706-Aug2019/ |access-date=6 January 2021 |archive-date=5 January 2021 |archive-url=https://web.archive.org/web/20210105102626/https://www.thejournal.ie/hpv-vaccine-for-boys-immunity-4757706-Aug2019/ |url-status=live }}</ref>

===== UK =====

UK introduced HPV vaccination for boys aged 12 as part of their National Immunization Plan in 2019.<ref>{{Cite news |date=2 September 2019 |title=What is the HPV vaccine for boys and are there any side effects? |url=https://www.standard.co.uk/news/health/hpv-vaccine-boys-side-effects-virus-symptoms-a4225181.html |url-status=live |archive-url=https://web.archive.org/web/20201107235957/https://www.standard.co.uk/news/health/hpv-vaccine-boys-side-effects-virus-symptoms-a4225181.html |archive-date=7 November 2020 |access-date=6 January 2021 |work=Evening Standard |language=en |vauthors=Herbert T}}</ref>

===== Portugal =====

Portugal introduced universal HPV vaccination for boys aged 10 years and above as part of its National Immunization Plan in 2020.<ref>{{Cite web |url=https://www.dn.pt/vida-e-futuro/vacinas-meningite-b-e-hpv-para-rapazes-passam-a-ser-obrigatorias-em-2020-11655276.html |title=Vacinas: Meningite B e HPV para rapazes passam a ser gratuitas em 2020 - DN |website=www.dn.pt |date=27 December 2019 |language=pt |access-date=30 January 2020 |archive-url=https://web.archive.org/web/20200130150553/https://www.dn.pt/vida-e-futuro/vacinas-meningite-b-e-hpv-para-rapazes-passam-a-ser-obrigatorias-em-2020-11655276.html |archive-date=30 January 2020 |url-status=live}}</ref>

=====United States=====

On 9 September 2009, an advisory panel recommended that the [[Food and Drug Administration]] (FDA) of the USA license Gardasil in the United States for boys and men ages 9–26 for the prevention of genital warts.<ref>{{cite journal | vauthors = Castle PE, Scarinci I | title = Should HPV vaccine be given to men? | journal = BMJ | volume = 339 | issue = 7726 | pages = b4127 | date = October 2009 | pmid = 19815585 | doi = 10.1136/bmj.b4127 | s2cid = 1922594 }}</ref> Soon after that, the vaccine was approved by the FDA for use in males aged 9 to 26 for prevention of genital warts<ref name="FDA-male-aprove" /><ref name="pmid_20508594" /> and [[anal cancer]].<ref name="FDA-anal-ca">{{cite press release |title=FDA: Gardasil approved to prevent anal cancer |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm237941.htm |year=2010 |publisher=U.S. [[Food and Drug Administration]] (FDA) |access-date=15 January 2015 |url-status=dead |archive-url=https://web.archive.org/web/20141218134237/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm237941.htm |archive-date=18 December 2014}}</ref><ref>{{cite web |title=Gardasil |website=U.S. [[Food and Drug Administration]] (FDA) |date=25 April 2019 |url=https://www.fda.gov/vaccines-blood-biologics/vaccines/gardasil |archive-url=https://web.archive.org/web/20191015074733/https://www.fda.gov/vaccines-blood-biologics/vaccines/gardasil |archive-date=15 October 2019 |url-status=live |access-date=15 October 2019 |id=STN 125126}}</ref><ref>{{cite web |title=Gardasil 9 |website=U.S. [[Food and Drug Administration]] (FDA) |date=25 April 2019 |url=https://www.fda.gov/vaccines-blood-biologics/vaccines/gardasil-9 |archive-url=https://web.archive.org/web/20191015075027/https://www.fda.gov/vaccines-blood-biologics/vaccines/gardasil-9 |archive-date=15 October 2019 |url-status=dead |access-date=15 October 2019 |id=STN 125508}}</ref>

In 2011, an advisory panel for the US [[Centers for Disease Control and Prevention]] (CDC) recommended the vaccine for boys ages 11–12.<ref name=pmid31415491 /> This was intended to prevent genital warts and anal cancers in males, and possibly prevent head and neck cancer (though the vaccine's effectiveness against head and neck cancers has not yet been proven).<ref>{{cite web | vauthors = Rettner R |title=Boys Should Get HPV Vaccine Too, CDC Says |date=25 October 2011 |url=http://www.livescience.com/16707-hpv-vaccine-boys-cdc-recommendations.html |publisher=[[LiveScience]] |access-date=11 November 2011 |url-status=live |archive-url=https://web.archive.org/web/20120703220809/http://www.livescience.com/16707-hpv-vaccine-boys-cdc-recommendations.html |archive-date=3 July 2012 }}</ref> The committee also made the vaccination recommendation for males 13 to 21 years who have not been vaccinated previously or who have not completed the three-dose series.<ref name=FDA-male-aprove /><ref>{{cite web |url=http://www.omaha.com/article/20111026/LIVEWELL01/710269893/1161 |archive-url=https://archive.today/20120905083115/http://www.omaha.com/article/20111026/LIVEWELL01/710269893/1161 |url-status=dead |archive-date=5 September 2012 |title=CDC panel recommends HPV vaccine for boys, too |date=26 October 2011}}</ref> For those under the age of 27 who have not been fully vaccinated the CDC recommends vaccination.<ref name=pmid31415491 />

Also in 2011, [[Harald zur Hausen]]'s support for vaccinating boys (so that they will be protected, and thereby so will women) was joined by professors Harald Moi and Ole-Erik Iversen.<ref>{{cite news |title=Gi guttene jentevaksine |newspaper=[[Dagens Næringsliv]] |date=17 December 2011 | vauthors = Moi H, Iversen OE |page=32 |language=no |quote=Zur Haussen, som fikk Nobelprisen i 2009 for sin HPV-forskning, har lenge argumentert for vaksinasjon av gutter, både som egen beskyttelse og beskyttelse av kvinner.}}</ref>

In 2018, the US [[Food and Drug Administration]] (FDA) released a summary basis for regulatory action and approval for expansion of usage and indication for Gardasil 9, the 9-valent HPV vaccine, to include men and women 27 to 45 years of age.<ref>{{Cite web |url=https://www.fda.gov/media/117054/download |title=Summary Basis for Regulatory Action | vauthors = Montague L |date=5 October 2018 |website=U.S. [[Food and Drug Administration]] (FDA) |archive-date=14 December 2019 |format=PDF |access-date=7 August 2019 |archive-url=https://web.archive.org/web/20191214034407/https://www.fda.gov/media/117054/download |url-status=live}}</ref>

===Public health===

====World Health Organization (WHO)====

The HPV vaccine is on the [[WHO Model List of Essential Medicines]].<ref name="WHO23rd">{{cite book | vauthors = ((World Health Organization)) | title = The selection and use of essential medicines 2023: web annex A: World Health Organization model list of essential medicines: 23rd list (2023) | year = 2023 | hdl = 10665/371090 | author-link = World Health Organization | publisher = World Health Organization | location = Geneva | id = WHO/MHP/HPS/EML/2023.02 | hdl-access=free }}</ref> The WHO recommends HPV vaccines as part of routine vaccinations in all countries, along with other prevention measures.<ref name="WHO2022" /> The WHO's priority purpose of HPV immunization is the prevention of cervical cancer, which accounts for 82% of all HPV-related cancers and more than 95% of which are caused by HPV.<ref name="WHO2022" /><ref name=WHO4October2024 /> The WHO has a global strategy for cervical cancer elimination.<ref name=WHO4October2024 /> Its first pillar is having 90% of girls fully vaccinated with the HPV vaccine by 15 years of age.<ref name=WHO4October2024 /> The WHO-recommended primary target population for HPV vaccination is girls aged 9–14 years before they become sexually active.<ref name="WHO2022" />{{rp|p=669}} Females aged ≥15 years, boys, older males or MSM are secondary target populations.<ref name="WHO2022" /> [[Cervical cancer screening]] is still required following vaccination.<ref name="WHO2022" />

====Global====

=====Cervical cancer=====

<blockquote>The large majority of cervical cancer cases in 2020 (88%) occurred in LMICs, where they account for 17% of all cancers in women, compared with only 2% in high-income countries (HICs). In sub-Saharan Africa, the region with the highest rates of young WLWH, approximately 20% of cervical cancer cases occur in WLWH [women living with HIV]. HPV infection is more likely to persist and to progress to cancer in WLWH.33 Mortality rates vary

50-fold between countries, ranging from <2 per 100 000 women in some HICs to >40 per 100 000 in some countries of sub-Saharan Africa.</blockquote><ref name="WHO2022" />{{rp|p=650}}

Of the 20 hardest hit countries by cervical cancer, 19 are in Africa.<ref name=WHO4October2024 />

The US [[National Cancer Institute]] states "Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds if all women were to take the vaccine and if protection turns out to be long-term. In addition, the vaccines can reduce the need for medical care, biopsies, and invasive procedures associated with the follow-up from abnormal Pap tests, thus helping to reduce health care costs and anxieties related to abnormal Pap tests and follow-up procedures."<ref name="National Cancer Institute HPV Q&A"/>

In 2004, preventive vaccines already protected against the two HPV types (16 and 18) that cause about 70% of cervical cancers worldwide.<ref name=Munoz2004 /> Because of the distribution of HPV types associated with cervical cancer, the vaccines were likely to be most effective in Asia, Europe, and North America.<ref name=Munoz2004 /> Some other high-risk types cause a larger percentage of cancers in other parts of the world.<ref name=Munoz2004 /> Vaccines that protect against more of the types common in cancers would prevent more cancers, and be less subject to regional variation.<ref name=Munoz2004 /> For instance, a vaccine against the seven types most common in cervical cancers (16, 18, 45, 31, 33, 52, 58) would prevent an estimated 87% of cervical cancers worldwide.<ref name=Munoz2004 />

In 2008, only 41% of women with cervical cancer in the developing world got medical treatment.<ref>{{cite journal | vauthors = Wittet S, Tsu V | title = Cervical cancer prevention and the Millennium Development Goals | journal = Bulletin of the World Health Organization | volume = 86 | issue = 6 | pages = 488–490 | date = June 2008 | pmid = 18568279 | pmc = 2647477 | doi = 10.2471/BLT.07.050450 | doi-broken-date = 11 November 2024 }}</ref> Therefore, prevention of HPV by vaccination may be a more effective way of lowering the disease burden in developing countries than cervical screening. The [[ESGO|European Society of Gynecological Oncology]] sees the developing world as most likely to benefit from HPV vaccination.<ref name="ESGO Statement on Cervical Cancer Vaccination">{{cite web |url=http://www.esgo.org/About_ESGO/Documents/Statement_HPV.pdf |title=ESGO Statement on Cervical Cancer Vaccination |publisher=ESGO |year=2007 |url-status=dead |archive-url=https://web.archive.org/web/20110726035137/http://www.esgo.org/About_ESGO/Documents/Statement_HPV.pdf |archive-date=26 July 2011}}</ref> However, individuals in many resource-limited nations, Kenya for example, are unable to afford the vaccine.<ref name="Cervarix Marketing in Kenya">{{cite web |url=http://www.medicalnewstoday.com/articles/81239.php |work=Medical News Today |title=Cervarix Marketing in Kenya |access-date=17 September 2010 |url-status=dead |archive-url=https://web.archive.org/web/20090103231515/http://www.medicalnewstoday.com/articles/81239.php |archive-date=3 January 2009}}</ref>

In more developed countries, populations that do not receive adequate medical care, such as the poor or minorities in the United States or parts of Europe also have less access to cervical screening and appropriate treatment, and are similarly more likely to benefit.<ref name=Tay>|{{cite journal | vauthors = Tay SK | title = Cervical cancer in the human papillomavirus vaccination era | journal = Current Opinion in Obstetrics & Gynecology | volume = 24 | issue = 1 | pages = 3–7 | date = February 2012 | pmid = 22123221 | doi = 10.1097/GCO.0b013e32834daed9 | s2cid = 23213383 }}</ref> In 2009, Dr. [[Diane Harper]], a researcher for the HPV vaccines, questioned whether the benefits of the vaccine outweigh its risks in countries where Pap smear screening is common.<ref>{{cite news |title=Gardasil Researcher Speaks Out |vauthors=Attkisson S |url=https://www.cbsnews.com/news/gardasil-researcher-speaks-out/ |work=CBS News |date=19 August 2009 |access-date=3 March 2022 |archive-date=3 March 2022 |archive-url=https://web.archive.org/web/20220303215612/https://www.cbsnews.com/news/gardasil-researcher-speaks-out/ |url-status=live }}</ref> She has also encouraged women to continue pap screening after they are vaccinated and to be aware of potential adverse effects.<ref>{{cite news |title=An Interview with Dr. Diane M. Harper, HPV Expert | vauthors = Yerman MG |url=https://www.huffingtonpost.com/marcia-g-yerman/an-interview-with-dr-dian_b_405472.html |newspaper=Huffington Post |date=28 December 2009 |access-date=28 August 2013 |url-status=live |archive-url=https://web.archive.org/web/20130813024347/http://www.huffingtonpost.com/marcia-g-yerman/an-interview-with-dr-dian_b_405472.html |archive-date=13 August 2013}}</ref>

=====United States=====

In 2012, according to the CDC, the use of the HPV vaccine had cut rates of infection with HPV-6, -11, -16, and -18 in half in American teenagers (from 11.5% to 4.3%) and by one-third in American women in their early twenties (from 18.5% to 12.1%).<ref name=Forbes>{{cite web | vauthors = Haelle T |author-link=Tara Haelle |url=https://www.forbes.com/sites/tarahaelle/2016/02/23/hpv-infection-rates-plummet-in-young-women-due-to-vaccine/ |title=HPV Infection Rates Plummet In Young Women Due To Vaccine |work=Forbes |date=23 February 2016 |access-date=23 February 2016 |url-status=live |archive-url=https://web.archive.org/web/20160226093032/http://www.forbes.com/sites/tarahaelle/2016/02/23/hpv-infection-rates-plummet-in-young-women-due-to-vaccine/ |archive-date=26 February 2016 }}</ref>

== Side effects ==

HPV vaccines are safe and well tolerated and can be used in persons who are immunocompromised or HIV-infected.<ref>{{cite journal|vauthors=((World Health Organization))|title=Human papillomavirus vaccines: WHO position paper (2022 update)|journal=[[Weekly Epidemiological Record]]|volume=97|issue=50|page=671|date=December 2022 |hdl=10665/365351|author-link = World Health Organization|hdl-access=free}}</ref> Pain at the site of injection occurs in between 35% and 88% of people<ref name="WHO2022" />{{rp|p=664}} Redness and swelling at the site and [[fever]] may also occur.<ref name="WHO2022" /> No link to [[Guillain–Barré syndrome]] has been found.<ref name="WHO2022" /> There is no increased risk of serious adverse effects.<ref name=Arbyn2018/> Extensive clinical trial and post-marketing safety surveillance data indicate that both Gardasil and Cervarix are well tolerated and safe.<ref name="Arbyn2018" /><ref>{{cite web |url=http://www.ncirs.edu.au/immunisation/fact-sheets/hpv-human-papillomavirus-fact-sheet.pdf |title=Human papillomavirus (HPV) vaccines for Australians |date=March 2013 |publisher=National Centre for Immunisation Research and Surveillance Factsheet |url-status=dead |archive-url=https://web.archive.org/web/20130420211055/http://ncirs.edu.au/immunisation/fact-sheets/hpv-human-papillomavirus-fact-sheet.pdf |archive-date=20 April 2013}}</ref> When comparing the HPV vaccine to a placebo (control) vaccine taken by women, there is no difference in the risk of severe adverse events.<ref name="Arbyn2018" />

=== United States ===

{{As of|2013|09|08}}, there were more than 57 million doses of Gardasil vaccine distributed in the United States, though it is unknown how many were administered.<ref>{{cite web |url=http://www.businesswire.com/news/home/20130509005227/en/GARDASIL%C2%AE-Human-Papillomavirus-Quadrivalent-Types-6-11 |title=GARDASIL®, Merck's HPV Vaccine, Available to Developing Countries through UNICEF Tender |publisher=BusinessWire |date=9 May 2013 |access-date=8 September 2013 |url-status=live |archive-url=https://web.archive.org/web/20141218143718/http://www.businesswire.com/news/home/20130509005227/en/GARDASIL%C2%AE-Human-Papillomavirus-Quadrivalent-Types-6-11 |archive-date=18 December 2014}}</ref> There have been 22,000 [[Vaccine Adverse Event Reporting System]] (VAERS) reports following the vaccination.<ref name="CDC VAERS - Vaccine Adverse Event Reporting System" /> 92% were reports of events considered to be non-serious (e.g., fainting, pain, and swelling at the injection site (arm), headache, nausea, and fever), and the rest were considered to be serious (death, permanent disability, life-threatening illness, and hospitalization). However, VAERS reports include any reported effects whether coincidental or causal. In response to concerns regarding the rates of adverse events associated with the vaccine, the CDC stated: "When evaluating data from VAERS, it is important to note that for any reported event, no cause-and-effect relationship has been established. VAERS receives reports on all potential associations between vaccines and adverse events."<ref name="CDC VAERS - Vaccine Adverse Event Reporting System">{{cite web |url=https://www.cdc.gov/vaccinesafety/Vaccines/HPV/gardasil.html |title=Reports of Health Concerns Following HPV Vaccination |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |date=5 November 2009 |access-date=8 September 2013 |url-status=live |archive-url=https://web.archive.org/web/20130917105741/http://www.cdc.gov/vaccinesafety/Vaccines/HPV/gardasil.html |archive-date=17 September 2013}}</ref>

{{As of|2009|9|1}}, in the US there were 44 reports of death in females after receiving the vaccine.<ref name="CDC VAERS - Vaccine Adverse Event Reporting System" /> None of the 27 confirmed deaths of women and girls who had taken the vaccine were linked to the vaccine.<ref name="CDC VAERS - Vaccine Adverse Event Reporting System" /> There is no evidence suggesting that Gardasil causes or raises the risk of [[Guillain–Barré syndrome]]. Additionally, there have been rare reports of blood clots forming in the heart, lungs, and legs.<ref name="CDC VAERS - Vaccine Adverse Event Reporting System"/> A 2015 review conducted by the [[European Medicines Agency]]'s Pharmacovigilance Risk Assessment Committee concluded that evidence does not support the idea that HPV vaccination causes [[complex regional pain syndrome]] or [[postural orthostatic tachycardia syndrome]].<ref>{{cite press release |url=http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2015/11/WC500196352.pdf |title=Review concludes evidence does not support that HPV vaccines cause CRPS or POTS |publisher=[[European Medicines Agency]] (EMA) |date=5 November 2015 |access-date=5 November 2015 |url-status=live |archive-url=https://web.archive.org/web/20160214143128/http://www.ema.europa.eu/docs/en_GB/document_library/Press_release/2015/11/WC500196352.pdf |archive-date=14 February 2016}}</ref>

{{As of|2013|09|08}}, the CDC continued to recommend Gardasil vaccination for the prevention of four types of HPV.<ref name="CDC VAERS - Vaccine Adverse Event Reporting System"/> The manufacturer of Gardasil has committed to ongoing research assessing the vaccine's safety.<ref>{{cite web |url=https://www.cdc.gov/vaccinesafety/vaccines/hpv/hpvarchived.html |title=Information from FDA and CDC on Gardasil and its Safety |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |date=22 July 2008 |access-date=8 September 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130902055251/http://www.cdc.gov/vaccinesafety/Vaccines/HPV/HPVArchived.html |archive-date=2 September 2013}}</ref>

According to the Centers for Disease Control and Prevention (CDC) and the FDA, the rate of adverse side effects related to Gardasil immunization in the safety review was consistent with what has been seen in the safety studies carried out before the vaccine was approved and were similar to those seen with other vaccines. However, a higher proportion of [[syncope (medicine)|syncope]] (fainting) was seen with Gardasil than is usually seen with other vaccines. The FDA and CDC have reminded healthcare providers that, to prevent falls and injuries, all vaccine recipients should remain seated or lying down and be closely observed for 15 minutes after vaccination.<ref name=CDC-HPV/> The HPV vaccination does not appear to reduce the willingness of women to undergo [[pap test]]s.<ref>{{cite journal | vauthors = Moghtaderi A, Dor A | title = Immunization and Moral Hazard: The HPV Vaccine and Uptake of Cancer Screening | journal = Medical Care Research and Review | volume = 78 | issue = 2 | pages = 125–137 | date = April 2021 | pmid = 31096862 | doi = 10.3386/w22523 | doi-access = free }}</ref>

===Contraindications===

While the use of HPV vaccines can help reduce cervical cancer deaths by two-thirds around the world,<ref>{{cite web |title=Human Papillomavirus (HPV) Vaccines |url=http://www.cancer.gov/cancertopics/factsheet/Prevention/HPV-vaccine |url-status=live |archive-url=https://web.archive.org/web/20140704184759/http://www.cancer.gov/cancertopics/factsheet/prevention/HPV-vaccine |archive-date=4 July 2014 |date=25 May 2018}}</ref> not everyone is eligible for vaccination. Some factors exclude people from receiving HPV vaccines. These factors include:<ref name="fact sheet">{{cite web |url=https://www.cdc.gov/std/hpv/stdfact-hpv-vaccine-hcp.htm |title=HPV Vaccine Information for Clinicians – Fact Sheet |publisher=CDC |url-status=live |archive-url=https://web.archive.org/web/20120501210857/http://www.cdc.gov/std/HPV/STDFact-HPV-vaccine-hcp.htm |archive-date=1 May 2012 |date=11 January 2019}}</ref>

* People with history of [[Type 1 hypersensitivity|immediate hypersensitivity]] to vaccine components. Patients with a [[hypersensitivity]] to [[yeast]] should not receive Gardasil since yeast is used in its production.

