Global HPV vaccination programs and coverage rates: a systematic review

Background: Many countries have included the human papillomavirus (HPV) vaccine in their national immunization programs. However, comprehensive studies on global HPV vaccination coverage remain scarce. This study aims to provide an in-depth overview of the current status of global HPV immunization programs and assess HPV vaccination coverage worldwide. Methods: In this study, we performed a comprehensive search of the PubMed and Embase databases (from their inception to February 28, 2025), websites, the WHO database, to identify HPV vaccination policies and coverage rate data from all 194 WHO member states. Studies included in our analysis reported population-based HPV vaccination coverage rates. Additionally, we analyzed trends in HPV vaccination coverage from 2010 to 2023 and evaluated cervical cancer incidence rates during the same period in 15 early-adopter countries of HPV vaccines. Subgroup analyses were conducted by sex and age. The systematic review was prospectively registered in PROSPERO (registration number: CRD42023488463). Findings: As of February 28, 2025, 148 WHO member states have incorporated the HPV vaccine into their national immunization programs. 132 countries reported HPV vaccination coverage estimates for the first dose and 129 countries reported full doses in 2023, and the weighted average coverage of the first and full dose of HPV vaccination in girls aged 9-14 years were 61.6% (95% CI: 50.9%-71.8%) and 47.6% (39.7%-57.4%) respectively. Among 132 countries, fifteen countries (11%) achieved 90% coverage for the first dose. Upper-middle income countries presented the highest coverage, with 71.7% (95% CI: 59.1%-78.6%) for the first dose. Age-specific analysis revealed that vaccination coverage of China peaked in women in 20-24 age group and was lowest in 9-14. Time trend analysis demonstrated that in most assessed countries, cervical cancer incidence is showing a declining trend. Interpretation: Global HPV vaccination coverage remains significantly below the target of 90%. Strategies to effectively enhance HPV vaccination coverage must be identified, developed, and implemented to address this gap. Funding: CAMS Innovation Fund for Medical Sciences (2021-I2M-1-004, 2023-I2M-3-019); National High Level Hospital Clinical Research Funding (2022-PUMCH-D-003); Supported by Sanming Project of Medicine in Shenzhen (SZSM202311011).