Nearly two decades after the first human papillomavirus (HPV) vaccine was approved, the scale of its public health impact is finally coming fully into view. Across multiple continents, countries that introduced HPV vaccination early — and achieved high coverage — are now reporting dramatic falls in cervical cancer incidence.
In a landmark study published in The Lancet, researchers analyzing national cancer registry data from England reported a near-elimination of cervical cancer among women who were offered HPV vaccination at ages 12–13. Compared with unvaccinated cohorts, cervical cancer rates fell by almost 90 percent, providing clear evidence that the vaccine is not only preventing infection, but averting cancer at a population level.
These findings underpin the global ambition set out by the World Health Organization (WHO) to eliminate cervical cancer as a public health problem. Central to this strategy is the 90–70–90 targets. This corresponds to vaccinating 90 percent of girls against HPV by age 15, screening 70 percent of women at least twice in their lifetime, and ensuring that 90 percent of those with disease receive appropriate treatment.
However, this success story is at risk of stalling. In many high-income countries, vaccination rates have declined in recent years, driven by pandemic-related disruption, widening health inequalities, and vaccine hesitancy.
A virus responsible for a global cancer burden
HPV is one of the most common viral infections globally, transmitted through close skin-to-skin contact. Most infections resolve spontaneously, but persistent infection with high-risk HPV types can cause cellular changes that progress to cancer years or even decades later. HPV is responsible for virtually all cervical cancers, as well as a substantial proportion of anal, penile, vaginal, vulvar, and oropharyngeal cancers.
More than 40 HPV types can be transmitted through direct sexual contact, of which approximately a dozen are classified as oncogenic, or high-risk. In particular, HPV types 16 and 18 account for approximately 70 percent of all cervical cancers, and HPV types 31, 33, 45, 52, and 58 contribute a further 20 percent.
The first HPV vaccine, Gardasil, was approved by the FDA in 2006, and protects against four HPV strains (6, 11, 16, and 18). This was followed by the bivalent vaccine Cervarix, approved by the European Medicines Agency (EMA) in 2007 and later by the FDA in 2009, which targets HPV types 16 and 18.
In 2014, Gardasil 9 was licensed by the FDA, extending protection to nine HPV types: 6, 11, 16, 18, 31, 33, 45, 52, and 58. The additional high-risk types covered by Gardasil 9 are estimated to account for a further 20 percent of cervical cancer cases, meaning the vaccine has the potential to prevent up to approximately 90 percent of cervical cancers.
Population-level evidence from early adopters
Countries that introduced school-based HPV vaccination programs in the late 2000s are now providing answers about the long-term effects. Multiple national studies have reported steep declines in HPV infection, high-grade precancerous lesions, and invasive cervical cancer among vaccinated cohorts.
In Scotland, for example, a population-wide linkage study from 2024 found no cases of invasive cervical cancer among women vaccinated at ages 12–13 after more than a decade of follow-up. In Sweden, a nationwide register-based cohort study with up to 18 years of follow-up showed that women vaccinated with Gardasil before age 17 had an almost 80 percent lower risk of invasive cervical cancer compared with unvaccinated peers, with protection persisting for more than 15 years and no evidence of waning immunity.
Studies from Denmark and the Netherlands have reported near-elimination of high-risk HPV infections and reductions of more than 90 percent in cervical cancer risk among fully vaccinated women.
Collectively, these data confirm that HPV vaccines could feasibly wipe out cervical cancer, if used at a large enough scale.
What about mortality?
In the latest study, researchers analyzed cervical cancer mortality data from England between 2001 and 2024 among women aged 20–24, 25–29, and 30–34 years. A national, school-based HPV vaccination program was introduced in England in 2008, initially targeting girls aged 12–13 years and later expanding to include boys in 2019. Before the COVID-19 pandemic, coverage reached 80–90 percent in the routine cohort, with around 90 percent receiving at least one dose.