* People with moderate or severe acute illnesses. This does not completely exclude patients from vaccination but postpones the time of vaccination until the illness has improved.<ref name="recommendations">{{cite web |url=http://pcph.pocahontascoia.us/pdfdocs/HPV_Vaccine.pdf |title=Human Papillomavirus (HPV) Vaccine Recommendations |publisher=FDA |url-status=dead |archive-url=https://web.archive.org/web/20140307081232/http://pcph.pocahontascoia.us/pdfdocs/HPV_Vaccine.pdf |archive-date=7 March 2014}}</ref>

===Pregnancy===

In the Gardasil clinical trials, 1,115 pregnant women received the HPV vaccine. Overall, the proportions of pregnancies with an adverse outcome were comparable in subjects who received Gardasil and subjects who received a placebo.<ref name="Merck_Pregnancy">{{cite web |title=Gardasil Pregnancy Registry |website=Merck & Co. |date=1 February 2012 |url=http://www.merckpregnancyregistries.com/gardasil.html |archive-url=https://web.archive.org/web/20120301125436/http://www.merckpregnancyregistries.com/gardasil.html |archive-date=1 March 2012 |url-status=dead |access-date=29 May 2007}}</ref><ref>{{cite web |title=Gardasil 9 Pregnancy Registry |website=Merck & Co. |url=http://merckpregnancyregistries.com/gardasil9.html |archive-url=https://web.archive.org/web/20180828030609/http://merckpregnancyregistries.com/gardasil9.html |archive-date=28 August 2018 |url-status=dead |access-date=21 October 2019}}</ref> However, the clinical trials had a relatively small sample size. {{As of|2018}}, the vaccine is not recommended for pregnant women.<ref name=Arbyn2018 /><ref name="Merck_Pregnancy" /><ref>{{cite web |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |url=https://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm#hpv |title=Who Should NOT Get Vaccinated with these Vaccines? |date=10 June 2010 |access-date=27 February 2011 |url-status=live |archive-url=https://web.archive.org/web/20110511125757/http://www.cdc.gov/vaccines/vpd-vac/should-not-vacc.htm#hpv |archive-date=11 May 2011}}</ref><ref>{{cite journal | vauthors = Goss MA, Lievano F, Buchanan KM, Seminack MM, Cunningham ML, Dana A | title = Final report on exposure during pregnancy from a pregnancy registry for quadrivalent human papillomavirus vaccine | journal = Vaccine | volume = 33 | issue = 29 | pages = 3422–3428 | date = June 2015 | pmid = 25869893 | doi = 10.1016/j.vaccine.2015.04.014 }}</ref>

The FDA has classified the HPV vaccine as a pregnancy Category B, meaning there is no apparent harm to the fetus in animal studies. HPV vaccines have not been causally related to adverse pregnancy outcomes or adverse effects on the fetus. However, data on vaccination during pregnancy is very limited, and vaccination during the pregnancy term should be delayed until more information is available. If a woman is found to be pregnant during the three-dose series of vaccination, the series should be postponed until pregnancy has been completed. While there is no indication for intervention for vaccine dosages administered during pregnancy, patients and healthcare providers are encouraged to report exposure to vaccines to the appropriate HPV vaccine pregnancy registry.<ref name="fact sheet"/><ref name="recommendations"/><ref>{{cite news |url=http://hpv.emedtv.com/hpv-vaccine/hpv-vaccine-and-pregnancy.html |title=HPV Vaccine and Pregnancy |newspaper=Emedtv: Health Information Brought to Life |publisher=eMedTV |url-status=live |archive-url=https://web.archive.org/web/20120724081239/http://hpv.emedtv.com/hpv-vaccine/hpv-vaccine-and-pregnancy.html |archive-date=24 July 2012 |author1=Emedtv }}</ref>

The HPV vaccines are based on hollow [[virus-like particle]]s (VLPs) assembled from [[Recombinant DNA|recombinant]] HPV [[Capsid|coat proteins]]. The natural virus [[capsid]] is composed of two proteins, L1 and L2, but vaccines only contain L1.

Gardasil contains inactive L1 proteins from four different HPV strains: 6, 11, 16, and 18, synthesized in the yeast ''Saccharomyces cerevisiae''. Each vaccine dose contains 225&nbsp;μg of aluminum, 9.56&nbsp;mg of sodium chloride, 0.78&nbsp;mg of [[L-histidine]], 50&nbsp;μg of [[polysorbate 80]], 35&nbsp;μg of sodium borate, and water. The combination of ingredients totals 0.5&nbsp;mL.<ref name="WikiMarkup">{{cite web |url=http://ciitn.missouri.edu/cgi-bin/pub_view_project_ind.cgi?g_num=2&c_id=2007008 |title=leftside |publisher=Ciitn.missouri.edu |date=22 January 2007 |access-date=29 December 2013 |url-status=dead |archive-url=https://web.archive.org/web/20131002130958/http://ciitn.missouri.edu/cgi-bin/pub_view_project_ind.cgi?g_num=2&c_id=2007008 |archive-date=2 October 2013}}</ref>

HPV types 16 and 18 cause about 70% of all [[cervical cancer]].<ref name=Munoz2004>{{cite journal | vauthors = Muñoz N, Bosch FX, Castellsagué X, Díaz M, de Sanjose S, Hammouda D, Shah KV, Meijer CJ | title = Against which human papillomavirus types shall we vaccinate and screen? The international perspective | journal = International Journal of Cancer | volume = 111 | issue = 2 | pages = 278–285 | date = August 2004 | pmid = 15197783 | doi = 10.1002/ijc.20244 | s2cid = 20679802 | doi-access = free }}</ref> Gardasil also targets HPV types 6 and 11, which together cause about 90 percent of all cases of [[genital warts]].<ref name="Journal of Clinical Investigation">{{cite journal | vauthors = Lowy DR, Schiller JT | title = Prophylactic human papillomavirus vaccines | journal = The Journal of Clinical Investigation | volume = 116 | issue = 5 | pages = 1167–1173 | date = May 2006 | pmid = 16670757 | pmc = 1451224 | doi = 10.1172/JCI28607 }}</ref>

Gardasil and Cervarix are designed to elicit virus-neutralizing [[antibody]] responses that prevent initial infection with the HPV types represented in the vaccine. The vaccines have been shown to offer 100 percent protection against the development of cervical [[pre-cancer]]s and genital warts caused by the HPV types in the vaccine, with few or no side effects. The protective effects of the vaccine are expected to last a minimum of 4.5 years after the initial vaccination.<ref name="Lancet">{{cite journal | vauthors = Harper DM, Franco EL, Wheeler CM, Moscicki AB, Romanowski B, Roteli-Martins CM, Jenkins D, Schuind A, Costa Clemens SA, Dubin G | title = Sustained efficacy up to 4.5 years of a bivalent L1 virus-like particle vaccine against human papillomavirus types 16 and 18: follow-up from a randomised control trial | journal = Lancet | volume = 367 | issue = 9518 | pages = 1247–1255 | date = April 2006 | pmid = 16631880 | doi = 10.1016/S0140-6736(06)68439-0 | s2cid = 18685310 | doi-access = free }}</ref>

While the study period was not long enough for cervical cancer to develop, the prevention of these cervical precancerous lesions (or [[dysplasia]]s) is believed highly likely to result in the prevention of those cancers.<ref>{{cite press release |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108666.htm |title=FDA Licenses New Vaccine for Prevention of Cervical Cancer and Other Diseases in Females Caused by Human Papillomavirus |publisher=U.S. [[Food and Drug Administration]] (FDA) |date=8 June 2006 |access-date=13 November 2009 |url-status=dead |archive-url=https://web.archive.org/web/20091019080918/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/2006/ucm108666.htm |archive-date=19 October 2009}}</ref>

==History==

In 1983, [[Harald zur Hausen]] culminated decades of research with the discovery that certain variants of human papillomaviruses (HPVs) could be found in a majority of tested cervical cancer specimens. This provided strong scientific evidence for a link between the viral infection and cervical cancer, and provided strong motivations for further research into HPVs.<ref name="Frazer_2019_HPV_Vaccine_Story">{{cite journal | vauthors = Frazer IH | title = The HPV Vaccine Story | journal = ACS Pharmacology & Translational Science | volume = 2 | issue = 3 | pages = 210–212 | date = June 2019 | pmid = 32259056 | pmc = 7089001 | doi = 10.1021/acsptsci.9b00032 }}</ref>

In 1990, [[Ian Frazer]] partnered with [[Jian Zhou]] and [[Xiao-Yi Sun]] at the [[University of Queensland]] in Australia to create synthetic HPVs for study in the lab. While working towards this goal, they were able to synthetically produce some of the capsid proteins of the HPVs, L1 and L2. Recognizing the potential of these proteins to form the basis of a vaccine, they filed a provisional patent on their production process in Australia in 1991.<ref name="Frazer_2019_HPV_Vaccine_Story"></ref>

The further invention then stalled while convincing developers of the market for the vaccine, and also while patent offices determined who the discovery belonged to. Three other organizations, the US [[National Cancer Institute]], [[Georgetown University Medical Center|Georgetown University]], and [[University of Rochester]], were also vying for the patent as a result of contributions in the space.<ref>{{cite journal | vauthors = McNeil C | title = Who invented the VLP cervical cancer vaccines? | journal = Journal of the National Cancer Institute | volume = 98 | issue = 7 | pages = 433 | date = April 2006 | pmid = 16595773 | doi = 10.1093/jnci/djj144 }}</ref> After providing evidence of the correctness of their L1 sequencing in 2004, the US patent court of appeals accorded priority to the University of Queensland in 2009.<ref>{{US patent|7476389}}, titled ''"Papilloma Virus Vaccines"'', was granted to co-inventors [[Ian Frazer]] and [[Jian Zhou]] (Zhou posthumously) on 13 January 2009. Its US application was filed on 19 January 1994 but claimed priority under a 20 July 1992, PTC filing to the date of an initial [AU] Australian patent application filed on 19 July 1991.</ref> As a result, the University of Queensland receives royalty payments from the sale of these vaccines even today.<ref name="Frazer_2019_HPV_Vaccine_Story"></ref>

By the early 2000s, developers, convinced of the market of the vaccine, had begun refining, researching, and trialing L1-based HPV vaccines.<ref>{{cite journal | vauthors = Harper DM, Franco EL, Wheeler C, Ferris DG, Jenkins D, Schuind A, Zahaf T, Innis B, Naud P, De Carvalho NS, Roteli-Martins CM, Teixeira J, Blatter MM, Korn AP, Quint W, Dubin G | title = Efficacy of a bivalent L1 virus-like particle vaccine in prevention of infection with human papillomavirus types 16 and 18 in young women: a randomised controlled trial | journal = Lancet | volume = 364 | issue = 9447 | pages = 1757–1765 | date = November 2004 | pmid = 15541448 | doi = 10.1016/S0140-6736(04)17398-4 }}</ref><ref name="Lancet"></ref> In 2006, the FDA approved the first preventive HPV vaccine, marketed by [[Merck & Co.]] under the trade name Gardasil. According to a Merck press release,<ref>{{Cite press release |url=http://www.merck.com/newsroom/press_releases/financial/2007_0723.html |archive-url=https://web.archive.org/web/20071012173613/http://www.merck.com/newsroom/press_releases/financial/2007_0723.html |url-status=dead |title=Merck Reports Double-Digit Earnings-Per-Share Growth for Second Quarter 2007 |archive-date=12 October 2007 |access-date=16 October 2019}}</ref> by the second quarter of 2007 it had been approved in 80 countries, many under fast-track or expedited review. Early in 2007, [[GlaxoSmithKline]] filed for approval in the United States for a similar preventive HPV vaccine, known as [[Cervarix]]. In June 2007, this vaccine was licensed in Australia, and it was approved in the [[European Union]] in September 2007.<ref>{{cite news |url=https://www.reuters.com/article/governmentFilingsNews/idUSL2446805720070924 |title=Glaxo prepares to launch Cervarix after EU okay |access-date=18 July 2008 |date=24 September 2007 |work=Reuters |url-status=live |archive-url=https://web.archive.org/web/20081025083933/http://www.reuters.com/article/governmentFilingsNews/idUSL2446805720070924 |archive-date=25 October 2008}}</ref> Cervarix was approved for use in the US in October 2009.<ref>{{cite web |url=https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm186959.htm |title=16 October 2009 Approval Letter – Cervarix |date=16 October 2009 |publisher=U.S. [[Food and Drug Administration]] (FDA) |access-date=13 November 2009 |url-status=dead |archive-url=https://web.archive.org/web/20091019061945/https://www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm186959.htm |archive-date=19 October 2009}}</ref>

Harald zur Hausen was awarded half of the $1.4&nbsp;million [[Nobel Prize in Medicine]] in 2008 for his work showing that cervical cancer is caused by certain types of HPVs. <ref>{{cite web |title=The Nobel Prize in Physiology or Medicine 2008 Press Release |url=https://www.nobelprize.org/prizes/medicine/2008/press-release/ |website=The Nobel Prize |access-date=2024-12-08 |archive-url=http://web.archive.org/web/20241203152424/https://www.nobelprize.org/prizes/medicine/2008/press-release/ |archive-date=2024-12-03}}<br>The other half of the award went to [[Françoise Barré-Sinoussi]] and [[Luc Montagnier]], two French virologists, for their part in the discovery of [[HIV]].</ref>

In December 2014, the US [[Food and Drug Administration]] (FDA) approved a vaccine called Gardasil 9 to protect females between the ages of 9 and 26 and males between the ages of 9 and 15 against nine strains of HPV.<ref name=Gardasil9>{{cite press release |url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm |type=press release |title=FDA approves Gardasil 9 for prevention of certain cancers caused by five additional types of HPV |publisher=U.S. [[Food and Drug Administration]] (FDA) |date=10 December 2014 |access-date=9 January 2015 |url-status=dead |archive-url=https://web.archive.org/web/20150110233107/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm |archive-date=10 January 2015}}</ref> Gardasil 9 protects against infection from the strains covered by the first generation of Gardasil (HPV-6, HPV-11, HPV-16, and HPV-18) and protects against five other HPV strains responsible for 20% of cervical cancers (HPV-31, HPV-33, HPV-45, HPV-52, and HPV-58).<ref name=Gardasil9/>

==Society and culture==

===Economics===

{{As of|2013}}, vaccinating girls and young women was estimated to be cost-effective in the [[low and middle-income countries]], especially in places without organized programs for [[Cervical cancer screening|screening cervical cancer]].<ref name=":3">{{cite journal | vauthors = Fesenfeld M, Hutubessy R, Jit M | title = Cost-effectiveness of human papillomavirus vaccination in low and middle-income countries: a systematic review | journal = Vaccine | volume = 31 | issue = 37 | pages = 3786–3804 | date = August 2013 | pmid = 23830973 | doi = 10.1016/j.vaccine.2013.06.060 }}</ref> When the cost of the vaccine itself, or the cost of administering it to individuals, were higher, or if cervical cancer screening were readily available, then vaccination was less likely to be cost-effective.

From a public health point of view, vaccinating men as well as women decreases the virus pool within the population but is only cost-effective to vaccinate men when the uptake in the female population is extremely low.<ref name="Kim2009">{{cite journal | vauthors = Kim JJ, Goldie SJ | title = Cost effectiveness analysis of including boys in a human papillomavirus vaccination programme in the United States | journal = BMJ | volume = 339 | issue = 7726 | pages = b3884 | date = October 2009 | pmid = 19815582 | pmc = 2759438 | doi = 10.1136/bmj.b3884 }}</ref> In the United States, the cost per [[quality-adjusted life year]] is greater than US$100,000 for vaccinating the male population, compared to less than US$50,000 for vaccinating the female population.<ref name="Kim2009" /> This assumes a 75% vaccination rate.

