HPV vaccine

Preventive vaccines

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. A one-or-two-dose schedule is also used in boys and men aged 9–20 years, though WHO makes no specific recommendation for males. WHO has prequalified a total of 6 kinds of vaccines. Among these, Cecolin (bivalent), Cervarix, Gardasil (quadrivalent) and Gardasil 9 (nonavalent) are confirmed for use in a single-dose schedule. The remaining vaccine, Walrinvax (bivalent), is only prequalified for two-dose schedule for now ().

The single-dose schedule is a recent (circa 2022) development based on studies on girls and women showing a similar level and duration of protection when taking one dose instead of two. It is a form of off-label use. Not much is known about the efficacy and protective duration of the simplified schedule in boys and men.

Background

Cervical cancer

Of the 20 hardest hit countries by cervical cancer, 19 are in Africa.

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."

In 2004, preventive vaccines already protected against the two HPV types (16 and 18) that cause about 70% of cervical cancers worldwide. 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. Some other high-risk types cause a larger percentage of cancers in other parts of the world. Vaccines that protect against more of the types common in cancers would prevent more cancers, and be less subject to regional variation. 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.

In 2008, only 41% of women with cervical cancer in the developing world got medical treatment. Therefore, prevention of HPV by vaccination may be a more effective way of lowering the disease burden in developing countries than cervical screening. The European Society of Gynecological Oncology sees the developing world as most likely to benefit from HPV vaccination. However, individuals in many resource-limited nations, Kenya for example, are unable to afford the vaccine.

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. 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. She has also encouraged women to continue pap screening after they are vaccinated and to be aware of potential adverse effects.

Medical uses

HPV vaccines are used to prevent HPV infection and therefore in particular cervical cancer. Vaccinating females between the ages of nine and thirteen is typically recommended, with many countries also vaccinating males in that age range. 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. The vaccines require three doses for those ages 15 and above. 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.

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. Since the vaccines only cover some high-risk types of HPV, cervical cancer screening is recommended even after vaccination. In the US, the recommendation is for women to receive routine Pap smears beginning at age 21. In Australia, the national screening program has changed from the two yearly cytology (pap smears) to being based on tests for HPV DNA, based on work by Karen Canfell and others. As of 2021, the World Health Organization recommends HPV DNA testing as the preferred screening method.

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. However, other high-risk HPV types are not affected by the vaccine. The protection against HPV 16 and 18 has lasted at least eight years after vaccination for Gardasil and more than nine years for Cervarix.

As of September 2024, 57 countries are implementing the single-dose schedule. 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. A single dose might be effective.

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. 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.

Neither Cervarix nor Gardasil prevent other sexually transmitted infections, and they do not treat existing HPV infections or cervical cancer.

Gardasil

When Gardasil was first introduced, it was recommended as a prevention for cervical cancer for women 25 years old or younger. Gardasil and Gardasil 9 protect against HPV types 6 and 11 which can cause genital warts, with the quadrivalent and nonavalent vaccines providing virtually complete protection.

Adenocarcinoma

HPV types 16, 18, and 45 contribute to 94% of cervical adenocarcinoma (cancers originating in the glandular cells of the cervix). While most cervical cancer arises in the squamous cells, adenocarcinomas make up a sizable minority of cancers. 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. Trials suggest that HPV vaccines may also reduce the incidence of adenocarcinoma.

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%).

Males

As of 2022, 47 countries (24% of WHO member states) have introduced HPV vaccine in their national immunization programme for boys. 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.

In males also, Gardasil and Gardasil 9 protect against HPV types 6 and 11 which can cause genital warts, with the quadrivalent and nonavalent vaccines providing virtually complete protection. 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.

From a public health point of view, vaccinating men as well as women (GNV, or Gender Neutral Vaccination) decreases the virus pool within the population. Whether this is cost-effective depends on a number of assumptions: (a) cost of the vaccine, (b) assumed duration of immunity, (c) whether diseases other than cervical cancer are considered, and (d) the assumed discount rate, for the cost of a vaccine is current but the cost of disease avoided is in the far future. A literature review in 2025 looked at studies of this questions. A majority of the studies concluded GNV was cost-effective, except perhaps in countries such as Great Britain and New Zealand that had very high female coverage.