This high uptake translated into marked reductions in cervical cancer incidence — up to 87 percent in cohorts vaccinated before age 16. However, until now, the impact of HPV vaccination on cervical cancer mortality had not been directly assessed.
Among women aged 20–24 years between 2020 and 2024, no deaths from cervical cancer were recorded, compared with an estimated 23 deaths expected based on historical trends — effectively a 100 percent reduction in mortality. In earlier birth cohorts that were offered vaccination up to age 18, cervical cancer deaths fell by 80 percent among women aged 20–24 during 2015–19, and by 69 percent among those aged 25–29 during 2020–24. Overall, HPV vaccination is estimated to have prevented around 200 cervical cancer deaths in England by the end of 2024.
The absence of deaths in women aged 20–24 years over the most recent five-year period is likely influenced by the already low baseline mortality in this age group and should not be interpreted as complete eradication. Nevertheless, the magnitude of the observed mortality reductions is consistent with near-complete protection against fatal cervical cancer in women vaccinated at ages 12–13. While vaccine effectiveness against mortality is unlikely to be truly 100 percent, residual risk in vaccinated women is probably offset by herd protection in the wider population.
The data clearly show that national HPV vaccination has led to a substantial and sustained reduction in cervical cancer mortality, matching — or exceeding — prior projections and confirming its impact on the most severe disease outcomes.
A cornerstone of global elimination strategy
HPV vaccination is one of the three pillars of the global cervical cancer elimination strategy set out by the WHO, alongside screening and timely treatment. Progress on vaccination has been substantial. As of December 2025, 159 countries have introduced HPV vaccines into their national immunization programs, representing 64 percent of the global population of girls (9–14 yrs old). Another clear trend since 2014 is the inclusion of boys in the target population for vaccination: 53 percent of HPV vaccination programs globally now vaccinate boys.
Where coverage is high, the trajectory toward elimination is increasingly plausible. A comparative modeling analysis predicted that if high-coverage HPV vaccination is combined with twice-lifetime cervical cancer screening globally, up to 97 percent of cervical cancer cases could be prevented by 2100.
However, HPV vaccination rates have declined in recent years. In England, only around 76 percent of girls were vaccinated by age 15 in 2024–25 — well below the WHO’s 90 percent target. Similarly, a recent report from the Kirby Institute, funded by the Australian Centre for Disease Control (CDC), revealed that vaccination coverage in adolescents aged 15 years fell from a peak of 85.7 percent in 2020 to 79.5 percent in 2024.
These declines are likely driven by a combination of factors, including pressures on health and education systems such as staffing and funding constraints, increased student absenteeism, competing priorities, and potential vaccine fatigue or erosion of trust in some communities.
Additionally, uptake varies by region and socioeconomic status, raising concerns that elimination could be achieved in some populations while others are left behind. In the US, completion rates range from nearly 80 percent in Massachusetts' to less than 40 percent in Mississippi — reflecting a mix of school policy variation and conservative opposition rooted in stigma around sexually transmitted diseases.
These gaps matter. The English mortality data show a clear dose-response relationship: The greatest reductions in deaths occurred in cohorts with the highest vaccine coverage and earliest vaccination. If coverage continues to slip, future cohorts may not experience the same level of protection.
A preventable cancer
The HPV vaccine is one of the most successful cancer prevention interventions ever developed. Nearly 20 years of evidence now show that it is safe, highly effective, and capable of preventing both cervical cancer and cervical cancer deaths.
The experience of countries like England, Scotland, Sweden, and the Netherlands demonstrates what is possible when vaccination programs achieve high coverage and are sustained over time. At the same time, falling uptake in some regions highlights how fragile progress can be.
Cervical cancer is no longer an inevitable disease. Elimination is scientifically and operationally achievable — but only if vaccination rates are restored, expanded, and protected. The next phase of the HPV story will not depend on laboratories or clinical trials, but on public health policy, community engagement, and global access.