In 2013, the two companies that sell the most common vaccines announced a price cut to less than US$5 per dose to poor countries, as opposed to US$130 per dose in the US.<ref>{{cite news |url=https://www.nytimes.com/2013/05/10/health/prices-cut-for-hpv-cervical-cancer-vaccines-for-neediest.html |work=[[The New York Times]] |title=Cancer Vaccines Get a Price Cut in Poor Nations | vauthors = McNeil Jr DG |author-link=Donald McNeil Jr. |date=5 May 2013 |access-date=23 November 2013 |url-status=live |archive-url=https://web.archive.org/web/20131123033948/http://www.nytimes.com/2013/05/10/health/prices-cut-for-hpv-cervical-cancer-vaccines-for-neediest.html?_r=0 |archive-date=23 November 2013 }}</ref>

=== Brand names ===

The vaccine is sold under various brand names including Gardasil, Cervarix, Cecolin,<ref name=WHO4October2024 /> and Walrinvax.<ref name=WHO4October2024 /><ref name=WHOcurrentdata>{{Cite web|title=Human papillomavirus vaccines (HPV)|url=https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)|website=World Health Organization|access-date=29 September 2024|archive-date=7 August 2024|archive-url=https://web.archive.org/web/20240807031253/https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)|url-status=live}}</ref>

===Vaccine implementation===

{{See also|Vaccination policy}}

The primary target group in most of the countries recommending HPV [[vaccination]] is young adolescent girls, aged 9–14.<ref name=WHOcurrentdata/> It's particularly cost-effective in resource-constrained settings.<ref name="WHO2022" />{{rp|p=666}} The [[vaccination schedule]] depends on the age of the vaccine recipient.<ref name=WHOcurrentdata/> As of 2023, 27% of girls aged 9–14 years worldwide received at least one dose (37 countries were implementing the single-dose schedule).<ref name=WHO4October2024/> Global coverage for the first dose of HPV vaccine in girls grew from 20% in 2022 to 27% in 2023.<ref name=WHO15July2024/> As of 10 September 2024, 57 countries are implementing the single-dose schedule.<ref name=WHO4October2024/> Vaccinating a large portion of the population may also benefit the unvaccinated by way of [[herd immunity]].<ref name="Cervical cancer prevention in Austr"/>

HPV vaccine introductions have been hampered by global supply shortages since 2018.<ref name=WHO4October2024/> Between 2019 and 2021, due to the [[COVID-19 pandemic]], HPV vaccination programs have been significantly affected in the United States, low-income and lower-middle-income countries.<ref>{{cite journal | vauthors = Toh ZQ, Russell FM, Garland SM, Mulholland EK, Patton G, Licciardi PV | title = Human Papillomavirus Vaccination After COVID-19 | journal = JNCI Cancer Spectrum | volume = 5 | issue = 2 | pages = pkab011 | date = April 2021 | pmid = 33748668 | pmc = 7962726 | doi = 10.1093/jncics/pkab011 | publisher = [[Oxford University Press]] | s2cid = 232295180 | doi-access = free | eissn = 2515-5091 }}</ref><ref>{{cite journal | vauthors = Daniels V, Saxena K, Roberts C, Kothari S, Corman S, Yao L, Niccolai L | title = Impact of reduced human papillomavirus vaccination coverage rates due to COVID-19 in the United States: A model based analysis | journal = Vaccine | volume = 39 | issue = 20 | pages = 2731–2735 | date = May 2021 | pmid = 33875269 | pmc = 8023201 | doi = 10.1016/j.vaccine.2021.04.003 | publisher = [[Elsevier]] | s2cid = 233034581 | doi-access = free | veditors= Poland G | editor-link = Gregory Poland }}</ref><ref name="stjude.org">{{cite web |vauthors=Sheffield M, Hobgood K |date=30 August 2021 |url=https://www.stjude.org/media-resources/news-releases/2021-medicine-science-news/st-jude-and-leading-cancer-centers-urge-vaccination-to-protect-against-hpv-and-other-diseases.html |title=St. Jude and leading cancer centers urge vaccination to protect against HPV and other diseases |website=www.stjude.org |location=[[Memphis, Tennessee]] |publisher=[[St. Jude Children's Research Hospital]] |access-date=8 September 2021 |archive-date=15 November 2021 |archive-url=https://web.archive.org/web/20211115101025/https://www.stjude.org/media-resources/news-releases/2021-medicine-science-news/st-jude-and-leading-cancer-centers-urge-vaccination-to-protect-against-hpv-and-other-diseases.html |url-status=live }}</ref><ref name="poz 2021">{{cite magazine | vauthors = Highleyman L |date=3 September 2021 |title=Get HPV Vaccination Back on Track, Experts Urge |url=https://www.poz.com/article/get-hpv-vaccination-back-track-experts-urge |url-status=live |magazine=[[POZ (magazine)|POZ]] |location=[[New York City]] |issn=1075-5705 |archive-url=https://web.archive.org/web/20210908050323/https://www.poz.com/article/get-hpv-vaccination-back-track-experts-urge |archive-date=8 September 2021 |access-date=8 September 2021}}</ref>

In developed countries, the widespread use of cervical "[[Pap smear]]" screening programs has reduced the incidence of invasive cervical cancer by 50% or more. Preventive vaccines reduce but do not eliminate the chance of getting cervical cancer. Therefore, experts recommend that women combine the benefits of both programs by seeking regular Pap smear screening, even after vaccination.<ref>{{cite journal | vauthors = Cutts FT, Franceschi S, Goldie S, Castellsague X, de Sanjose S, Garnett G, Edmunds WJ, Claeys P, Goldenthal KL, Harper DM, Markowitz L | title = Human papillomavirus and HPV vaccines: a review | journal = Bulletin of the World Health Organization | volume = 85 | issue = 9 | pages = 719–726 | date = September 2007 | pmid = 18026629 | pmc = 2636411 | doi = 10.2471/BLT.06.038414 | doi-broken-date = 11 November 2024 }}</ref> School-entry vaccination requirements were found to increase the use of the HPV vaccine.<ref>{{Cite journal |vauthors=Ko JS, Goldbeck CS, Baughan EB, Klausner JD |date=September 2020 |title=Association Between Human Papillomavirus Vaccination School-Entry Requirements and Vaccination Initiation |journal=JAMA Pediatrics |volume=174 |issue=9 |pages=861–867 |doi=10.1001/jamapediatrics.2020.1852 |pmc=7325070 |pmid=32597928}}</ref><ref name="ri-school" />

====HPV vaccine included in national immunization program====

At least 144 countries (at least 74% of WHO member states) provided the HPV vaccine in their national immunization schedule for girls, as of November 2024.<ref name=WHO17November2024/><ref name=WHO15July2024/> As of 2022, 47 countries (24% of WHO member states) also did it for boys.<ref name="WHO2022" />{{rp|p=654}}

=====Africa=====

Of the 20 hardest hit countries by cervical cancer, 19 are in Africa.<ref name=WHO4October2024 />

In 2013, with support from [[GAVI|Gavi, the Vaccine Alliance]], eight low-income countries, mainly in sub-Saharan Africa, began the rollout of the HPV vaccine.<ref name=GAVI2013>{{cite web | vauthors = Frazer I |url=http://www.gavialliance.org/support/nvs/human-papillomavirus-vaccine-support/ |title=Human papillomavirus vaccine – New and underused vaccines support – Types of support |publisher=GAVI Alliance |access-date=29 December 2013 |url-status=dead |archive-url=https://web.archive.org/web/20140118193616/http://www.gavialliance.org/support/nvs/human-papillomavirus-vaccine-support/ |archive-date=18 January 2014}}</ref>

======Algeria======

No<ref name=WHOHPVDashboard>{{Cite web|date=12 September 2024|title=HPV Dashboard|url=https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)/hpv-clearing-house/hpv-dashboard|website=[[World Health Organization]]|access-date=6 October 2024}}</ref>

======Angola======

No<ref name=WHOHPVDashboard/>

======Chad======

No<ref name=WHOHPVDashboard/>

======Central African Republic======

No<ref name=WHOHPVDashboard/>

======Democratic Republic of Congo======

No<ref name=WHOHPVDashboard/>

======Ghana======

[[Human Papillomavirus (HPV) in Ghana|No]] (GAVI support in 2013)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

======Guinea-Bissau======

No<ref name=WHOHPVDashboard/>

======Kenya======

Both Cervarix and Gardasil are approved for use within [[Kenya]] by the Pharmacy and Poisons Board. However, at a cost of 20,000 Kenyan shillings, which is more than the average annual income for a family, the director of health promotion in the Ministry of Health, [[Mwangi Ruheni|Nicholas Muraguri]], states that many Kenyans are unable to afford the vaccine.<ref name="Cervarix Marketing in Kenya"/> It has received GAVI support in 2013.<ref name=GAVI2013/>

======Madagascar======

No (GAVI support in 2013)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

======Malawi======

Yes (GAVI support in 2013)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

======Mozambique======

Yes (GAVI support for HPV demonstration projects in 2014)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

======Niger======

No (GAVI support in 2013)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

======Nigeria======

Yes<ref name=WHOHPVDashboard/>

======Rwanda======

Yes (GAVI support in 2014)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

======Senegal======

Yes<ref name=WHOHPVDashboard/>

======Sierra Leone======

Yes (GAVI support in 2013)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

====South Africa====

Cervical cancer represents the most common cause of cancer-related deaths—more than 3,000 deaths per year—among women in [[South Africa]] because of high [[HIV]] prevalence, making the introduction of the vaccine highly desirable.<ref name=southa1>{{cite news |title=Life saving cancer vaccine will be difficult to implement | vauthors = Green A |url=http://mg.co.za/article/2013-06-07-life-saving-cancer-vaccine-will-be-difficult-to-implement |newspaper=Mail & Guardian |date=7 June 2013 |access-date=7 August 2013 |url-status=live |archive-url=https://web.archive.org/web/20130717105051/http://mg.co.za/article/2013-06-07-life-saving-cancer-vaccine-will-be-difficult-to-implement |archive-date=17 July 2013}}</ref> A [[Papanicolaou test]] program was established in 2000 to help screen for cervical cancer, but since this program has not been implemented widely, vaccination would offer more efficient form of prevention.<ref name=southa2 >{{cite journal | vauthors = Botha MH, Dochez C | title = Introducing human papillomavirus vaccines into the health system in South Africa | journal = Vaccine | volume = 30 | issue = Suppl 3 | pages = C28–C34 | date = September 2012 | pmid = 22939017 | doi = 10.1016/j.vaccine.2012.03.032 }}</ref> In May 2013 the [[Minister of Health (South Africa)|Minister of Health]] of South Africa, [[Aaron Motsoaledi]], announced the government would provide free HPV vaccines for girls aged 9 and 10 in the poorest 80% of schools starting in February 2014 and the fifth quintile later on.<ref name=southa3>{{cite news |title=Schoolgirls to get cancer vaccine |author=SAPA |url=http://www.iol.co.za/news/south-africa/schoolgirls-to-get-cancer-vaccine-1.1516523 |newspaper=ioL News |date=15 May 2013 |access-date=7 August 2013 |url-status=live |archive-url=https://web.archive.org/web/20130812082111/http://www.iol.co.za/news/south-africa/schoolgirls-to-get-cancer-vaccine-1.1516523#.UgLbJpI3uLU |archive-date=12 August 2013}}</ref> South Africa will be the first African country with an immunisation schedule that includes vaccines to protect people from HPV infection, but because the effectiveness of the vaccines in women who later become infected with [[HIV]] is not yet fully understood, it is difficult to assess how cost-effective the vaccine will be. Negotiations are currently{{When|date=October 2019}} underway for more affordable HPV vaccines since they are up to 10 times more expensive than others already included in the immunization schedule.<ref name=southa1 /><ref name=southa3 />

===== United Republic of Tanzania =====

Yes (GAVI support in 2013)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

===== Zimbabwe =====

Yes (GAVI support for HPV demonstration projects in 2014)<ref name=WHOHPVDashboard/><ref name=GAVI2013/>

=====Australia=====

In April 2007, Australia became the second country—after Austria—to introduce a government-funded National Human Papillomavirus (HPV) Vaccination Program to protect young women against HPV infections that can lead to cancers and disease.<ref name="HPV Prevalence">Tabrizi S. Brotherton J. Kaldor J et al. Fall in Human Papillomavirus Prevalence Following a National Vaccination Program. ''Journal of Infectious Diseases''. 24 October 2012.</ref> The National HPV Vaccination Program is listed on the National Immunisation Program (NIP) Schedule and funded under the Immunise Australia Program.<ref name="Information about the program">{{cite web | url = http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/about-the-program | title = Information about the HPV immunisation program | work = The Immunise Australia Program | publisher = Department of Health, Commonwealth of Australia | archive-url = https://web.archive.org/web/20150504202400/http://immunise.health.gov.au/internet/immunise/publishing.nsf/Content/about-the-program | archive-date=4 May 2015 }}</ref> The Immunise Australia Program is a joint Federal, State, and Territory Government initiative to increase immunisation rates for vaccine-preventable diseases.

The National HPV Vaccination Program for females was made up of two components: an ongoing school-based program for 12- and 13-year-old girls; and a time-limited catch-up program (females aged 14–26 years) delivered through schools, general practices, and community immunization services, which ceased on 31 December 2009.

During 2007–2009, an estimated 83% of females aged 12–17 years received at least one dose of HPV vaccine and 70% completed the 3-dose HPV vaccination course.<ref name="HPV Prevalence" /> By 2017, HPV coverage data on the Immunise Australia website show that by 15 years of age, over 82% of Australian females had received all three doses.<ref>{{Cite web |url=https://www.health.gov.au/resources/publications/historical-human-papillomavirus-hpv-immunisation-coverage-rates |title=Historical Human Papillomavirus (HPV) immunisation coverage rates |date=4 December 2019 |website=[[Department of Health (Australia)|Australian Government Department of Health]] |access-date=28 September 2021 |archive-date=28 September 2021 |archive-url=https://web.archive.org/web/20210928213304/https://www.health.gov.au/resources/publications/historical-human-papillomavirus-hpv-immunisation-coverage-rates |url-status=live }}</ref>

Since the National HPV Vaccination Program commenced in 2007, there has been a reduction in HPV-related infections in young women. A study published in ''[[The Journal of Infectious Diseases]]'' in October 2012 found the prevalence of vaccine-preventable HPV types (6, 11, 16, and 18) in Papanicolaou test results of women aged 18–24 years has significantly decreased from 28.7% to 6.7% four years after the introduction of the National HPV Vaccination Program.<ref name="HPV Prevalence" /> A 2011 report published found the diagnosis of genital warts (caused by HPV types 6 and 11) had also decreased in young women and men.<ref name="Kirby Report">{{cite web | url = http://www.kirby.unsw.edu.au/surveillance/2011-annual-surveillance-report-hiv-viral-hepatitis-stis | title = 2011 Annual Surveillance Report of HIV, viral hepatitis, STIs | work = The Kirby Institute for Infection and Immunity | location = Sydney NSW | publisher = University of New South Wales | archive-url = https://web.archive.org/web/20130522183751/http://www.kirby.unsw.edu.au/surveillance/2011-annual-surveillance-report-hiv-viral-hepatitis-stis | archive-date=22 May 2013 | page = 28 }}</ref>

In October 2010, the Australian regulatory agency, the Therapeutic Goods Administration, extended the registration of the quadrivalent vaccine (Gardasil) to include use in males aged 9 through 26 years of age, for the prevention of external genital lesions and infection with HPV types 6, 11, 16 and 18.

In November 2011, the Pharmaceutical Benefits Advisory Committee (PBAC) recommended the extension of the National HPV Vaccination Program to include males. The PBAC made its recommendation on the preventive health benefits that can be achieved, such as a reduction in the incidence of anal and penile cancers and other HPV-related diseases. In addition to the direct benefit to males, it was estimated that routine HPV vaccination of adolescent males would contribute to the reduction of vaccine HPV-type infection and associated disease in women through herd immunity.<ref name="Pharmaceutical Benefits Scheme">{{Cite web |url=https://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/pbac-outcomes/2011-11 |archive-url=https://web.archive.org/web/20130419214008/http://www.pbs.gov.au/info/industry/listing/elements/pbac-meetings/pbac-outcomes/2011-11 |url-status=dead |title=Pharmaceutical Benefits Scheme (PBS) &#124; Recommendations made by the PBAC - November 2011 |archive-date=19 April 2013 |publisher=[[Department of Health (Australia)|Australian Government Department of Health]]}}</ref>

In 2012, the Australian Government announced it would be extending the National HPV Vaccination Program to include males, through the [[National Immunisation Program Schedule]].<ref>{{Cite web |url=https://www.acrf.com.au/news/latest-news/world-first-hpv-vaccination-plan-will-protect-young-australian-men-from-cancer/ |title=Young men to be protected from cancers through HPV vaccine |date=13 July 2012 |website=[[Australian Cancer Research Foundation]] |access-date=28 September 2021 |archive-date=28 September 2021 |archive-url=https://web.archive.org/web/20210928213256/https://www.acrf.com.au/news/latest-news/world-first-hpv-vaccination-plan-will-protect-young-australian-men-from-cancer/ |url-status=live }}</ref>

Updated results were reported in 2014.<ref name="Vic HPV cross-sectional study">{{cite journal | vauthors = Tabrizi SN, Brotherton JM, Kaldor JM, Skinner SR, Liu B, Bateson D, McNamee K, Garefalakis M, Phillips S, Cummins E, Malloy M, Garland SM | title = Assessment of herd immunity and cross-protection after a human papillomavirus vaccination programme in Australia: a repeat cross-sectional study | journal = The Lancet. Infectious Diseases | volume = 14 | issue = 10 | pages = 958–966 | date = October 2014 | pmid = 25107680 | doi = 10.1016/S1473-3099(14)70841-2 }}</ref>

Since February 2013, free HPV vaccine has been provided through school-based programs for:

* males and females aged 12–13 years (ongoing program); and

* males aged between 14 and 15 years – until the end of the school year in 2014 (catch-up program).

=====Canada=====

HPV vaccines were first approved in Canada in July 2006 for use in females,<ref>{{cite web |title=Summary Safety Review - Gardasil (Quadrivalent Human Papillomavirus [Types 6, 11, 16, 18] Recombinant Vaccine) - Assessing General Safety with a Focus on Autoimmune and Cardiovascular Diseases |website=Health Canada |date=9 December 2015 |url=https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-gardasil-quadrivalent-human-papillomavirus-types-6-11-16-18.html |archive-url=https://web.archive.org/web/20190926060643/https://www.canada.ca/en/health-canada/services/drugs-health-products/medeffect-canada/safety-reviews/summary-safety-review-gardasil-quadrivalent-human-papillomavirus-types-6-11-16-18.html |archive-date=26 September 2019 |url-status=live |access-date=21 October 2019}}</ref> and February 2010 for use in males.<ref>{{cite journal | vauthors = Dawar DM, Harris MT, McNeil DS | title = Update on Human Papillomavirus (HPV) Vaccines: An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI) '''^†''' | journal = Canada Communicable Disease Report | volume = 38 | issue = ACS-1 | pages = 1–62 | date = January 2012 | pmid = 31701955 | pmc = 6802461 | doi = 10.14745/ccdr.v38i00a01 | url = https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2012-38/canada-communicable-disease-report.html | access-date = 21 October 2019 | url-status = live | archive-url = https://web.archive.org/web/20191021163126/https://www.canada.ca/en/public-health/services/reports-publications/canada-communicable-disease-report-ccdr/monthly-issue/2012-38/canada-communicable-disease-report.html | archive-date = 21 October 2019 }}</ref>

The vaccines Cervarix, Gardasil, and Gardasil 9 are authorized for use in Canada,<ref name="canada-imm-guide">{{Cite web |date=May 2017 |title=Human papillomavirus vaccine: Canadian Immunization Guide |url=https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html |access-date=11 January 2023 |website=Public Health Agency of Canada |archive-date=11 January 2023 |archive-url=https://web.archive.org/web/20230111234029/https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-part-4-active-vaccines/page-9-human-papillomavirus-vaccine.html |url-status=live }}</ref> with Gardasil 9 the primary vaccine used.<ref name="canada-access2022">{{Cite web |date=November 2022 |title=HPV vaccine access in Canada, 2022 |url=https://www.partnershipagainstcancer.ca/topics/hpv-vaccine-access-2022/ |access-date=11 January 2023 |website=Canadian Partnership Against Cancer |language=en-US |archive-date=11 January 2023 |archive-url=https://web.archive.org/web/20230111234029/https://www.partnershipagainstcancer.ca/topics/hpv-vaccine-access-2022/ |url-status=live }}</ref> All provinces and territories (except Quebec) administer Gardasil 9 on a two or three-dose schedule: individuals under age 15 are given two doses, while individuals who are immunocompromised, living with HIV, or age 15+ are given three doses. Quebec provides two doses to individuals under 18 years (the first dose is Gardasil 9, and the second dose is Cervarix) and three doses of Gardasil 9 to people age 18+.<ref name="canada-access2022" />

The administration of free vaccination programs is provided by individual province and territory governments. All provincial and territorial governments offer free vaccination for school-aged children, irrespective of gender.<ref>{{cite web | url=https://www.canada.ca/en/public-health/services/vaccination-children/when-to-vaccinate.html | title=Vaccines for children: Childhood vaccination schedule | date=17 April 2018 | access-date=11 September 2023 | archive-date=11 September 2023 | archive-url=https://web.archive.org/web/20230911032046/https://www.canada.ca/en/public-health/services/vaccination-children/when-to-vaccinate.html | url-status=live }}</ref> The school grades in which the vaccine is provided varies by province and territory: grade 4 and secondary 3 (Quebec); grade 6 (British Columbia, Manitoba, Newfoundland and Labrador, Nunavut, Prince Edward Island, Saskatchewan, Yukon); grades 6 and 9 (Alberta); grades 4-6 (Northwest Territories); or grade 7 (New Brunswick, Nova Scotia, Ontario).<ref name="canada-access2022" /> Publicly funded HPV vaccines are also provided in certain provinces and territories for other groups of people, such as men who have sex with men, individuals living with HIV, and individuals who identify as transgender. Individuals who do not qualify for any of the publicly funded programs can privately purchase the three-dose HPV vaccine series for $510 to $630.<ref name="canada-access2022" />

