Population-level impact of HPV vaccination: a global systematic review of ecological, cross-sectional, and cohort studies

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: 58-100% reduction in HPV infection; 30-88% reduction in CIN2+; 60-90% reduction in genital warts; 70-88% reduction in invasive cervical cancer

• Primary Outcome: Population-level reductions in HPV-related diseases following vaccination programs

• Nnt Or Sensitivity: Greatest impact observed with ≥70% coverage and pre-sexual debut vaccination

• Confidence Interval: Not reported in abstract

Clinical Application

School-based delivery programs demonstrate highest effectiveness for achieving optimal coverage and timing Highly relevant to Australia's National HPV Vaccination Program; supports current NHMRC recommendations for school-based delivery and high coverage targets. Findings reinforce PBS-funded vaccination strategy and TGA-approved vaccine schedules. All populations eligible for HPV vaccination, particularly adolescents prior to sexual debut

Abstract

BACKGROUND: Human papillomavirus (HPV) causes approximately 4.5% of cancers globally, with the highest burden in low- and middle-income countries (LMICs). Since their introduction in 2006, HPV vaccination programs have led to substantial declines in HPV-related outcomes, although impact varies across settings. RESEARCH DESIGN AND METHODS: We conducted a systematic review to evaluate the population-level impact of HPV vaccination on HPV infection, cervical intraepithelial neoplasia grade 2 or higher (CIN2+), genital warts, invasive cervical cancer (ICC), and oropharyngeal cancer (OPC), and examined the influence of coverage, age at initiation, and vaccine type. The review followed PRISMA 2020. RESULTS: Of 13,549 records screened, 63 were included: 9 assessed HPV infection, 24 on CIN2+, 25 on genital warts, and 7 on ICC. Greatest reductions were observed in settings with at least 70% coverage and early vaccination prior to sexual debut, typically achieved through school-based programs. Reported declines ranged from 58-100% for HPV infection, 30-88% for CIN2+, 60-90% for genital warts, and 70-88% for ICC. CONCLUSIONS: HPV vaccination offers strong protection, especially when delivered early and at high coverage within schools. Expanding access and prioritizing underserved populations are essential to achieving global cancer prevention goals. Limitations include heterogeneity across designs, outcome definitions, and follow-up.

References

1. 1.Zeleke, A. J., Reifferscheid, L., Yunusa, U., Gandhi, K., Kennedy, M., Sadarangani, M., & MacDonald, S. E. (2026). Population-level impact of HPV vaccination: a global systematic review of ecological, cross-sectional, and cohort studies. Expert Review of Vaccines. https://doi.org/10.1080/14760584.2026.2667734