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.

Recommendations from authorities

Recommendations by national bodies

Australia

Australia introduced HPV vaccination for boys in 2013.

Ireland

Ireland introduced HPV vaccination for boys aged 13 as part of their National Immunization Plan in 2019.

UK

UK introduced HPV vaccination for boys aged 12 as part of their National Immunization Plan in 2019.

Portugal

Portugal introduced universal HPV vaccination for boys aged 10 years and above as part of its National Immunization Plan in 2020.

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. Soon after that, the vaccine was approved by the FDA for use in males aged 9 to 26 for prevention of genital warts and anal cancer.

In 2011, an advisory panel for the US Centers for Disease Control and Prevention (CDC) recommended the vaccine for boys ages 11–12. 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. For those under the age of 27 who have not been fully vaccinated the CDC recommends vaccination.

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.

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.

World Health Organization (WHO)

The HPV vaccine is on the WHO Model List of Essential Medicines. The WHO recommends HPV vaccines as part of routine vaccinations in all countries, along with other prevention measures. 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. The WHO has a global strategy for cervical cancer elimination. Its first pillar is having 90% of girls fully vaccinated with the HPV vaccine by 15 years of age. The WHO-recommended primary target population for HPV vaccination is girls aged 9–14 years before they become sexually active. Females aged ≥15 years, boys, older males or MSM are secondary target populations. Cervical cancer screening is still required following vaccination.

Side effects

HPV vaccines are safe and well tolerated and can be used in persons who are immunocompromised or HIV-infected. Pain at the site of injection occurs in between 35% and 88% of people Redness and swelling at the site and fever may also occur. No link to Guillain–Barré syndrome has been found. There is no increased risk of serious adverse effects. When comparing the HPV vaccine to a placebo (control) vaccine taken by women, there is no difference in the risk of severe adverse events.

United States

, there were more than 57 million doses of Gardasil vaccine distributed in the United States, though it is unknown how many were administered. There have been 22,000 Vaccine Adverse Event Reporting System (VAERS) reports following the vaccination. 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."

, in the US there were 44 reports of death in females after receiving the vaccine. None of the 27 confirmed deaths of women and girls who had taken the vaccine were linked to the vaccine. 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. 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.

, the CDC continued to recommend Gardasil vaccination for the prevention of four types of HPV. The manufacturer of Gardasil has committed to ongoing research assessing the vaccine's safety.

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 (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.

Contraindications

While the use of HPV vaccines can help reduce cervical cancer deaths by two-thirds around the world, not everyone is eligible for vaccination. Some factors exclude people from receiving HPV vaccines. These factors include:

• People with history of 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.

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. However, the clinical trials had a relatively small sample size. , the vaccine is not recommended for pregnant women.

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.

Mechanism of action

The HPV vaccines are based on hollow virus-like particles (VLPs) assembled from recombinant HPV 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 μg of aluminum, 9.56 mg of sodium chloride, 0.78 mg of L-histidine, 50 μg of polysorbate 80, 35 μg of sodium borate, and water. The combination of ingredients totals 0.5 mL. HPV types 16 and 18 cause about 70% of all cervical cancer. Gardasil also targets HPV types 6 and 11, which together cause about 90 percent of all cases of genital warts.

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-cancers 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.

While the study period was not long enough for cervical cancer to develop, the prevention of these cervical precancerous lesions (or dysplasias) is believed highly likely to result in the prevention of those cancers.

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.

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.

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, and University of Rochester, were also vying for the patent as a result of contributions in the space. 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. As a result, the University of Queensland receives royalty payments from the sale of these vaccines even today.

By the early 2000s, developers, convinced of the market of the vaccine, had begun refining, researching, and trialing L1-based HPV vaccines. 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, 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. Cervarix was approved for use in the US in October 2009.

Harald zur Hausen was awarded half of the $1.4 million Nobel Prize in Medicine in 2008 for his work showing that cervical cancer is caused by certain types of HPVs.