=====China=====

GlaxoSmithKline China announced in 2016, that Cervarix (HPV vaccine 16 and 18) had been approved by the China Food and Drug Administration (CFDA).<ref>{{cite press release |title=GSK announces Cervarix approved in China to help protect women from cervical cancer |website=GlaxoSmithKline |date=18 July 2016 |url=http://www.gsk-china.com/en-gb/media/press-releases/2016/gsk-announces-cervarix-approved-in-china-to-help-protect-women-from-cervical-cancer/ |archive-url=https://web.archive.org/web/20160724055754/http://www.gsk-china.com/en-gb/media/press-releases/2016/gsk-announces-cervarix-approved-in-china-to-help-protect-women-from-cervical-cancer/ |archive-date=24 July 2016 |url-status=live |access-date=20 October 2019}}</ref> Cervarix is registered in China for girls aged 9 to 45, adopting 3-dose program within 6 months.<ref>{{cite press release |title=Cervarix is approved for cervical cancer prevention in female population aged 9-45 years in mainland China |website=GlaxoSmithKline |date=29 May 2018 |url=http://www.gsk-china.com/en-gb/media/press-releases/2018/cervarix-is-approved-for-cervical-cancer-prevention-in-female-population-aged-9-45-years-in-mainland-china |archive-url=https://web.archive.org/web/20190331184428/http://www.gsk-china.com/en-gb/media/press-releases/2018/cervarix-is-approved-for-cervical-cancer-prevention-in-female-population-aged-9-45-years-in-mainland-china |archive-date=31 March 2019 |url-status=live |access-date=20 October 2019}}</ref> Cervarix was launched in China in 2017, and it was the first approved HPV vaccine in China.<ref>{{cite press release |title=Cervarix, first vaccine for cervical cancer prevention in mainland China, has officially launched |website=GlaxoSmithKline |date=31 July 2017 |url=http://www.gsk-china.com/en-gb/media/press-releases/2017/cervarix-first-vaccine-for-cervical-cancer-prevention-in-mainland-china-has-officially-launched/ |archive-url=https://web.archive.org/web/20170904162746/http://www.gsk-china.com/en-gb/media/press-releases/2017/cervarix-first-vaccine-for-cervical-cancer-prevention-in-mainland-china-has-officially-launched/ |archive-date=4 September 2017 |url-status=live |access-date=20 October 2019}}</ref>

=====Colombia=====

The vaccine was introduced in 2012, approved for girls aged 9.<ref>{{cite news | vauthors = Carvajal Pineda L |title=Girón ya está vacunando contra el papiloma humano |url=http://www.vanguardia.com/santander/area-metropolitana/172741-giron-ya-esta-vacunando-contra-el-papiloma-humano |access-date=29 July 2015 |work=Vanguardia |date=4 September 2012 |language=es |url-status=live |archive-url=https://web.archive.org/web/20160304062949/http://www.vanguardia.com/santander/area-metropolitana/172741-giron-ya-esta-vacunando-contra-el-papiloma-humano |archive-date=4 March 2016}}</ref><ref>{{cite news |last1=<!--Staff writer(s); no by-line.--> |title=Vacuna contra el Papiloma Humano será gratuita |url=http://www.caracol.com.co/noticias/actualidad/vacuna-contra-el-papiloma-humano-sera-gratuita/20130503/nota/1892388.aspx |access-date=29 July 2015 |work=Caracol Radio |issue=Actualidad |publisher=Prisa Radio |date=3 May 2013 }}{{Dead link|date=February 2022 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> The HPV vaccine was initially offered to girls aged 9 and older, and attending the fourth grade of school. Since 2013 the age of coverage was extended to girls in school from grade four (who have reached the age of 9) to grade eleven (independent of age); and no schooling from age 9–17 years 11 months and 29 days old.<ref>{{cite web |last1=<!--Staff writer(s); no by-line.--> |title=ABC VPH vaccine |url=http://www.minsalud.gov.co/Paginas/ABC-de-la-vacuna-contra-el-cancer-cuello-uterino.aspx |website=www.minsalud.gov.co |access-date=29 July 2015 |url-status=dead |archive-url=https://web.archive.org/web/20150804084811/http://www.minsalud.gov.co/Paginas/ABC-de-la-vacuna-contra-el-cancer-cuello-uterino.aspx |archive-date=4 August 2015}}</ref><!--Please keep the list of countries in this table alphabetized. -->

<!--If something in this table is incorrect and/or outdated, feel free to correct it with a source attached. -->

<!--Note: This table is to provide a brief overview of each country. If content on a country is to be expanded considerably, create a section for that country below the table. -->

=====Costa Rica=====

Since June 2019, the vaccine has been administered compulsorily by the state, free of charge to girls at ten years of age.<ref>{{Cite web |url=https://ticotimes.net/2019/04/25/costa-rica-to-begin-administering-hpv-vaccine |title=Costa Rica to begin administering HPV vaccine |website=The Tico Times Costa Rica |date=25 April 2019 |access-date=14 June 2019 |archive-url=https://web.archive.org/web/20190615053347/https://ticotimes.net/2019/04/25/costa-rica-to-begin-administering-hpv-vaccine |archive-date=15 June 2019 |url-status=live}}</ref><ref>{{Cite web |url=https://ticotimes.net/2019/06/04/costa-rica-begins-nationwide-hpv-vaccination-campaign |title=Costa Rica begins nationwide HPV vaccination campaign |website=The Tico Times Costa Rica |date=4 June 2019 |access-date=14 June 2019 |archive-url=https://web.archive.org/web/20190612032316/https://ticotimes.net/2019/06/04/costa-rica-begins-nationwide-hpv-vaccination-campaign |archive-date=12 June 2019 |url-status=live}}</ref>

=====Europe=====

As of 2020, the [[European Centre for Disease Prevention and Control]] (ECDC) reports that the vaccine uptake among females is the following:<ref name=ECDC2020p.6>{{Cite web |url=https://www.ecdc.europa.eu/sites/default/files/documents/Guidance-on-HPV-vaccination-in-EU-countries2020-03-30.pdf |title=European Centre for Disease Prevention and Control. Guidance on HPV vaccination in EU countries: focus on boys, people living with HIV and 9-valent HPV vaccine introduction, 2020. Stockholm: ECDC; 2020. p.6 |access-date=22 September 2024 |archive-date=10 July 2024 |archive-url=https://web.archive.org/web/20240710202331/https://www.ecdc.europa.eu/sites/default/files/documents/Guidance-on-HPV-vaccination-in-EU-countries2020-03-30.pdf |url-status=live }}</ref>

<blockquote>Finland, Hungary, Iceland, Malta, Norway, Portugal, Spain, Sweden, and the UK have reported national coverage above 70%. In some countries, including France and Germany, coverage has been consistently below 50%, though recently increasing in France.</blockquote><ref name=ECDC2020p.6/>

!Country

!Date of introduction

!Gender(s)

!Target age group

!Financed by

!Policy

| align="center" |[[Austria]]

| align="center" |2006

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |10–12

|Fully financed by national health authorities<ref>{{cite web |url=https://www.wien.gv.at/gesundheit/beratung-vorsorge/impfen/kalender/schulkinder.html |title=Impfkalender für Schulkinder |archive-url=https://web.archive.org/web/20160924040825/https://www.wien.gv.at/gesundheit/beratung-vorsorge/impfen/kalender/schulkinder.html |archive-date=24 September 2016 |url-status=live |access-date=6 September 2016}}</ref> for everyone age 9 to 20 years<ref>{{Cite web |date=29 January 2023 |title=Free HPV vaccination to start in February |url=https://austrianpress.com/2023/01/29/free-hpv-vaccination-to-start-in-february/ |access-date=22 February 2023 |website=Austrian News |language=en-US}}</ref>

|Voluntary immunization

| align="center" |[[Belgium]]

| align="center" |2007

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |10–13

|Fully financed by national health authorities

|Mandatory; part of the national immunization schedule

| align="center" |[[Croatia]]

| align="center" |20 May 2016

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |12

|Fully financed by national health authorities

|Voluntary immunization for women not yet sexually active

| align="center" |[[Czech Republic]]

| align="center" |

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |

|

|

| align="center" |[[Denmark]]<ref>{{cite news |title=Childhood vaccination programme |url=https://en.ssi.dk/vaccination/the-danish-childhood-vaccination-programme |access-date=28 November 2019 |work=en.ssi.dk |publisher=National Institute for Health Data and Disease Control |archive-url=https://web.archive.org/web/20191128134318/https://en.ssi.dk/vaccination/the-danish-childhood-vaccination-programme |archive-date=28 November 2019 |language=en}}</ref>

| align="center" |1 January 2009

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |12

|Fully financed by national health authorities

|Part of the Danish Childhood Vaccination program

| align="center" |[[Finland]]<ref>{{cite news |url=http://stm.fi/en/hpv-vaccinations |title=HPV vaccination: Coverage |date=18 February 2010 |access-date=25 April 2017 |archive-url=https://web.archive.org/web/20170426060333/http://stm.fi/en/hpv-vaccinations |archive-date=26 April 2017 |url-status=dead |publisher=Ministry of Social Affairs and Health}}</ref>

| align="center" |21 November 2013 for female, 20 May 2020 for male<ref>{{cite news |url=https://www.rokotustieto.fi/en/news/hpv-vaccine-will-now-also-be-offered-boys |title=HPV vaccine will now also be offered to boys |date=20 May 2020 |access-date=3 September 2020 |publisher=Lääketietokeskus |archive-date=9 August 2020 |archive-url=https://web.archive.org/web/20200809113239/https://www.rokotustieto.fi/en/news/hpv-vaccine-will-now-also-be-offered-boys |url-status=live }}</ref>

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |11–12

|Fully financed by national health authorities

|Part of the Finnish National Vaccination program

|-

| align="center" |[[France]]<ref>{{cite news |url=http://www.service-public.fr/actualites/00589.html |title=Cancer of the cervix: reimbursement of Gardasil |date=17 July 2007 |access-date=10 August 2013 |archive-url=https://web.archive.org/web/20141218134743/http://www.service-public.fr/actualites/00589.html |archive-date=18 December 2014 |url-status=dead |language=fr}}</ref>

| align="center" |11 July 2007

| align="center" |F

| align="center" |14–23

|Financed 65% by national health authorities

|Voluntary immunization for women not yet sexually active

|-

| align="center" |[[Germany]]<ref name="gerita2">{{cite news |url=http://www.vaccinerx.com/news/cervical-cancer/gardasil-merck-hpv-vaccine-gets-german-and-italian-approval-for-girls-20070326-149-26.html |title=Gardasil, Merck HPV Vaccine, Gets German And Italian Approval For Girls | vauthors = Fagbire OJ |date=26 March 2007 |access-date=10 August 2013 |archive-url=https://web.archive.org/web/20070928024949/http://www.vaccinerx.com/news/cervical-cancer/gardasil-merck-hpv-vaccine-gets-german-and-italian-approval-for-girls-20070326-149-26.html |archive-date=28 September 2007 |publisher=Vaccine Rx }}</ref><ref>{{cite web |title=HPV-Impfung jetzt auch für Jungen Kassenleistung |url=https://www.kbv.de/html/1150_38383.php |publisher=Kassenärztliche Vereinigung |access-date=18 November 2020 |language=de |date=6 December 2018 |archive-date=1 December 2020 |archive-url=https://web.archive.org/web/20201201211856/https://www.kbv.de/html/1150_38383.php |url-status=live }}</ref>

| align="center" |26 March 2007

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |9–14

|Fully financed by mandatory health insurance

|Voluntary immunization

|-

| align="center" |[[Greece]]<ref>{{cite news |url=http://www.iatronet.gr/article.asp?art_id=4247 |title=Vaccination against HPV in Greece | vauthors = Karakitsos P |date=7 March 2008 |access-date=10 August 2013 |archive-url=https://web.archive.org/web/20130430110429/http://www.iatronet.gr/article.asp?art_id=4247 |archive-date=30 April 2013 |url-status=dead |language=el}}</ref><ref>{{cite news |url=http://www.fskilkis.gr/index.php?option=com_content&task=view&id=218&Itemid=2. |title=The vaccine against cervical cancer and Cervarix vs Gardasil |date=12 February 2008 |access-date=10 August 2013 |archive-url=https://web.archive.org/web/20130613173032/http://www.fskilkis.gr/index.php?option=com_content&task=view&id=218&Itemid=2. |archive-date=13 June 2013 |url-status=live |language=el}}</ref>

| align="center" |12 February 2007

| align="center" |F

| align="center" |12–26

|Fully financed by national health authorities

|Mandatory for all girls entering 7th grade

|-

| align="center" |[[Hungary]]<ref>{{Cite web |url=https://www.antsz.hu/felso_menu/temaink/jarvany/hpv_2018/hpv_gyik_2018.html|archive-url=https://web.archive.org/web/20240226014721/https://www.antsz.hu/felso_menu/temaink/jarvany/hpv_2018/hpv_gyik_2018.html |url-status=live |title=Kérdések és válaszok a HPV elleni védőoltásról |archive-date=26 February 2024 |website=www.antsz.hu |date=4 September 2018 |access-date=26 February 2024}}</ref>

| align="center" |September 2014 for females<ref name=VaccinesHungary2017>{{Cite journal |title=Young Hungarian Students' Knowledge about HPV and Their Attitude Toward HPV Vaccination (March 2017) |date=2016 |pmc=5371737 |journal=Vaccines |volume=5 |issue=1 |page=1 |doi=10.3390/vaccines5010001 |doi-access=free |pmid=28036070 | vauthors = Balla BC, Terebessy A, Tóth E, Balázs P }}</ref> and 2020 for males<ref name=HPVCentreHungary>{{Cite web |url=https://hpvcentre.net/statistics/reports/HUN_FS.pdf |title=Hungary: Human Papillomavirus and Related Cancers, Fact Sheet 2023 |access-date=22 September 2024 |archive-date=22 September 2024 |archive-url=https://web.archive.org/web/20240922225256/https://hpvcentre.net/statistics/reports/HUN_FS.pdf |url-status=live }}</ref>

| align="center" |M/F<ref name=HPVCentreHungary/>

| align="center" |12-13<ref name=VaccinesHungary2017/>

|Fully financed by national health authorities for 7th grade schoolgirls (12–13 years old).<ref name=VaccinesHungary2017/><ref name=ECDCHungary2020>{{Cite web |url=https://www.ecdc.europa.eu/sites/default/files/documents/Guidance-on-HPV-vaccination-in-EU-countries2020-03-30.pdf |title=European Centre for Disease Prevention and Control. Guidance on HPV vaccination in EU countries: focus on boys, people living with HIV and 9-valent HPV vaccine introduction, 2020. Stockholm: ECDC; 2020. p.7 |access-date=22 September 2024 |archive-date=10 July 2024 |archive-url=https://web.archive.org/web/20240710202331/https://www.ecdc.europa.eu/sites/default/files/documents/Guidance-on-HPV-vaccination-in-EU-countries2020-03-30.pdf |url-status=live }}</ref> Several local governments have decided to pursue their own earlier initiative, thus providing the vaccine to those who are not eligible for the national vaccination programme due to their age.<ref name=ECDCHungary2020/> Subsidised by some local councils for 13- and 14-year-olds.

|Public vaccination program<ref name=VaccinesHungary2017/>

|-

| align="center" |[[Iceland]]

| align="center" |2011

| align="center" |

| align="center" |12

|Fully financed by national health authorities

|

|-

| align="center" |[[Republic of Ireland|Ireland]]<ref name=":02">{{Cite news |url=https://www.irishtimes.com/news/health/hpv-vaccine-to-be-offered-to-boys-from-start-of-school-year-in-2019-1.3723594 |title=HPV vaccine to be offered to boys from start of school year in 2019 | vauthors = Cullen P |newspaper=[[The Irish Times]] |access-date=16 October 2019 |archive-url=https://web.archive.org/web/20190904222847/https://www.irishtimes.com/news/health/hpv-vaccine-to-be-offered-to-boys-from-start-of-school-year-in-2019-1.3723594 |archive-date=4 September 2019 |url-status=live}}</ref>

| align="center" |2009

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |12–13

|Fully financed by national health authorities

|Offered to males and females in the first year of secondary school. Non-mandatory. HPV vaccination was introduced to the national immunisation scheme for males in 2019.

|-

| align="center" |[[Italy]]<ref name="gerita2" />

| align="center" |26 March 2007

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |12

|Fully financed by national health authorities initially for girls only. Offered to boys from 2017.

|

|-

| align="center" |[[Latvia]]

| align="center" |2009

| align="center" |

| align="center" |12

|Fully financed by national health authorities

|

|-

| align="center" |[[Liechtenstein]]

| align="center" |

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |

|

|

|-

| align="center" |[[Luxembourg]]

| align="center" |2008

| align="center" |

| align="center" |12

|Fully financed by national health authorities

|

|-

| align="center" |[[Netherlands]]

| align="center" |2009

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |10-18

|Fully financed by national health authorities Offered to boys starting from February 2022<ref>{{cite web | url=https://lci.rivm.nl/richtlijnen/hpv-vaccinatie | title=HPV-vaccinatie &#124; LCI richtlijnen | access-date=26 July 2024 | archive-date=7 October 2023 | archive-url=https://web.archive.org/web/20231007052828/https://lci.rivm.nl/richtlijnen/hpv-vaccinatie | url-status=live }}</ref><ref>{{cite web | url=https://www.rivm.nl/hpv-humaan-papillomavirus | title=HPV - Humaan Papillomavirus &#124; RIVM | access-date=26 July 2024 | archive-date=1 February 2022 | archive-url=https://web.archive.org/web/20220201015127/https://www.rivm.nl/hpv-humaan-papillomavirus | url-status=live }}</ref>

|

|-

| align="center" |[[North Macedonia]]

| align="center" |2009

| align="center" |F

| align="center" |12

|Fully financed by national health authorities

|Mandatory; part of the national immunization schedule

|-

| align="center" |[[Norway]]

| align="center" |2009

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |12–13

|

|Part of the national immunization program

|-

| align="center" |[[Portugal]]

| align="center" |2007

| align="center" |F

| align="center" |13

|Fully financed by national health authorities

|Part of the national immunization program for both boys and girls

|-

| align="center" |[[Romania]]

| align="center" |November 2008

| align="center" |F

| align="center" |10-18

|Fully financed by national health authorities

|Part of the national immunization program, but not mandatory for 10–14 years old girls until August 2021, up to 18 years old as of 3 September 2021

|-

| align="center" |[[Slovenia]]

| align="center" |2009

| align="center" |

| align="center" |11–12

|Fully financed by national health authorities

|

|-

| align="center" |[[Spain]]

| align="center" |2007

| align="center" |

| align="center" |11–14

|Fully financed by national health authorities

|

|-

| align="center" |[[Sweden]]<ref>{{cite web |date=18 February 2022 |title=Vaccination programmes |url=https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/vaccinations/vaccination-programmes/ |url-status=live |archive-url=https://web.archive.org/web/20220712161621/https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/vaccinations/vaccination-programmes |archive-date=12 July 2022 |access-date=26 November 2022 |website=Folkhälsomyndigheten |publisher=The Public Health Agency of Sweden |language=en}}</ref>

| align="center" |2012<ref>{{Cite web |date=14 May 2022 |title=Statistik för HPV-vaccinationer — Folkhälsomyndigheten |url=https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/vaccinationsstatistik/statistik-for-hpv-vaccinationer/ |url-status=live |archive-url=https://web.archive.org/web/20220602222617/https://www.folkhalsomyndigheten.se/folkhalsorapportering-statistik/statistikdatabaser-och-visualisering/vaccinationsstatistik/statistik-for-hpv-vaccinationer/ |archive-date=2 June 2022 |access-date=26 November 2022 |website=Folkhälsomyndigheten |language=sv}}</ref>

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |10–11

|The school-based vaccination program is fully financed by national health authorities, initially for girls only. Offered to all children in fifth grade from August 2020 (boys born in 2009 are included).<ref>{{Cite web |date=21 February 2022 |title=Vaccin mot humant papillomvirus (HPV) — Folkhälsomyndigheten |url=https://www.folkhalsomyndigheten.se/smittskydd-beredskap/vaccinationer/vacciner-a-o/humant-papillomvirus-hpv/ |url-status=live |archive-url=https://web.archive.org/web/20221026122603/https://www.folkhalsomyndigheten.se/smittskydd-beredskap/vaccinationer/vacciner-a-o/humant-papillomvirus-hpv/ |archive-date=26 October 2022 |access-date=26 November 2022 |website=Folkhälsomyndigheten |language=sv}}</ref>

|All vaccinations within the national vaccination programme for children are voluntary.

|-

| align="center" |[[Switzerland]]

| align="center" |2008

| align="center" |

| align="center" |11–14

|Fully financed by national health authorities

|

|-

| align="center" |[[United Kingdom|UK]]

| align="center" |September 2008

| align="center" |M/F<ref name=ECDC2020p.6/>

| align="center" |M: 9–45

F: 9–45

|Fully financed by national health authorities initially for girls only. Offered to boys aged 12 and 13 years from September 2019.<ref>{{Cite journal |date=July 2019 |title=Boys aged 12 and 13 years to be offered HPV vaccine from September 2019, PHE announces |url=https://pharmaceutical-journal.com/article/news/boys-aged-12-and-13-years-to-be-offered-hpv-vaccine-from-september-2019-phe-announces |url-status=live |journal=[[Pharmaceutical Journal]] |volume=303 |issue=7927 |doi=10.1211/PJ.2019.20206777 |s2cid=239219776 |issn=2053-6186 |archive-url=https://web.archive.org/web/20220809103909/https://pharmaceutical-journal.com/article/news/boys-aged-12-and-13-years-to-be-offered-hpv-vaccine-from-september-2019-phe-announces |archive-date=9 August 2022}}</ref> The HPV vaccine is available for free on the NHS up until a person's 25th birthday if they were eligible and missed the HPV vaccine offered in Year 8 at school,:<ref name=":5">{{Cite web|date=31 July 2019|title=HPV vaccine overview|url=https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/|access-date=5 February 2022|website=nhs.uk|language=en|archive-date=1 January 2019|archive-url=https://web.archive.org/web/20190101134126/https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/|url-status=live}}</ref>

* girls born after 1 September 1991

* boys born after 1 September 2006

Also fully financed by national health authorities since 2018 for men aged up to and including 45 years of age who have sex with other men (MSM) when they visit sexual health clinics and HIV clinics in England. Trans women (people who were assigned male at birth) are eligible in the same way as MSM if their risk of getting HPV is similar to the risk of MSM who are eligible for the HPV vaccine. Trans men (people who were assigned female at birth) are eligible if they have sex with other men and are aged 45 or under.<ref name=":5" />

|Offered to males and females in the second year of secondary school, as well as at sexual health and HIV clinics in England. Non-mandatory.

====Hong Kong====

HPV vaccines are approved for use in Hong Kong. As part of the Hong Kong Childhood Immunisation Programme, HPV vaccines became mandatory for students in the 2019/2020 school year, exclusively for females at primary 5 and 6 levels.<ref>{{Cite web |url=https://www.chp.gov.hk/en/features/102146.html |title=Centre for Health Protection, Department of Health - About human papillomavirus (HPV) vaccination |website=www.chp.gov.hk |access-date=15 August 2020 |archive-date=8 March 2021 |archive-url=https://web.archive.org/web/20210308171607/https://www.chp.gov.hk/en/features/102146.html |url-status=live }}</ref>

===== India =====

HPV vaccine (both Gardasil and Cervarix) was introduced in Indian markets in 2008, but it is yet to be included in the country's universal immunization programme. In Punjab and Sikkim (states of India), it is included in the state immunization program and the coverage is up to 97% of targeted girls.<ref>{{Cite web |title=India resolves to reduce cervical cancer by vaccinating girls |url=https://www.gavi.org/vaccineswork/india-resolves-reduce-cervical-cancer-vaccinating-girls |access-date=2024-11-04 |website=www.gavi.org |language=en}}</ref> HPV vaccination has been recommended by the [[National Immunization Technical Advisory Group|National Technical Advisory Group on Immunization]], but has not been implemented in India as of 2018.<ref>{{cite journal | vauthors = Das M | title = Cervical cancer vaccine controversy in India | journal = The Lancet. Oncology | volume = 19 | issue = 2 | pages = e84 | date = February 2018 | pmid = 29413482 | doi = 10.1016/S1470-2045(18)30018-4 }}</ref>

In 2023, Serum Institute of India (SII) developed a new vaccine Cervavax targeting HPV types 6, 11, 16, and 18. The newly developed vaccine shows equal capability to Merck's Gardasil 9. Cervavax vaccine isn't commercially available yet.<ref>Schiller, J. T., & Kreimer, A. R. (2023). [https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(23)00535-1/fulltext An HPV vaccine from India: broadening possibilities for cervical cancer control]. The Lancet Oncology, 24(12), 1288-1289.</ref> In 2024, the HPV vaccine drive was announced by Finance Minister Nirmala Sitharaman as part of Nari Shakti ("Women Power") campaign but hasn't been implemented yet. The vaccine is commercially available in the market at a price between ₹ 3,000 ($35) and ₹ 15,000 ($180).

===== Ireland =====

The HPV vaccination programme in Ireland is part of the national strategy to protect females from [[cervical cancer]]. Since 2009, the [[Health Service Executive]] has offered the HPV vaccine, free of charge, to all girls from the first year onwards (ages 12–13). Secondary schools began implementing the vaccine program on an annual basis from September 2010 onwards.<ref>{{Cite web |url=http://www.hpsc.ie/a-z/vaccinepreventable/vaccination/immunisationuptakestatistics/hpvimmunisationuptakestatistics/File,16039,en.pdf |title=HSPC HPV vaccine uptake in Ireland |access-date=16 October 2019 |archive-url=https://web.archive.org/web/20190111232554/http://www.hpsc.ie/a-z/vaccinepreventable/vaccination/immunisationuptakestatistics/hpvimmunisationuptakestatistics/File,16039,en.pdf |archive-date=11 January 2019 |url-status=dead}}</ref> The programme was expanded to include males in 2019.<ref name=":12">{{Cite web |url=https://www.lenus.ie/bitstream/handle/10147/110568/XPDFFile16404en.pdf?sequence=3&isAllowed=y |title=HSE Guidelines for staff HPV second level school vaccination campaign |access-date=16 October 2019 |archive-url=https://web.archive.org/web/20190111232834/https://www.lenus.ie/bitstream/handle/10147/110568/XPDFFile16404en.pdf?sequence=3&isAllowed=y |archive-date=11 January 2019 |url-status=live}}</ref> Two HPV vaccines are licensed for use in Ireland: [[Cervarix]] and [[Gardasil]]. To ensure high uptake, the vaccine is administered to teenagers aged 12–13 in their first year of secondary school, with the first dose administered between September and October and the final dose in April of the following year.<ref name=":12" /><ref>{{Cite news |url=https://www.hse.ie/eng/health/immunisation/hcpinfo/othervaccines/hpv/hpv.html |title=HPV |website=HSE.ie |access-date=11 January 2019 |archive-url=https://web.archive.org/web/20190112044222/https://www.hse.ie/eng/health/immunisation/hcpinfo/othervaccines/hpv/hpv.html |archive-date=12 January 2019 |url-status=live}}</ref> Males and females aged 12–13 who are outside of the traditional school setting (home school, etc.) are invited to [[Health Service Executive|Health service Executive]] clinics for their vaccines. HPV vaccination in Ireland is not mandatory and consent is obtained before vaccination.<ref name=":02" /><ref name=":12" /> For males and females aged 16 and under, consent is granted by a parent or guardian unless it is explicitly refused by the child. Any male or female aged 16 and over may provide their own consent if they want to be vaccinated.<ref name=":12" /> [[Health Information and Quality Authority|HIQA]] has stated the vaccine will provide further protection, particularly to men who have sex with men. The vaccine has been extended following evidence that 25% of HPV cancers occur in men.<ref name=":03">{{Cite news |url=https://www.irishtimes.com/news/health/hpv-vaccine-to-be-offered-to-boys-from-start-of-school-year-in-2019-1.3723594 |title=Irish times- HPV vaccine to be offered to boys from start of school year in 2019 |newspaper=[[The Irish Times]] |access-date=11 January 2019 |archive-url=https://web.archive.org/web/20181208155442/https://www.irishtimes.com/news/health/hpv-vaccine-to-be-offered-to-boys-from-start-of-school-year-in-2019-1.3723594 |archive-date=8 December 2018 |url-status=live}}</ref> Additionally, [[Health Information and Quality Authority|HIQA]] is aiming to replace the current vaccination, which covers 4 major HPV strains, with an updated vaccine protecting against nine strains. The cost with the "gender-neutral nine-talent" vaccine is estimated to be nearly €11.66&nbsp;million over the next five years.<ref name=":02"/>

=====Israel=====

Introduced in 2012. Target age group 13–14. Fully financed by national health authorities only for this age group. For the year 2013–2014, girls in the eighth grade may get the vaccine free of charge only in school, and not in Ministry of Health offices or clinics. Girls in the ninth grade may receive the vaccine free of charge only at Ministry of Health offices, and not in schools or clinics.<ref>{{cite web | url = http://www.health.gov.il/English/SearchResults/Pages/GlobalSearch.aspx | title = health.gov.il | location = Israel | work = Ministry of Health | archive-url = https://web.archive.org/web/20131029123205/http://www.health.gov.il/English/SearchResults/Pages/GlobalSearch.aspx| archive-date = 29 October 2013}}</ref> Religious and conservative groups are expected to refuse the vaccination.<ref>{{cite web |url=http://www.jpost.com/Health-and-Science/Health-Ministry-decides-to-offer-free-HPV-vaccine-to-13-year-old-girls-328276 |title=Health Ministry decides to offer free HPV vaccine to 13-year-old girls &#124; JPost &#124; Israel News | vauthors = Siegel J |date=9 October 2013 |publisher=JPost |archive-url=https://web.archive.org/web/20131202044011/http://www.jpost.com/Health-and-Science/Health-Ministry-decides-to-offer-free-HPV-vaccine-to-13-year-old-girls-328276 |archive-date=2 December 2013 |url-status=live |access-date=29 December 2013 }}</ref>

=====Japan=====

The quadrivalent vaccine has been approved for males and the 9-valent one for females.<ref>[https://pubmed.ncbi.nlm.nih.gov/34334535/ Risk-Benefit Analysis of the 9-Valent HPV Vaccination for Adolescent Boys from an Individual Perspective]</ref> Since 2010, young women in Japan have been eligible to receive the cervical cancer vaccination for free.<ref name="Japan2013">{{cite news|url=http://ajw.asahi.com/article/behind_news/social_affairs/AJ201306150057|title=Health ministry withdraws recommendation for cervical cancer vaccine |date=15 June 2013|newspaper=The Asahi Shimbun|archive-url=https://web.archive.org/web/20130619025016/http://ajw.asahi.com/article/behind_news/social_affairs/AJ201306150057|archive-date=19 June 2013}}</ref> In June 2013, the Japanese [[Ministry of Health, Labor and Welfare (Japan)|Ministry of Health, Labor and Welfare]] mandated that, before administering the vaccine, medical institutions must inform women that the ministry does not recommend it.<ref name="Japan2013" /> However, the vaccine is still available at no cost to Japanese women who choose to accept the vaccination.<ref name="Japan2013" /> It is widely available only since April 2013. Fully financed by national health authorities to females aged 11 to 16 years. In June 2013, however, Japan's Vaccine Adverse Reactions Review Committee (VARRC) suspended the recommendation of the vaccine due to fears of adverse events. This directive has been criticized by researchers at the [[University of Tokyo]] as a failure of governance since the decision was taken without the presentation of adequate scientific evidence.<ref>{{cite journal | vauthors = Gilmour S, Kanda M, Kusumi E, Tanimoto T, Kami M, Shibuya K | title = HPV vaccination programme in Japan | journal = Lancet | volume = 382 | issue = 9894 | pages = 768 | date = August 2013 | pmid = 23993189 | doi = 10.1016/S0140-6736(13)61831-0 | s2cid = 40619281 }}</ref> At the time, Ministry spokespeople emphasized that "The decision does not mean that the vaccine itself is problematic from the viewpoint of safety," but that they wanted time to conduct analyses on possible adverse effects, "to offer information that can make the people feel more at ease."<ref name="Mulcahy2013">{{cite news | vauthors = Mulcahy N |title=Japan Withdraws HPV Vaccine Recommendation for Girls |url=https://www.medscape.com/viewarticle/806645 |access-date=17 May 2020 |work=[[Medscape]] |date=25 June 2013 |archive-date=23 April 2020 |archive-url=https://web.archive.org/web/20200423180959/https://www.medscape.com/viewarticle/806645 |url-status=live }}</ref> However, the suspension of the Ministry's endorsement was still in place as of February 2019, by which time the HPV vaccination rate among younger women fell from approximately 70% in 2013 to 1% or less.<ref name="Ikeda2019">{{cite journal | vauthors = Ikeda S, Ueda Y, Yagi A, Matsuzaki S, Kobayashi E, Kimura T, Miyagi E, Sekine M, Enomoto T, Kudoh K | title = HPV vaccination in Japan: what is happening in Japan? | journal = Expert Review of Vaccines | volume = 18 | issue = 4 | pages = 323–325 | date = April 2019 | pmid = 30768373 | doi = 10.1080/14760584.2019.1584040 | doi-access = free }}</ref> Over an overlapping time period (2009–2019), the age-adjusted mortality rate from cervical cancer increased by 9.6%.<ref name="Ikeda2019"/> Japan to Resume Active Promotion of HPV Vaccinations in April 2022.<ref>{{cite news |title=Japan to Resume Active Promotion of HPV Vaccinations in April |url=https://sp.m.jiji.com/english/show/16360 |access-date=28 November 2021 |work=[[Jiji Press News]] |date=26 November 2021 |archive-date=28 November 2021 |archive-url=https://web.archive.org/web/20211128135918/https://sp.m.jiji.com/english/show/16360 |url-status=live }}</ref><ref>{{cite news |title='Finally we can protect women': Japan's HPV vaccine battle |url=https://sg.news.yahoo.com/finally-protect-women-japans-hpv-025214302.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr&guccounter=1&guce_referrer=aHR0cHM6Ly90LmNvLw&guce_referrer_sig=AQAAAItWrEEBphE__k51pSYRm4Fwc89sX6fQLsT9IC7fEDQa96ym64moGw97mwxmniV93oSjoweQt7LDVTzgKXh-obP33kcUhks85muw5V59J9-AP9TyhdWI3v0qhZcrasMFVZB5tDr4rP8gIknu8MPKijwd8R4g1MX6SwyxjdJmPFNB |access-date=2 April 2022 |work=[[AFP News]] |date=31 March 2022 |archive-date=22 April 2022 |archive-url=https://web.archive.org/web/20220422000238/https://sg.news.yahoo.com/finally-protect-women-japans-hpv-025214302.html?soc_src=social-sh&soc_trk=tw&tsrc=twtr&guccounter=1&guce_referrer=aHR0cHM6Ly90LmNvLw&guce_referrer_sig=AQAAAItWrEEBphE__k51pSYRm4Fwc89sX6fQLsT9IC7fEDQa96ym64moGw97mwxmniV93oSjoweQt7LDVTzgKXh-obP33kcUhks85muw5V59J9-AP9TyhdWI3v0qhZcrasMFVZB5tDr4rP8gIknu8MPKijwd8R4g1MX6SwyxjdJmPFNB |url-status=live }}</ref> In December 2021, the [[Ministry of Health, Labour and Welfare]] has decided to allow free vaccines to women born between fiscal year 1997 and 2005 after eight-year hiatus.<ref>{{cite news |title=Japan to allow free HPV vaccines to women born FY1997-2005 after 8-year hiatus |url=https://mainichi.jp/english/articles/20211224/p2a/00m/0li/019000c |access-date=28 December 2021 |work=[[Mainichi Shimbun]] |date=24 December 2021 |archive-date=28 December 2021 |archive-url=https://web.archive.org/web/20211228145712/https://mainichi.jp/english/articles/20211224/p2a/00m/0li/019000c |url-status=live }}</ref> A panel of Japan's [[Ministry of Health, Labour and Welfare]] agreed to give women (born between fiscal 1997 and fiscal 2005), free vaccinations, if they missed the country's free vaccination program.<ref>{{cite news|title=Japan to Give Free HPV Vaccinations to Those Who Missed Them|url=https://www.nippon.com/en/news/yjj2021111500997/|access-date=4 February 2022|work=nippon.com|date=15 November 2021|archive-date=15 November 2021|archive-url=https://web.archive.org/web/20211115134735/https://www.nippon.com/en/news/yjj2021111500997/|url-status=live}}</ref> 225,993 girls were vaccinated for the first round of routine vaccination in 2022, and the vaccination rate was 42.2%.<ref>{{cite web|url=https://www.mhlw.go.jp/content/10906000/001128683.pdf|title=HPVワクチンに関する調査結果等について Survey results, etc. regarding HPV vaccines|work=Ministry of Health, Labour and Welfare of Japan|date=1 August 2023|access-date=2 August 2023|archive-date=2 August 2023|archive-url=https://web.archive.org/web/20230802150409/https://www.mhlw.go.jp/content/10906000/001128683.pdf|url-status=live}}</ref> The Osaka University Graduate School of Medicine and Faculty of Medicine reported the first vaccination rate and cumulative first vaccination rate for each year of birth in 2022 at a meeting of the Ministry of Health, Labor and Welfare. For 12-year-old girls born in 2010, the rate was 2.8%.<ref>{{cite web|url=https://www.mhlw.go.jp/content/10601000/001198130.pdf|title=HPV ワクチンの接種状況に関する検討|trans-title=HPV Consideration of HPV vaccination status|work=Ministry of Health, Labour and Welfare of Japan|date=26 June 2024|access-date=20 February 2024|archive-date=5 February 2024|archive-url=https://web.archive.org/web/20240205071058/https://www.mhlw.go.jp/content/10601000/001198130.pdf|url-status=live}}</ref>

{{Vertical bar chart|1992|0|1993|0|1994|53.4|1995|74.4|1996|78.2|1997|81.8|1998|80.8|1999|71.8|2000|20.0|2001|9.1|2002|9.3|2003|10.8|2004|18.2|2005|31.6|2006|25.2|2007|16.7|2008|12.9|2009|8.1|2010|2.8|color=blue|full_name=Human Papillomavirus Vaccination by Birth Fiscal Year in Japan<ref>{{cite journal | vauthors = Yagi A, Ueda Y, Oka E, Nakagawa S, Kimura T | title = Human Papillomavirus Vaccination by Birth Fiscal Year in Japan | journal = JAMA Network Open | volume = 7 | issue = 7 | pages = e2422513 | date = July 2024 | pmid = 39012629 | pmc = 11252895 | doi = 10.1001/jamanetworkopen.2024.22513 }}</ref><ref>{{Cite web|title=Consideration of HPV vaccination status|url=https://www.mhlw.go.jp/content/10900000/001255917.pdf|website=Ministry of Health, Labour and Welfare of Japan|access-date=11 August 2024|archive-date=16 August 2024|archive-url=https://web.archive.org/web/20240816152744/https://www.mhlw.go.jp/content/10900000/001255917.pdf|url-status=live}}</ref>}}

=====Laos=====

In 2013, [[Laos]] began implementation of the HPV vaccine, with the assistance of [[GAVI|Gavi, the Vaccine Alliance]].<ref name=GAVI2013/>

=====Malaysia=====

In 2010, Malaysia launched a national vaccination program to provide three doses of HPV vaccines to all 13-year-old girls. In 2015, the program transitioned to a two-dose regimen.<ref name="NCBI">{{cite journal | vauthors = Wong LP, Alias H, Lim SH | title = Factors Influencing HPV Vaccine Intentions in Malaysian Men Who Have Sex with Men: A Cross-Sectional Study in Malaysia | journal = Pathogens | volume = 12 | issue = 10 | page = 1261 | date = October 2023 | pmid = 37887777 | pmc = 10610168 | doi = 10.3390/pathogens12101261 | doi-access = free }}</ref>

High rates of school enrolment for 13-year-olds (96.0%) and retention of female students in secondary schools have made it possible for the HPV vaccination to be integrated into the School Health Service Program and ensure equal access to the HPV vaccine between urban and rural areas.<ref name="BMC Public Health">{{cite journal | vauthors = Muhamad NA, Buang SN, Jaafar S, Jais R, Tan PS, Mustapha N, Lodz NA, Aris T, Sulaiman LH, Murad S | title = Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme | journal = BMC Public Health | volume = 18 | issue = 1 | pages = 1402 | date = December 2018 | pmid = 30577816 | pmc = 6303856 | doi = 10.1186/s12889-018-6316-6 | doi-access = free }}</ref>

=====Mexico=====

The vaccine was introduced in 2008 to 5% of the population. This percentage of the population had the lowest development index which correlates with the highest incidence of cervical cancer.<ref name="Pan American Health Organization">{{cite web |title=New technologies for cervical cancer prevention: from scientific evidence to program planning. |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6040a2.htm#tab |publisher=Pan American Health Organization |access-date=18 April 2012 |url-status=live |archive-url=https://web.archive.org/web/20120509061540/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6040a2.htm#tab |archive-date=9 May 2012}}</ref> The HPV vaccine is delivered to girls 12 – 16 years old following the 0-2-6 dosing schedule. By 2009 [[Mexico]] had expanded the vaccine use to girls, 9–12 years of age, the dosing schedule in this group was different, the time elapsed between the first and second dose was six months, and the third dose 60 months later.<ref name="cdc.gov">{{cite web |title=Progress Toward Implementation of Human Papillomavirus Vaccination—the Americas, 2006–2010 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6040a2.htm#tab |publisher=Center for Disease and Control Prevention |access-date=18 April 2012 |url-status=live |archive-url=https://web.archive.org/web/20120509061540/http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6040a2.htm#tab |archive-date=9 May 2012}}</ref> In 2011 Mexico approved a nationwide use of HPV vaccination program to include vaccination of all 9-year-old girls.<ref name="cdc.gov"/>

=====New Zealand=====

Immunization as of 2017 is free for males and females aged 9 to 26 years.<ref name="NZQA">{{cite web |title=Questions and answers about HPV immunisation |url=https://www.health.govt.nz/your-health/healthy-living/immunisation/immunisation-older-children/human-papillomavirus-hpv/questions-and-answers-about-hpv-immunisation |website=Ministry of Health NZ |access-date=24 November 2021 |url-status=live |date=29 September 2021 |archive-date=26 February 2018 |archive-url=https://web.archive.org/web/20180226211753/https://www.health.govt.nz/your-health/healthy-living/immunisation/immunisation-older-children/human-papillomavirus-hpv/questions-and-answers-about-hpv-immunisation }}</ref>

The public funding began on 1 September 2008. The vaccine was initially offered only to girls, usually through a school-based program in Year 8 (approximately age 12), but also through general practices and some family planning clinics. Over 200,000 New Zealand girls and young women have received HPV immunization.<ref name="NZQA"/>

=====Panama=====

The vaccine was added to the national immunization program in 2008, to target 10-year-old girls.<ref name="Pan American Health Organization"/>

=====South Korea=====

On 27 July 2007, [[South Korea]]n government approved Gardasil for use in girls and women aged 9 to 26 and boys aged 9 to 15.<ref>{{cite news |url=http://www.msd-korea.com/content/corporate/news/announcement/company22-gardasil.html |title=가다실 제품 허가 공지 |date=27 June 2007 |access-date=6 August 2007 |url-status=dead |archive-url=https://web.archive.org/web/20070929191557/http://www.msd-korea.com/content/corporate/news/announcement/company22-gardasil.html |archive-date=29 September 2007}}</ref> Approval for use in boys was based on safety and [[immunogenicity]] but not efficacy.