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. 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).

Society and culture

Economics

, 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 screening cervical cancer. 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 (GNV, or Gender Neutral Vaccination) decreases the virus pool within the population. Whether this is cost-effective depends on a number of assumptions: (a) cost of the vaccine, (b) assumed duration of immunity, (c) whether diseases other than cervical cancer are considered, and (d) the assumed discount rate, for the cost of a vaccine is current but the cost of disease avoided is in the far future. A literature review in 2025 looked at studies of this questions. A majority of the studies concluded GNV was cost-effective, except perhaps in countries such as Great Britain and New Zealand that had very high female coverage.

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.

Brand names

The vaccine is sold under various brand names including Gardasil, Cervarix, Cecolin,

Vaccine implementation

The primary target group in most of the countries recommending HPV vaccination is young adolescent girls, aged 9–14. It's particularly cost-effective in resource-constrained settings. The vaccination schedule depends on the age of the vaccine recipient. As of 2023, 27% of girls aged 9–14 years worldwide received at least one dose (37 countries were implementing the single-dose schedule). Global coverage for the first dose of HPV vaccine in girls grew from 20% in 2022 to 27% in 2023. As of 10 September 2024, 57 countries are implementing the single-dose schedule. Vaccinating a large portion of the population may also benefit the unvaccinated by way of herd immunity.

HPV vaccine introductions have been hampered by global supply shortages since 2018.

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. School-entry vaccination requirements were found to increase the use of the HPV vaccine.

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. As of 2022, 47 countries (24% of WHO member states) also did it for boys.

Africa

Of the 20 hardest hit countries by cervical cancer, 19 are in Africa. In 2013, with support from Gavi, the Vaccine Alliance, eight low-income countries, mainly in sub-Saharan Africa, began the rollout of the HPV vaccine.

Algeria

No

Angola

No

Chad

No

Central African Republic

No

Democratic Republic of Congo

No

Ghana

No (GAVI support in 2013)

Guinea-Bissau

No

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, Nicholas Muraguri, states that many Kenyans are unable to afford the vaccine. It has received GAVI support in 2013.

Madagascar

No (GAVI support in 2013)

Malawi

Yes (GAVI support in 2013)

Mozambique

Yes (GAVI support for HPV demonstration projects in 2014)

Niger

No (GAVI support in 2013)

Nigeria

Yes

Rwanda

Yes (GAVI support in 2014)

Senegal

Yes

Sierra Leone

Yes (GAVI support in 2013)

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. 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. In May 2013 the 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. South Africa became 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.

United Republic of Tanzania

Yes (GAVI support in 2013)

Zimbabwe

Yes (GAVI support for HPV demonstration projects in 2014)

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. The National HPV Vaccination Program is listed on the National Immunisation Program (NIP) Schedule and funded under the Immunise Australia Program. 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. 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.

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. 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.

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.

In 2012, the Australian Government announced it would be extending the National HPV Vaccination Program to include males, through the National Immunisation Program Schedule.

Updated results were reported in 2014.

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, and February 2010 for use in males.

The vaccines Cervarix, Gardasil, and Gardasil 9 are authorized for use in Canada, with Gardasil 9 the primary vaccine used. 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+.

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. 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). 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.

China

GlaxoSmithKline China announced in 2016, that Cervarix (HPV vaccine 16 and 18) had been approved by the China Food and Drug Administration (CFDA). Cervarix is registered in China for girls aged 9 to 45, adopting 3-dose program within 6 months. Cervarix was launched in China in 2017, and it was the first approved HPV vaccine in China.

China has since developed two HPV vaccines of its own: Cecolin (licensed in China in 2019) and Walrinvax (licensed in China in 2022).

Colombia

The vaccine was introduced in 2012. 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.

Costa Rica

Since June 2019, the vaccine has been administered compulsorily by the state, free of charge to girls at ten years of age.

Europe

As of 2020, the European Centre for Disease Prevention and Control (ECDC) reports that the vaccine uptake among females is the following:

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