Since 2016, HPV vaccination has been part of the National Immunization Program, offered free of charge to all children under 12 in South Korea, with costs fully covered by the Korean government.<ref>{{cite web |url=http://news.kukinews.com/article/view.asp?arcid=0010258599&code=46111501&cp=nv |title=&#91;기획&#93; 어린이 자궁경부암 예방접종 무료…가다실 Vs 서바릭스 어떤 백신 도입될까 |date=18 January 2016 |access-date=27 January 2016 |url-status=live |archive-url=https://web.archive.org/web/20160203030125/http://news.kukinews.com/article/view.asp?arcid=0010258599&code=46111501&cp=nv |archive-date=3 February 2016}}</ref>

For 2016 only, Korean girls born between 1 January 2003 and 31 December 2004 were also eligible to receive the free vaccinations as a limited-time offer. From 2017, the free vaccines are available to those under 12 only.<ref>{{cite web |url=http://www.rapportian.com/n_news/news/view.html?no=26458 |title=[자궁경부'앎'은 힘이다! - 가다실] "자궁경부암 백신 무료접종으로 공중보건 질적 향상 기대" - 라포르시안 |date=5 April 2016 |website=rapportian.com |access-date=7 May 2018 |archive-date=28 August 2021 |archive-url=https://web.archive.org/web/20210828095440/https://www.rapportian.com/news/articleView.html?idxno=26458 |url-status=live }}</ref>

=====Trinidad and Tobago=====

Introduced in 2013. Target Group 9–26. Fully financed by national health authorities. But was suspended later on that year owing to objections and concerns raised by the Catholic Board, but fully available in local health centers.<ref>{{cite web |url=https://caribbeanmedicalnews.com/2013/12/hpv-vaccine-for-first-form-students-in-barbados-while-trinidad-suspends-the-same-in-schools/ |title=HPV vaccine for first form students in Barbados while Trinidad suspends the same in schools |work=Caribbean Medical News |access-date=27 October 2021 |date=1 December 2013 |archive-date=27 October 2021 |archive-url=https://web.archive.org/web/20211027044600/https://caribbeanmedicalnews.com/2013/12/hpv-vaccine-for-first-form-students-in-barbados-while-trinidad-suspends-the-same-in-schools/ |url-status=live }}</ref>

=====United Arab Emirates=====

The World Health Organization ranks cervical cancer as the fourth most frequent cancer among women in UAE, at 7.4 per 100,000 women,<ref>{{cite news | vauthors = D'Souza C |title=Cervical cancer vaccination could be mandatory in UAE |url=https://gulfnews.com/news/uae/health/cervical-cancer-vaccination-could-be-mandatory-in-uae-1.1174754 |access-date=16 September 2018 |work=Gulf News |date=24 April 2013 |archive-url=https://web.archive.org/web/20180916163940/https://gulfnews.com/news/uae/health/cervical-cancer-vaccination-could-be-mandatory-in-uae-1.1174754 |archive-date=16 September 2018 |url-status=live}}</ref> and according to Abu Dhabi Health Authority, the cancer is also the seventh highest cause of death of women in the U.A.E.<ref>{{cite news | vauthors = Al Nowais S |title=Greater understanding of HPV in UAE may help reduce cervical cancer cases |url=https://www.thenational.ae/uae/greater-understanding-of-hpv-in-uae-may-help-reduce-cervical-cancer-cases-1.94278 |access-date=17 September 2018 |work=The National |date=21 May 2016 |archive-url=https://web.archive.org/web/20180917105308/https://www.thenational.ae/uae/greater-understanding-of-hpv-in-uae-may-help-reduce-cervical-cancer-cases-1.94278 |archive-date=17 September 2018 |url-status=live}}</ref>

In 2007, the HPV vaccine was approved for girls and young women, 15 to 26 years of age, and offered optionally at hospitals and clinics.<ref>{{cite news |title=UAE gets cervical cancer vaccine |url=https://www.khaleejtimes.com/article/20070107/ARTICLE/301079962/1002 |access-date=17 September 2018 |work=Khaleej Times |date=7 January 2007 |archive-url=https://web.archive.org/web/20180917105201/https://www.khaleejtimes.com/article/20070107/ARTICLE/301079962/1002 |archive-date=17 September 2018 |url-status=live}}</ref><ref>{{Cite web |url=https://www.haad.ae/simplycheck/tabid/73/Default.aspx |title=Prevention |access-date=16 September 2018 |archive-url=https://web.archive.org/web/20180916130440/https://www.haad.ae/simplycheck/tabid/73/Default.aspx |archive-date=16 September 2018 |url-status=live}}</ref> Moreover, starting 1 June 2013, the vaccine was offered free of charge for women between the ages of 18 and 26, in Abu Dhabi.<ref>{{cite news | vauthors = Al Hassani Z |title=Free vaccination against cervical cancer for Abu Dhabi women |url=https://www.thenational.ae/uae/health/free-vaccination-against-cervical-cancer-for-abu-dhabi-women-1.316238 |access-date=17 September 2018 |work=The National |date=14 May 2013 |archive-url=https://web.archive.org/web/20180917105310/https://www.thenational.ae/uae/health/free-vaccination-against-cervical-cancer-for-abu-dhabi-women-1.316238 |archive-date=17 September 2018 |url-status=live}}</ref> However, on 14 September 2018, the U.A.E's Ministry of Health and Community Protection announced that HPV vaccine became a mandatory part of the routine vaccinations for all girls in the U.A.E.<ref>{{cite news | vauthors = Al-Sabai W |title=قرار وزاري بإلزامية تطعيم سرطان عنق الرحم | trans-title = A ministerial decision mandating cervical cancer vaccination|url=https://www.emaratalyoum.com/local-section/health/2018-09-15-1.1134633 |access-date=16 September 2018 |work=Emarat Alyoum |date=15 September 2018 |language=ar |archive-url=https://web.archive.org/web/20180915114151/https://www.emaratalyoum.com/local-section/health/2018-09-15-1.1134633 |archive-date=15 September 2018 |url-status=live}}</ref> The vaccine is to be administers to all school girls in the 8th grade girls, aged 13.<ref>{{cite news | vauthors = Al Ali I |title=Cervical cancer vaccination for Dubai schools |url=http://gulftoday.ae/portal/90134988-8c9b-44a0-82e4-7834d7ecda42.aspx |access-date=16 September 2018 |work=Gulf Today |date=15 September 2018 |archive-url= https://web.archive.org/web/20180915143547/http://www.gulftoday.ae/portal/90134988-8c9b-44a0-82e4-7834d7ecda42.aspx |archive-date=15 September 2018 |url-status=dead }}</ref>

=====United Kingdom=====

In the UK the vaccine is licensed for females aged 9–26, for males aged 9–15, and for [[men who have sex with men]] aged 18–45.<ref name=GayJab>{{cite news |url=http://news.bbc.co.uk/1/hi/health/6342105.stm |title=Gay men seek 'female cancer' jab |publisher=BBC |date=23 February 2007 | vauthors = Roberts M |url-status=live |archive-url=https://web.archive.org/web/20090130110634/http://news.bbc.co.uk/1/hi/health/6342105.stm |archive-date=30 January 2009 }}</ref>

HPV vaccination was introduced into the national immunisation programme in September 2008, for girls aged 12–13 across the UK. A two-year catch-up campaign started in Autumn 2009 to vaccinate all girls up to 18 years of age. Catch-up vaccination was offered to girls aged between 16 and 18 from autumn 2009, and girls aged between 15 and 17 from autumn 2010. It will be many years before the vaccination programme affects cervical cancer incidence so women are advised to continue accepting their invitations for cervical screening.<ref>{{cite web |url=http://www.cancerscreening.nhs.uk/cervical/index.html |title=NHS Cervical Screening Program |archive-url=https://web.archive.org/web/20080914172627/http://www.cancerscreening.nhs.uk/cervical/index.html |archive-date=14 September 2008 |url-status=live |access-date=26 June 2008}}</ref> [[Men who have sex with men]] up to and including the age of 45 became eligible for free HPV vaccination on the [[National Health Service|NHS]] in April 2018. They get the vaccine by visiting sexual health clinics and HIV clinics in England.<ref name=":2">{{Cite web |url=https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/ |title=HPV vaccine |date=9 May 2018 |website=nhs.uk |access-date=3 January 2019 |archive-url=https://web.archive.org/web/20190101134126/https://www.nhs.uk/conditions/vaccinations/hpv-human-papillomavirus-vaccine/ |archive-date=1 January 2019 |url-status=live}}</ref> A meta-analysis of vaccinations for men who have sex with men showed that this strategy is most effective when combined with gender-neutral vaccination of all boys, regardless of their sexual orientation.<ref>{{cite journal | vauthors = Nadarzynski T, Frost M, Miller D, Wheldon CW, Wiernik BM, Zou H, Richardson D, Marlow LA, Smith H, Jones CJ, Llewellyn C | title = Vaccine acceptability, uptake and completion amongst men who have sex with men: A systematic review, meta-analysis and theoretical framework | journal = Vaccine | volume = 39 | issue = 27 | pages = 3565–3581 | date = June 2021 | pmid = 34034949 | doi = 10.1016/j.vaccine.2021.05.013 | s2cid = 235203871 | url = http://sro.sussex.ac.uk/id/eprint/99742/3/Accepted%20version%20for%20VACCINE.pdf | access-date = 8 June 2022 | archive-date = 19 June 2022 | archive-url = https://web.archive.org/web/20220619004930/http://sro.sussex.ac.uk/id/eprint/99742/3/Accepted%20version%20for%20VACCINE.pdf | url-status = live }}</ref>

From the 2019/2020 school year, it is expected that 12- to 13-year-old boys will also become eligible for the HPV vaccine as part of the national immunisation programme. This follows a statement by the [[Joint Committee on Vaccination and Immunisation]].<ref>{{cite web |title=JCVI statement: extending the HPV vaccination programme – conclusions |url=https://www.gov.uk/government/publications/jcvi-statement-extending-the-hpv-vaccination-programme-conclusions |website=GOV.UK |access-date=4 January 2019 |archive-url=https://web.archive.org/web/20190104021557/https://www.gov.uk/government/publications/jcvi-statement-extending-the-hpv-vaccination-programme-conclusions |archive-date=4 January 2019 |url-status=live}}</ref> The first dose of the HPV vaccine will be offered routinely to boys aged 12 and 13 in school year 8, in the same way that it is currently (May 2018) offered to girls.<ref name=":2" /> [[Boots UK]] opened a private HPV vaccination service to boys and men aged 12–44 years in April 2017 at a cost of £150 per vaccination. In children aged 12–14 years two doses are recommended, while those aged 15–44 years a course of three is recommended.<ref>{{Cite journal |date=April 2017 |title=Boots launches HPV vaccination for boys and men |url=https://pharmaceutical-journal.com/article/news/boots-launches-hpv-vaccination-for-boys-and-men |url-status=live |journal=The Pharmaceutical Journal |volume=298 |issue=7900 |doi=10.1211/PJ.2017.20202616 |doi-broken-date=5 November 2024 |issn=2053-6186 |archive-url=https://web.archive.org/web/20220704051724/https://pharmaceutical-journal.com/article/news/boots-launches-hpv-vaccination-for-boys-and-men |archive-date=4 July 2022}}</ref>

[[Cervarix]] was the HPV vaccine offered from its introduction in September 2008, to August 2012, with [[Gardasil]] being offered from September 2012.<ref name=":2" /><ref>{{Cite web |url=https://www.gov.uk/government/publications/human-papillomavirus-hpv-the-green-book-chapter-18a |title=Human papillomavirus (HPV): the green book, chapter 18a |date=20 March 2013 |website=Public Health England |archive-url=https://web.archive.org/web/20191015065605/https://www.gov.uk/government/publications/human-papillomavirus-hpv-the-green-book-chapter-18a |url-status=live |archive-date=15 October 2019 |access-date=3 January 2019}}</ref> The change was motivated by Gardasil's added protection against genital warts.<ref>{{Cite news |url=http://immunisation.dh.gov.uk/hpv-vacc-prog-switch-to-gardasil-sept-2012/ |title=HPV vaccination programme switching to Gardasil from September 2012 |website=immunisation.dh.gov.uk |publisher=Department of Health |date=28 November 2011 |url-status=dead |archive-url=http://webarchive.nationalarchives.gov.uk/20130104163807/http://immunisation.dh.gov.uk/hpv-vacc-prog-switch-to-gardasil-sept-2012/ |archive-date=4 January 2013 |access-date=3 January 2019 }}</ref>

===== United States =====

======Adoption======

On 30 August 2021, fifteen leading academic and freestanding cancer centers with membership in the [[Association of American Cancer Institutes]] (AACI), all [[National Cancer Institute]] (NCI)-designated cancer centers, the [[American Cancer Society]], the [[American Society of Clinical Oncology]], the [[American Association for Cancer Research]], and the [[St. Jude Children's Research Hospital]] have issued a joint statement urging the US health care systems, physicians, parents, children, and young adults to get HPV vaccination and other recommended vaccinations back on track during the National Immunization Awareness Month.<ref name="stjude.org"/><ref name="poz 2021"/>

{{As of|2007|alt=As of late 2007}}, about one-quarter of US females aged 13–17 years had received at least one of the three HPV shots.<ref>{{cite news |title=1 in 4 US teen girls got cervical cancer shot |agency=Associated Press |url=http://usatoday30.usatoday.com/news/health/2008-10-09-hpv-cervical-vaccine_N.htm |work=[[USA Today]] |date=9 October 2008 |access-date=10 August 2013 |archive-url=https://web.archive.org/web/20131014154212/http://usatoday30.usatoday.com/news/health/2008-10-09-hpv-cervical-vaccine_N.htm |archive-date=14 October 2013 |url-status=live}}</ref> {{As of |2014| alt=By 2014}}, the proportion of such females receiving an HPV vaccination had risen to 38%.<ref name="ap2014">{{cite news |url=http://www.dddmag.com/news/2014/07/more-us-girls-now-getting-cervical-cancer-vaccine |title=More US Girls Now Getting Cervical Cancer Vaccine |work=Discovery and Development |date=25 July 2014 |agency=Associated Press |url-status=live |archive-url=https://web.archive.org/web/20140726214553/http://www.dddmag.com/news/2014/07/more-us-girls-now-getting-cervical-cancer-vaccine |archive-date=26 July 2014}}</ref> The government began recommending vaccination for boys in 2011; {{As of |2014| alt =by 2014}}, the vaccination rate among boys (at least one dose) had reached 35%.<ref name ="ap2014" />

According to the US [[Centers for Disease Control and Prevention]] (CDC), getting as many girls vaccinated as early and as quickly as possible will reduce the cases of cervical cancer among middle-aged women in 30 to 40 years and reduce the transmission of this highly communicable infection. Barriers include the limited understanding by many people that HPV causes cervical cancer, the difficulty of getting pre-teens and teens into the doctor's office to get a shot, and the high cost of the vaccine ($120/dose, $360 total for the three required doses, plus the cost of doctor visits).<ref name = pmid_17380109 /><ref name = CDC:STDfactsheet /> Community-based interventions can increase the uptake of HPV vaccination among adolescents.<ref>{{cite journal | vauthors = Niccolai LM, Hansen CE | title = Practice- and Community-Based Interventions to Increase Human Papillomavirus Vaccine Coverage: A Systematic Review | journal = JAMA Pediatrics | volume = 169 | issue = 7 | pages = 686–692 | date = July 2015 | pmid = 26010507 | pmc = 4862306 | doi = 10.1001/jamapediatrics.2015.0310 }}</ref>

A survey was conducted in 2009 to gather information about knowledge and adoption of the HPV vaccine. Thirty percent of 13- to 17-year-olds and 9% of 18- to 26-year-olds out of the total 1,011 young women surveyed reported receipt of at least one HPV injection. Knowledge about HPV varied; however, 5% or fewer subjects believed that the HPV vaccine precluded the need for regular cervical cancer screening or safe-sex practices. Few girls and young women overestimate the protection provided by the vaccine. Despite moderate uptake, many females at risk of acquiring HPV have not yet received the vaccine.<ref name=caskey>{{cite journal | vauthors = Caskey R, Lindau ST, Alexander GC | title = Knowledge and early adoption of the HPV vaccine among girls and young women: results of a national survey | journal = The Journal of Adolescent Health | volume = 45 | issue = 5 | pages = 453–462 | date = November 2009 | pmid = 19837351 | doi = 10.1016/j.jadohealth.2009.04.021 | url = https://pubmed.ncbi.nlm.nih.gov/19837351/ | url-status = live | archive-url = https://web.archive.org/web/20141017081402/http://www.ncbi.nlm.nih.gov/pubmed?term=19837351 | archive-date = 17 October 2014 }}</ref> For example, young black women are less likely to receive HPV vaccines compared to young white women. Additionally, young women of all races and [[ethnicities]] without health insurance are less likely to get vaccinated.<ref>{{cite journal | vauthors = Fisher H, Trotter CL, Audrey S, MacDonald-Wallis K, Hickman M | title = Inequalities in the uptake of human papillomavirus vaccination: a systematic review and meta-analysis | journal = International Journal of Epidemiology | volume = 42 | issue = 3 | pages = 896–908 | date = June 2013 | pmid = 23620381 | pmc = 3733698 | doi = 10.1093/ije/dyt049 }}</ref>

As of 2017, [[Gardasil|Gardasil 9]] is the only HPV vaccine available in the United States as it provides protection against more HPV types than the earlier approved vaccines (the original Gardasil and Cervarix).<ref>{{cite web |title=What's New with VISs |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |date=5 April 2019 |url=https://www.cdc.gov/vaccines/hcp/vis/what-is-new.html |archive-url=https://web.archive.org/web/20191015064022/https://www.cdc.gov/vaccines/hcp/vis/what-is-new.html |archive-date=15 October 2019 |url-status=live |access-date=14 October 2019}}</ref><ref name="Kaiser" /> Since the approval of Gardasil in 2006 and despite low vaccine uptake, prevalence of HPV among teenagers aged 14–19 has been cut in half with an 88% reduction among vaccinated women. No decline in prevalence was observed in other age groups, indicating the vaccine to have been responsible for the sharp decline in cases. The drop in number of infections is expected to in turn lead to a decline in cervical and other HPV-related cancers in the future.<ref>{{cite news |title=Study: Vaccine against sexually transmitted HPV cut infections in teen girls by half | vauthors = Stobbe M |url= http://www.startribune.com/lifestyle/health/212186591.html |newspaper=Star Tribune |date=19 June 2013 |access-date=7 August 2013 |url-status=live |archive-url=https://web.archive.org/web/20130623195911/http://www.startribune.com/lifestyle/health/212186591.html |archive-date=23 June 2013 }}</ref><ref>{{cite news |title=Vaccine Against HPV Has Cut Infections In Teenage Girls | vauthors = Knox R |url= https://www.npr.org/blogs/health/2013/06/19/193478716/vaccine-against-hpv-has-cut-infections-in-teenage-girls |newspaper=NPR |date=19 June 2013 |access-date=21 June 2013 |url-status=live |archive-url=https://web.archive.org/web/20130620075437/http://www.npr.org/blogs/health/2013/06/19/193478716/vaccine-against-hpv-has-cut-infections-in-teenage-girls |archive-date=20 June 2013 }}</ref>

======Legislation======

Four states have laws that require HPV vaccination for school students:<ref name="Kaiser">{{Cite web |date=12 July 2021 |title=The HPV Vaccine: Access and Use in the U.S. |url=https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/ |url-status=live |archive-url=https://web.archive.org/web/20221231133033/https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in-the-u-s/ |archive-date=31 December 2022 |access-date=1 January 2023 |website=[[The Henry J. Kaiser Family Foundation]]}}</ref> [[Hawaii]], [[Rhode Island]], [[Virginia]], and [[Washington D.C.]] Students in those states must have started HPV vaccination before entering the 7th grade. All school immunization laws grant exemptions to children for medical reasons, with other "[[opt-out]]" policies varying by state.<ref>{{Cite web |date=25 May 2022 |title=States With Religious and Philosophical Exemptions From School Immunization Requirements |url=https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx |access-date=2 January 2023 |website=[[National Conference of State Legislatures]] |archive-date=22 October 2020 |archive-url=https://archive.today/20201022191725/https://www.ncsl.org/research/health/school-immunization-exemption-state-laws.aspx |url-status=live }}</ref>

Shortly after the first HPV vaccine was approved, bills to make the vaccine mandatory for school attendance were introduced in many states.<ref name = Schwartz>{{cite journal | vauthors = Schwartz JL | title = HPV vaccination's second act: promotion, competition, and compulsion | journal = American Journal of Public Health | volume = 100 | issue = 10 | pages = 1841–1844 | date = October 2010 | pmid = 20724671 | pmc = 2936995 | doi = 10.2105/AJPH.2010.193060 }}</ref> Only two such bills passed (in Virginia and Washington DC) during the first four years after vaccine introduction.<ref name = Schwartz /> Mandates have been effective at increasing uptake of other vaccines, such as mumps, measles, rubella, and hepatitis B (which is also sexually transmitted).<ref name=CDC:STDfactsheet>{{cite web |url=https://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm |title=HPV Vaccine Information For Young Women |publisher=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=14 June 2009 |url-status=live |archive-url=https://web.archive.org/web/20090628203926/http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-young-women.htm |archive-date=28 June 2009}}</ref> However most such efforts developed for five or more years after vaccine release, while financing and supply were arranged, further safety data was gathered, and education efforts increased understanding, before mandates were considered.<ref name = Schwartz /> Most public policies including school mandates have not been effective in promoting HPV vaccination while receiving a recommendation from a physician increased the probability of vaccination.<ref>{{cite journal | vauthors = Moghtaderi A, Adams S | title = The Role of Physician Recommendations and Public Policy in Human Papillomavirus Vaccinations | journal = Applied Health Economics and Health Policy | volume = 14 | issue = 3 | pages = 349–359 | date = June 2016 | pmid = 26873090 | doi = 10.1007/s40258-016-0225-6 | s2cid = 25655517 }}</ref>

In July 2015, Rhode Island added an HPV vaccine requirement for admittance into public schools. This mandate requires all students entering the seventh grade to receive at least one dose of the HPV vaccine starting in August 2015, all students entering the eighth grade to receive at least two doses of the HPV vaccine starting in August 2016, and all students entering the ninth grade to receive at least three doses of the HPV vaccine starting in August 2017.<ref name="ri-school" /><ref>{{Cite web |title=Immunization Information for Schools & Childcare Providers: Department of Health |url=http://www.health.ri.gov/immunization/for/schools/ |publisher=www.health.ri.gov |access-date=20 November 2015 |url-status=live |archive-url=https://web.archive.org/web/20151121015506/http://www.health.ri.gov/immunization/for/schools/ |archive-date=21 November 2015}}</ref><ref>216 R.I. Code R. § 216-RICR-30-05-3.5</ref> No legislative action is required for the [[Rhode Island Department of Health]] to add new vaccine mandates. Rhode Island is the only state that requires the vaccine for both male and female 7th graders.<ref name="ri-school">{{Cite journal |vauthors=Thompson EL, Livingston MD, Daley EM, Saslow D, Zimet GD |date=August 2020 |title=Rhode Island Human Papillomavirus Vaccine School Entry Requirement Using Provider-Verified Report |journal=American Journal of Preventive Medicine |volume=59 |issue=2 |pages=274–277 |doi=10.1016/j.amepre.2020.02.022 |pmid=32430223 |s2cid=218758834 |hdl=1805/28509|hdl-access=free }}</ref>

======Immigrants======

Between July 2008 and December 2009, proof of the first of three doses of HPV Gardasil vaccine was required for women ages 11–26 intending to legally enter the United States. This requirement stirred controversy because of the cost of the vaccine, and because all the other vaccines so required to prevent diseases that are spread by respiratory route and considered highly contagious.<ref>{{cite news |title=Gardasil Requirement for Immigrants Stirs Backlash |url=https://www.wsj.com/articles/SB122282354408892791 |access-date=15 January 2009 | vauthors = Jordan M |work=[[The Wall Street Journal]] |date=1 October 2008 |url-status=live |archive-url=https://web.archive.org/web/20141218185826/http://www.wsj.com/articles/SB122282354408892791 |archive-date=18 December 2014 |url-access=subscription }}</ref> The [[Centers for Disease Control and Prevention]] repealed all HPV vaccination directives for immigrants effective 14 December 2009.<ref>{{cite news |title=Green card seekers won't have to get HPV vaccine |url=http://www.nwcn.com/news/national/70217772.html |access-date=31 January 2011 |date=16 November 2009 |url-status=dead |archive-url=https://web.archive.org/web/20110927154211/http://www.nwcn.com/news/national/70217772.html |archive-date=27 September 2011}}</ref> Uptake in the United States appears to vary by ethnicity and whether someone was born outside the United States.<ref>{{cite journal | vauthors = Budhwani H, De P | title = Human papillomavirus vaccine initiation in Asian Indians and Asian subpopulations: a case for examining disaggregated data in public health research | journal = Public Health | volume = 153 | pages = 111–117 | date = December 2017 | pmid = 29028565 | doi = 10.1016/j.puhe.2017.07.036 }}</ref><ref>{{cite journal | vauthors = De P, Budhwani H | title = Human papillomavirus (HPV) vaccine initiation in minority Americans | journal = Public Health | volume = 144 | pages = 86–91 | date = March 2017 | pmid = 28274389 | doi = 10.1016/j.puhe.2016.11.005 }}</ref>

======Coverage======

Measures have been considered including requiring insurers to cover HPV vaccination and funding HPV vaccines for those without insurance. The cost of the HPV vaccines for females under 18 who are uninsured is covered under the federal [[Vaccines for Children Program]].<ref>{{cite web |url=https://www.cdc.gov/vaccines/programs/vfc/ |title=Vaccines for Children Program (VFC) |publisher=Centers for Disease Control and Prevention |access-date=10 August 2013 |url-status=live |archive-url=https://web.archive.org/web/20130928105413/http://www.cdc.gov/VACCINEs/programs/vfc/ |archive-date=28 September 2013}}</ref> As of 23 September 2010, vaccines are required to be covered by insurers under the [[Patient Protection and Affordable Care Act]]. HPV vaccines specifically are to be covered at no charge for women, including those who are pregnant or nursing.<ref>{{cite web |url=http://www.immunizationforwomen.org/practice_management/affordable_care_act |title=ACA Preventative Services Benefits for Women and Pregnant Women |website=Immunization for Women |access-date=10 August 2013 |url-status=dead |archive-url=https://web.archive.org/web/20130909204524/http://www.immunizationforwomen.org/practice_management/affordable_care_act |archive-date=9 September 2013}}</ref>

Medicaid covers HPV vaccination in accordance with the ACIP recommendations, and immunizations are a mandatory service under Medicaid for eligible individuals under age 21.<ref>{{cite web |title=Human Papillomavirus Vaccination Coverage Among Female Adolescents in Managed Care Plans — United States, 2013 |publisher=Center of Disease Control and Prevention |date=30 October 2015 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6442a1.htm |access-date=10 September 2020 |archive-date=18 October 2020 |archive-url=https://web.archive.org/web/20201018231913/https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6442a1.htm |url-status=live }}</ref> In addition, Medicaid includes the Vaccines for Children Program.<ref name=":1">{{Cite web |url=https://www.cdc.gov/vaccines/programs/vfc/about/index.html |title=About VFC |date=25 May 2018 |website=U.S. [[Centers for Disease Control and Prevention]] (CDC) |access-date=7 November 2018 |archive-url=https://web.archive.org/web/20181107224856/https://www.cdc.gov/vaccines/programs/vfc/about/index.html |archive-date=7 November 2018 |url-status=live}}</ref> This program provides immunization services for children 18 and under who are Medicaid eligible, uninsured, underinsured, receiving immunizations through a Federally Qualified Health Center or Rural Health Clinic, or are Native American or Alaska Native.<ref name=":1" />

The vaccine manufacturers also offer help for people who cannot afford HPV vaccination. [[GlaxoSmithKline]]'s Vaccines Access Program<ref>{{cite web | url = https://www.gsk-vap.com/patient-eligibility.html | title = Patient Eligibility | work = GSK Vaccine Access Program | publisher = GlaxoSmithKline | archive-url = https://web.archive.org/web/20160409105347/http://www.gsk-vap.com/patient-eligibility.html | archive-date = 9 April 2016 }}</ref> provides Cervarix<ref>{{Cite web |url=https://www.gskforyou.com/vaccines-patient-assistance/ |archive-url=https://web.archive.org/web/20160715045037/http://www.gskforyou.com/patient-assistance-programs/gsk-vaccines.html |url-status=dead |title=Patient Assistance for Vaccines &#124; GSKForYou |archive-date=15 July 2016 |website=www.gskforyou.com |access-date=16 October 2019}}</ref> free of charge 1-877-VACC-911<ref>(877-822-2911)</ref> to low-income women, ages 19 to 25, who do not have insurance.<ref>{{Cite web |url=http://www.gskforyou.com/mobile/patient-assistance-programs/gsk-vaccines.html |archive-url=https://web.archive.org/web/20160821190349/http://www.gskforyou.com/mobile/patient-assistance-programs/gsk-vaccines.html |url-status=dead |title=GSK Vaccines Access Program |archive-date=21 August 2016 |access-date=16 October 2019}}</ref> [[Merck & Co.|Merck]]'s Vaccine Patient Assistance Program 1-800-293-3881<ref>1-800-727-5400</ref> provides Gardasil free to low-income women and men, ages 19 to 26, who do not have insurance, including immigrants who are legal residents.<ref>{{Cite web |url=https://www.merckhelps.com/Programs.aspx?tab=VPAP |archive-url=https://web.archive.org/web/20160605041427/http://www.merckhelps.com/GARDASIL |url-status=dead |title=Merck Programs to Help Those in Need - Programs |archive-date=5 June 2016 |website=www.merckhelps.com |access-date=16 October 2019}}</ref>

======Opposition in the United States======

The idea that the HPV vaccine is linked to increased sexual behavior is not supported by scientific evidence. A review of nearly 1,400 adolescent girls found no difference in teen pregnancy, incidence of [[sexually transmitted infection]], or [[contraceptive]] counseling regardless of whether they received the HPV vaccine.<ref name="Smith2015" /> Thousands of Americans die each year from cancers preventable by the vaccine.<ref name="Smith2015">{{cite journal | vauthors = Smith MJ | title = Promoting Vaccine Confidence | journal = Infectious Disease Clinics of North America | volume = 29 | issue = 4 | pages = 759–769 | date = December 2015 | pmid = 26337737 | doi = 10.1016/j.idc.2015.07.004 | type = Review }}</ref> A disproportionate rate of HPV-related cancers exists amongst [[Latinx|LatinX]] populations, leading researchers to explore how communication and messaging can be adjusted to address vaccine hesitancy.<ref>{{cite journal | vauthors = Reno JE, Dempsey AF | title = Promoting HPV vaccination among Latinx: an application of the extended parallel processing model | journal = Journal of Behavioral Medicine | date = February 2022 | volume = 46 | issue = 1–2 | pages = 324–334 | pmid = 35178652 | doi = 10.1007/s10865-022-00293-7 | s2cid = 246905792 }}</ref>

======Insurance companies======

There has been significant opposition from health insurance companies to covering the cost of the vaccine ($360).<ref>{{cite web | vauthors = Fayed L | date = 2007 | work = About.com: Cancer | url = http://cancer.about.com/od/hpvvaccine/a/drvaccine.htm | title = HPV Vaccine—Why Your Doctor Doesn't Offer the HPV Vaccine—Gardasil | archive-url = https://web.archive.org/web/20071231140333/http://cancer.about.com/od/hpvvaccine/a/drvaccine.htm | archive-date = 31 December 2007 }}</ref><ref>{{cite web |url=http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=43913 |title=''Detroit News'' Examines Cost of HPV Vaccine Gardasil |date=29 March 2007 |work=Kaiser Family Foundation |url-status=dead |archive-url=https://web.archive.org/web/20071015083828/http://kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=43913 |archive-date=15 October 2007}}</ref><ref>{{Cite web |url=http://www.columbiatribune.com/2007/Jun/20070615Feat001.asp |archive-url=https://web.archive.org/web/20071015083253/http://columbiatribune.com/2007/Jun/20070615Feat001.asp |url-status=dead |title=A question of protection<!-- Bot generated title --> |archive-date=15 October 2007 |access-date=16 October 2019}}</ref>

======Religious and conservative groups======

Opposition due to the safety of the vaccine has been addressed through studies, but there is still some opposition focused on the sexual implications of the vaccine. Conservative<ref>{{cite web | vauthors = Gabriel T, Grady D |author-link1=Trip Gabriel |title=Rick Perry Under Fire by Republican Rivals for Requiring HPV Vaccine for Girls |work=[[The New York Times]] |date=13 September 2011 |url=https://www.nytimes.com/2011/09/14/us/politics/republican-candidates-battle-over-hpv-vaccine.html |access-date=22 February 2017 |archive-url=https://web.archive.org/web/20110914111415/http://www.nytimes.com/2011/09/14/us/politics/republican-candidates-battle-over-hpv-vaccine.html |archive-date=14 September 2011 |url-status=live}}</ref>{{Who|date=July 2012}} groups in the US have opposed the concept of making HPV vaccination mandatory for pre-adolescent girls, claiming that making the vaccine mandatory is a violation of parental rights and that it will give a false sense of immunity to sexually transmitted infection, leading to early sexual activity. (See [[Peltzman effect]]) Both the [[Family Research Council]] and the group [[Focus on the Family]] support widespread (universal) availability of HPV vaccines but oppose mandatory HPV vaccinations for entry to public school.<ref>{{cite news |url=https://www.washingtonpost.com/wp-dyn/content/article/2006/07/14/AR2006071401532.html |title=Pro-Family, Pro-Vaccine—But Keep It Voluntary | vauthors = Sprigg P |newspaper=[[The Washington Post]] |date=15 July 2006 |access-date=4 February 2007 |url-status=live |archive-url=https://web.archive.org/web/20121105102136/http://www.washingtonpost.com/wp-dyn/content/article/2006/07/14/AR2006071401532.html |archive-date=5 November 2012 }}</ref><ref>{{cite news |url=http://newstandardnews.net/content/index.cfm/items/2552 |title=Cervical Cancer Vaccine Raises 'Promiscuity' Controversy | vauthors = Coyne B |work=The New Standard |access-date=28 August 2006 |date=2 November 2005 |url-status=live |archive-url=https://web.archive.org/web/20060807192416/http://newstandardnews.net/content/index.cfm/items/2552 |archive-date=7 August 2006 }}</ref><ref>{{cite web |url=http://www.frc.org/get.cfm?i=IF07B01 |publisher=Family Research Council |date=7 February 2008 |title=IF07B01 |url-status=live |archive-url=https://web.archive.org/web/20070804091313/http://www.frc.org/get.cfm?i=IF07B01 |archive-date=4 August 2007}}</ref><ref>{{cite web |url=http://www.family.org/socialissues/A000000357.cfm |publisher=Focus on the Family |title=Position Statement: Human Papillomavirus Vaccines |url-status=dead |archive-url=https://web.archive.org/web/20080830052331/http://www.family.org/socialissues/A000000357.cfm |archive-date=30 August 2008 |access-date=4 January 2008}}</ref> Parents also express confusion over recent mandates for entry to public school, pointing out that HPV is transmitted through sexual contact, not through attending school with other children.<ref name=":0">{{Cite web |title=Opposition To HPV Vaccine Stirs Passion, Bewilderment |url=http://ripr.org/post/opposition-hpv-vaccine-stirs-passion-bewilderment |website=ripr.org |date=17 September 2015 |access-date=20 November 2015 |url-status=live |archive-url=https://web.archive.org/web/20151121060907/http://ripr.org/post/opposition-hpv-vaccine-stirs-passion-bewilderment |archive-date=21 November 2015}}</ref>

Conservative groups are concerned children will see the vaccine as a safeguard against STIs and will have sex sooner than they would without the vaccine while failing to use contraceptives.<ref name=":0" /> However, the [[American Academy of Pediatrics]] disagreed with the argument that the vaccine increases sexual activity among teens.<ref>{{cite web |title=HPV Vaccination Does Not Lead to Increased Sexual Activity |url=http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/HPV-Vaccination-Does-Not-Lead-to-Increased-Sexual-Activity.aspx |publisher=AAP |access-date=3 February 2014 |type=press release |url-status=live |archive-url=https://web.archive.org/web/20140225014227/http://www.aap.org/en-us/about-the-aap/aap-press-room/pages/HPV-Vaccination-Does-Not-Lead-to-Increased-Sexual-Activity.aspx |archive-date=25 February 2014}}</ref> Christine Peterson, director of the University of Virginia's Gynecology Clinic, said "The presence of seat belts in cars doesn't cause people to drive less safely. The presence of a vaccine in a person's body doesn't cause them to engage in risk-taking behavior they would not otherwise engage in."<ref>{{cite web |title=Lifesaving Politics |magazine=[[Ms. (magazine)|Ms.]] |pages=12–13 |date=Spring 2007 |url=https://msmagazine.com/spring2007/ |url-status=dead |archive-url=https://web.archive.org/web/20070601201340/https://msmagazine.com/spring2007/ |archive-date=1 June 2007}}</ref><ref>{{cite web | vauthors = Artega A |title=The Shape and Structure of HPV |publisher=Zimbio |url=http://www.zimbio.com/Oropharyngeal+Cancer/articles/16/The+shape+and+structure+of+hpv |access-date=7 March 2012 |url-status=dead |archive-url=https://web.archive.org/web/20130517122955/http://www.zimbio.com/Oropharyngeal+Cancer/articles/16/The+shape+and+structure+of+hpv |archive-date=17 May 2013 }}</ref> A 2018 study of college-aged students found that HPV vaccination did not increase sexual activity.<ref>{{cite journal | vauthors = Brouwer AF, Delinger RL, Eisenberg MC, Campredon LP, Walline HM, Carey TE, Meza R | title = HPV vaccination has not increased sexual activity or accelerated sexual debut in a college-aged cohort of men and women | journal = BMC Public Health | volume = 19 | issue = 1 | pages = 821 | date = June 2019 | pmid = 31238911 | pmc = 6593582 | doi = 10.1186/s12889-019-7134-1 | doi-access = free }}</ref>{{Unreliable medical source|sure=y|date=July 2022}}

====== Parental opposition ======

Many parents opposed to providing the HPV vaccine to their pre-teens agree the vaccine is safe and effective, but find talking to their children about sex uncomfortable. Elizabeth Lange, of Waterman Pediatrics in Providence, RI, addresses this concern by emphasizing what the vaccine is doing for the child. Lange suggests parents should focus on the cancer prevention aspect without being distracted by words like 'sexually transmitted'. Everyone wants cancer prevention, yet here parents are denying their children a form of protection due to the nature of the cancer—Lange suggests that this much controversy would not surround a [[breast cancer]] or [[Colorectal cancer|colon cancer]] vaccine. The HPV vaccine is suggested for 11-year-olds because it should be administered before possible exposure to HPV, but also because the [[immune system]] has the highest response for creating [[Antibody|antibodies]] around this age. Lange also emphasized the studies showing that the HPV vaccine does not cause children to be more promiscuous than they would be without the vaccine.<ref name=":0" />

Controversy over the HPV vaccine remains present in the media. Parents in Rhode Island have created a Facebook group called "Rhode Islanders Against Mandated HPV Vaccinations" in response to Rhode Island's mandate that males and females entering the 7th grade, as of September 2015, be vaccinated for HPV before attending public school.<ref name="ri-school" /><ref name=":0" />

====== Physician impact ======

The effectiveness of a physician's recommendation for the HPV vaccine also contributes to low vaccination rates and controversy surrounding the vaccine. A 2015 study of national physician communication and support for the HPV vaccine found physicians routinely recommend HPV vaccines less strongly than they recommend [[DPT vaccine|Tdap]] or [[meningitis]] vaccines, find the discussion about HPV to be long and burdensome, and discuss the HPV vaccine last, after all other vaccines. Researchers suggest these factors discourage patients and parents from setting up timely HPV vaccines. To increase vaccination rates, this issue must be addressed and physicians should be better trained to handle discussing the importance of the HPV vaccine with patients and their families.<ref>{{cite journal | vauthors = Gilkey MB, Moss JL, Coyne-Beasley T, Hall ME, Shah PD, Brewer NT | title = Physician communication about adolescent vaccination: How is human papillomavirus vaccine different? | journal = Preventive Medicine | volume = 77 | pages = 181–185 | date = August 2015 | pmid = 26051197 | pmc = 4490050 | doi = 10.1016/j.ypmed.2015.05.024 }}</ref>

=== Ethics ===

Some researchers have compared the need for adolescent HPV vaccination to that of other childhood diseases such as chicken pox, measles, and mumps. This is because vaccination before infection decreases the risk of several forms of cancer.<ref>{{cite journal | vauthors = Gostin LO | title = HPV Vaccination: A Public Good and a Health Imperative | journal = The Journal of Law, Medicine & Ethics | volume = 46 | issue = 2 | pages = 511–513 | date = June 2018 | pmid = 30147001 | doi = 10.1177/1073110518782958 | s2cid = 52092917 }}</ref><ref>{{cite journal | vauthors = Dunne EF, Unger ER, Sternberg M, McQuillan G, Swan DC, Patel SS, Markowitz LE | title = Prevalence of HPV infection among females in the United States | journal = JAMA | volume = 297 | issue = 8 | pages = 813–819 | date = February 2007 | pmid = 17327523 | doi = 10.1001/jama.297.8.813 | doi-access = free }}</ref>

There has been some controversy around the HPV vaccine's rollout and distribution. Countries have taken different routes based on economics and social climate leading to issues of forced vaccination and marginalization of segments of the population in some cases.<ref name=pmid20853152>{{cite journal | vauthors = Malmqvist E, Helgesson G, Lehtinen J, Natunen K, Lehtinen M | title = The ethics of implementing human papillomavirus vaccination in developed countries | journal = Medicine, Health Care and Philosophy | volume = 14 | issue = 1 | pages = 19–27 | date = February 2011 | pmid = 20853152 | doi = 10.1007/s11019-010-9285-9 | s2cid = 27444545 }}</ref>

The rollout of a country's vaccination program is more divisive, compared to the act of providing vaccination against HPV. In more affluent countries, arguments have been made for publicly funded programs aimed at vaccinating all adolescents voluntarily. These arguments are supported by World Health Organization (WHO) surveys showing the effectiveness of cervical cancer prevention with HPV vaccination.<ref name=pmid20853152 />

In developing countries, the cost of the vaccine, dosing schedule, and other factors have led to suboptimal levels of vaccination. Future research is focused on low-cost generics and single-dose vaccination in efforts to make the vaccine more accessible.<ref>{{cite journal | vauthors = Oberlin AM, Rahangdale L, Chinula L, Fuseini NM, Chibwesha CJ | title = Making HPV vaccination available to girls everywhere | journal = International Journal of Gynaecology and Obstetrics | volume = 143 | issue = 3 | pages = 267–276 | date = December 2018 | pmid = 30144050 | pmc = 6221992 | doi = 10.1002/ijgo.12656 }}</ref>

==Research==

There are high-risk HPV types that are not affected by available vaccines.<ref name="Lancet" /> Ongoing research is focused on the development of HPV vaccines that will offer protection against a broader range of HPV types. One such method is a vaccine based on the minor capsid protein L2, which is highly conserved across HPV genotypes.<ref name=currentstatus2010 >{{cite journal | vauthors = Ma B, Roden R, Wu TC | title = Current status of human papillomavirus vaccines | journal = Journal of the Formosan Medical Association = Taiwan Yi Zhi | volume = 109 | issue = 7 | pages = 481–483 | date = July 2010 | pmid = 20677402 | pmc = 2917202 | doi = 10.1016/S0929-6646(10)60081-2 }}</ref> Efforts for this have included boosting the immunogenicity of L2 by linking together short amino acid sequences of L2 from different oncogenic HPV types or by displaying L2 peptides on a more immunogenic carrier.<ref>{{cite journal | vauthors = Jagu S, Karanam B, Gambhira R, Chivukula SV, Chaganti RJ, Lowy DR, Schiller JT, Roden RB | title = Concatenated multitype L2 fusion proteins as candidate prophylactic pan-human papillomavirus vaccines | journal = Journal of the National Cancer Institute | volume = 101 | issue = 11 | pages = 782–792 | date = June 2009 | pmid = 19470949 | pmc = 2689872 | doi = 10.1093/jnci/djp106 }}</ref><ref>{{cite journal | vauthors = Tumban E, Peabody J, Tyler M, Peabody DS, Chackerian B | title = VLPs displaying a single L2 epitope induce broadly cross-neutralizing antibodies against human papillomavirus | journal = PLOS ONE | volume = 7 | issue = 11 | pages = e49751 | year = 2012 | pmid = 23185426 | pmc = 3501453 | doi = 10.1371/journal.pone.0049751 | doi-access = free | bibcode = 2012PLoSO...749751T }}</ref> There is also substantial research interest in the development of [[therapeutic vaccine]]s, which seek to elicit immune responses against established HPV infections and HPV-induced cancers.<ref>{{cite journal | vauthors = van Driel WJ, Ressing ME, Brandt RM, Toes RE, Fleuren GJ, Trimbos JB, Kast WM, Melief CJ | title = The current status of therapeutic HPV vaccine | journal = Annals of Medicine | volume = 28 | issue = 6 | pages = 471–477 | date = December 1996 | pmid = 9017105 | doi = 10.3109/07853899608999110 }}</ref>

===Therapeutic vaccines===

In addition to preventive vaccines, laboratory research, and several human clinical trials are focused on the development of therapeutic HPV vaccines. In general, these vaccines focus on the main HPV [[oncogenes]], E6 and E7. Since expression of E6 and E7 is required for promoting the growth of cervical cancer cells (and cells within warts), it is hoped that immune responses against the two oncogenes might eradicate established [[tumor]]s.<ref>{{cite journal | vauthors = Roden RB, Ling M, Wu TC | title = Vaccination to prevent and treat cervical cancer | journal = Human Pathology | volume = 35 | issue = 8 | pages = 971–982 | date = August 2004 | pmid = 15297964 | doi = 10.1016/j.humpath.2004.04.007 }}</ref>

There is a working therapeutic HPV vaccine. It has gone through three clinical trials. The vaccine is officially called the MEL-1 vaccine but also known as the MVA-E2 vaccine. In a study it has been suggested that an immunogenic peptide pool containing epitopes that can be effective against all the high-risk HPV strains circulating globally and 14 conserved immunogenic peptide fragments from four early proteins (E1, E2, E6 and E7) of 16 high-risk HPV types providing CD8+ responses.<ref name = "Albarran_2007">{{cite journal | vauthors = Albarran Y, Carvajal A, de la Garza A, Cruz Quiroz BJ, Vazquez Zea E, Díaz Estrada I, Mendez Fuentez E, López Contreras M, Andrade-Manzano A, Padilla S, Varela AR, Rosales R | title = MVA E2 recombinant vaccine in the treatment of human papillomavirus infection in men presenting intraurethral flat condyloma: a phase I/II study | journal = BioDrugs | volume = 21 | issue = 1 | pages = 47–59 | year = 2007 | pmid = 17263589 | doi = 10.2165/00063030-200721010-00006 | s2cid = 26415621 }}</ref><ref>{{cite journal | vauthors = Corona Gutierrez CM, Tinoco A, Navarro T, Contreras ML, Cortes RR, Calzado P, Reyes L, Posternak R, Morosoli G, Verde ML, Rosales R | title = Therapeutic vaccination with MVA E2 can eliminate precancerous lesions (CIN 1, CIN 2, and CIN 3) associated with infection by oncogenic human papillomavirus | journal = Human Gene Therapy | volume = 15 | issue = 5 | pages = 421–431 | date = May 2004 | pmid = 15144573 | doi = 10.1089/10430340460745757 }}</ref><ref>{{cite web |url=http://www.getfilings.com/sec-filings/110624/ACCELERATED-ACQUISITION-X_8-K.A/ |title=Virolab, Inc. – FORM 8-K/A |date=24 June 2011 |publisher=Getfilings.com |access-date=29 December 2013 |url-status=live |archive-url=https://web.archive.org/web/20131203031639/http://www.getfilings.com/sec-filings/110624/ACCELERATED-ACQUISITION-X_8-K.A/ |archive-date=3 December 2013}}</ref><ref>{{cite journal | vauthors = Singh KP, Verma N, Akhoon BA, Bhatt V, Gupta SK, Gupta SK, Smita S | title = Sequence-based approach for rapid identification of cross-clade CD8+ T-cell vaccine candidates from all high-risk HPV strains | journal = 3 Biotech | volume = 6 | issue = 1 | pages = 39 | date = June 2016 | pmid = 28330110 | pmc = 4729761 | doi = 10.1007/s13205-015-0352-z }}</ref>

Therapeutic [[DNA vaccine]] VGX-3100, which consists of [[plasmid]]s pGX3001 and pGX3002, has been granted a waiver by the [[European Medicines Agency]] for pediatric treatment of [[squamous intraepithelial lesion]]s of the cervix caused by HPV types 16 and 18.<ref>{{cite web |title=European Medicines Agency decision P/0367/2016 |url=http://www.ema.europa.eu/docs/en_GB/document_library/PIP_decision/WC500220368.pdf |website=www.ema.europa.eu |publisher=European Medicines Agency |access-date=2 November 2017 |archive-url=https://web.archive.org/web/20171102071141/http://www.ema.europa.eu/docs/en_GB/document_library/PIP_decision/WC500220368.pdf |archive-date=2 November 2017}}</ref> According to an article published 16 September 2015 in ''[[The Lancet]]'', which reviewed the safety, efficacy, and [[immunogenicity]] of VGX-3100 in a double-blind, [[randomized controlled trial]] (phase 2b) targeting HPV-16 and HPV-18 E6 and E7 proteins for [[cervical intraepithelial neoplasia]] 2/3, it is the first therapeutic vaccine to show efficacy against CIN 2/3 associated with HPV-16 and HPV-18.<ref name="pmid26386540">{{cite journal | vauthors = Trimble CL, Morrow MP, Kraynyak KA, Shen X, Dallas M, Yan J, Edwards L, Parker RL, Denny L, Giffear M, Brown AS, Marcozzi-Pierce K, Shah D, Slager AM, Sylvester AJ, Khan A, Broderick KE, Juba RJ, Herring TA, Boyer J, Lee J, Sardesai NY, Weiner DB, Bagarazzi ML | title = Safety, efficacy, and immunogenicity of VGX-3100, a therapeutic synthetic DNA vaccine targeting human papillomavirus 16 and 18 E6 and E7 proteins for cervical intraepithelial neoplasia 2/3: a randomised, double-blind, placebo-controlled phase 2b trial | journal = Lancet | volume = 386 | issue = 10008 | pages = 2078–2088 | date = November 2015 | pmid = 26386540 | pmc = 4888059 | doi = 10.1016/S0140-6736(15)00239-1 }}</ref> In June 2017, VGX-3100 entered a phase III clinical trial called REVEAL-1 for the treatment of HPV-induced high-grade squamous intraepithelial lesions.<ref>{{cite web |title=Inovio Begins Phase 3 Clinical Trial of VGX-3100 for the Treatment of HPV-Related Cervical Pre-Cancer |url=http://ir.inovio.com/news-and-media/news/press-release-details/2017/Inovio-Begins-Phase-3-Clinical-Trial-of-VGX-3100-for-the-Treatment-of-HPV-Related-Cervical-Pre-Cancer/default.aspx |website=www.inovio.com |publisher=Inovio Pharmaceuticals |access-date=2 November 2017 |archive-url=https://web.archive.org/web/20171102080221/http://ir.inovio.com/news-and-media/news/press-release-details/2017/Inovio-Begins-Phase-3-Clinical-Trial-of-VGX-3100-for-the-Treatment-of-HPV-Related-Cervical-Pre-Cancer/default.aspx |archive-date=2 November 2017}}</ref> The estimated completion time for collecting primary [[clinical endpoint]] data is August 2019.<ref>{{cite web |title=REVEAL 1 (Evaluation of VGX-3100 and Electroporation for the Treatment of Cervical HSIL) |url=https://clinicaltrials.gov/ct2/show/NCT03185013?term=vgx-3100&rank=5 |website=clinicaltrials.gov |publisher=The National Library of Medicine |access-date=2 November 2017 |archive-url=https://web.archive.org/web/20171102080820/https://clinicaltrials.gov/ct2/show/NCT03185013?term=vgx-3100&rank=5 |archive-date=2 November 2017}}</ref>

As of October 2020, there are multiple therapeutic HPV vaccines in active development and in clinical trials, based on diverse vaccine platforms (protein-based, [[viral vector vaccine|viral vector]], bacterial vector, lipid encapsulated [[mRNA vaccine|mRNA]]).<ref>{{cite journal | vauthors = Smalley Rumfield C, Roller N, Pellom ST, Schlom J, Jochems C | title = Therapeutic Vaccines for HPV-Associated Malignancies | journal = ImmunoTargets and Therapy | volume = 9 | pages = 167–200 | date = 7 October 2020 | pmid = 33117742 | pmc = 7549137 | doi = 10.2147/ITT.S273327 | doi-access = free }}</ref>

=== Awards ===

In 2009, as part of the [[Q150]] celebrations, the cervical cancer vaccine was announced as one of the [[Q150 Icons]] of Queensland for its role in "innovation and invention".<ref>{{Cite press release |url=http://statements.qld.gov.au/statement/id/64301 |title=Premier Unveils Queensland's 150 Icons | vauthors = Bligh A |author-link=Anna Bligh |date=10 June 2009 |publisher=[[Queensland Government]] |archive-url=https://web.archive.org/web/20170524033717/http://statements.qld.gov.au/statement/id/64301 |archive-date=24 May 2017 |url-status=live |access-date=24 May 2017 }}</ref>

In 2017, [[National Cancer Institute]] scientists [[Douglas R. Lowy]] and [[John T. Schiller]] received the [[Lasker-DeBakey Clinical Medical Research Award]] for their contributions leading to the development of HPV vaccines.<ref>{{Cite press release |url=https://www.nih.gov/news-events/news-releases/ncis-douglas-r-lowy-john-t-schiller-receive-2017-lasker-award |title=NCI's Douglas R. Lowy and John T. Schiller to receive 2017 Lasker Award |date=6 September 2017 |publisher=[[National Institutes of Health]] (NIH) |url-status=live |archive-url=https://web.archive.org/web/20171107030657/https://www.nih.gov/news-events/news-releases/ncis-douglas-r-lowy-john-t-schiller-receive-2017-lasker-award |archive-date=7 November 2017}}</ref>

== References ==

{{Reflist}}

== Further reading ==

{{refbegin}}

* {{cite book |vauthors=((World Health Organization)) |title=The immunological basis for immunization series: module 19: human papillomavirus infection |publisher=World Health Organization (WHO) |year=2011 |hdl=10665/44604 |isbn=9789241501590 |hdl-access=free}}

* {{cite book |vauthors=((World Health Organization)) |title=Scaling-up HPV vaccine introduction |publisher=World Health Organization (WHO) |year=2016 |hdl=10665/251909 |isbn=9789241511544 |hdl-access=free}}

* {{cite journal | vauthors = Phillips A, Hickie M, Totterdell J, Brotherton J, Dey A, Hill R, Snelling T, Macartney K | title = Adverse events following HPV vaccination: 11 years of surveillance in Australia | journal = Vaccine | volume = 38 | issue = 38 | pages = 6038–6046 | date = August 2020 | pmid = 32709432 | doi = 10.1016/j.vaccine.2020.06.039 | doi-access = free }}

* {{cite book |title=Immunisation against infectious disease |chapter=Chapter 18a: Human papillomavirus (HPV) |chapter-url=https://www.gov.uk/government/publications/human-papillomavirus-hpv-the-green-book-chapter-18a |publisher=Public Health England |veditors=Ramsay M |url=https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book |year=2019 |access-date=3 January 2021 |archive-date=12 November 2019 |archive-url=https://web.archive.org/web/20191112005859/https://www.gov.uk/government/publications/pneumococcal-the-green-book-chapter-25 |url-status=live }}

* {{cite book | publisher = U.S. [[Centers for Disease Control and Prevention]] (CDC) | title = Epidemiology and Prevention of Vaccine-Preventable Diseases | veditors = Hall E, Wodi AP, Hamborsky J, Morelli V, Schillie S | edition = 14th | location = Washington D.C. | year = 2021 | chapter = Chapter 11: Human Papillomavirus | chapter-url = https://www.cdc.gov/vaccines/pubs/pinkbook/hpv.html | url = https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | access-date = 17 February 2023 | archive-date = 30 December 2016 | archive-url = https://web.archive.org/web/20161230001534/https://www.cdc.gov/vaccines/pubs/pinkbook/index.html | url-status = live }}

* {{cite journal | vauthors = Yousefi Z, Aria H, Ghaedrahmati F, Bakhtiari T, Azizi M, Bastan R, Hosseini R, Eskandari N | title = An Update on Human Papilloma Virus Vaccines: History, Types, Protection, and Efficacy | journal = Frontiers in Immunology | volume = 12 | issue = | pages = 805695 | date = 2021 | pmid = 35154080 | pmc = 8828558 | doi = 10.3389/fimmu.2021.805695 | doi-access = free | title-link = doi }}

{{refend}}

== External links ==

* {{cite web |title=HPV (Human Papillomavirus) Vaccine Information Statement |website=U.S. [[Centers for Disease Control and Prevention]] (CDC)|date=6 August 2021|access-date=1 September 2024|url=https://www.cdc.gov/vaccines/hcp/vis/vis-statements/hpv.html}}

* {{cite web |url=https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet |title=Human Papillomavirus (HPV) Vaccines|date=25 May 2021|access-date=1 September 2024|publisher=[[National Institutes of Health]] (NIH)}}

* {{MeshName|Papillomavirus Vaccines}}

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