This chapter shows the potential impact of scaling up vaccination for human papilloma virus (HPV). It shows how vaccination for HPV offers a unique opportunity to protect future generations from cervical cancer and discusses the current status of national vaccination campaigns. The chapter presents results from OECD Strategic Public Health Planning (SPHeP) for Non-Communicable Diseases (NCDs) model, which was used to quantify the potential impact of optimising HPV vaccination, and discusses approaches to increase the coverage rates.
Tackling the Impact of Cancer on Health, the Economy and Society
OECD Health Policy Studies
Abstract
HPV vaccination offers a unique opportunity to protect future generations from cervical cancer
Infection with the human papillomavirus (HPV) can lead to various forms of cancer, with cervical cancer accounting for 91% of all HPV-related cancers.
Vaccines protecting against HPV infection are highly effective and safe, and they have been added to the national immunisation programmes of nearly all OECD and EU countries. However, the population coverage remains low.
Only four OECD countries (Spain, Portugal, Chile and Norway) achieved the target of vaccinating at least 90% of girls in 2022.
The average coverage in the OECD was 69% in 2022 (EU 56%), but this varied immensely across countries: from 8% in Japan to 96% in Norway.
Optimally implemented vaccination schemes could prevent between 84% and 92% of all cervical cancer cases, and 89% of all premature mortality due to cervical cancer.
It would also reduce the total burden of cancer on health expenditure by 1.3% in the OECD (1.6% in the EU) and add the equivalent of 120 000 full-time workers to the OECD workforce, and 40 000 to the EU. In monetary terms, this equates to a workforce output of EUR PPP 5.7 billion per year in the OECD (EUR PPP 1.6 billion in the EU).
To benefit fully from the impact of HPV vaccination on population health, healthcare expenditure and workforce productivity, countries should increase uptake and coverage by:
Evaluating the benefits and challenges of adopting a single‑dose schemes and considering its implementation based on the national circumstances: while initially a two‑dose schedule was advised, a single‑dose schedule has recently been found to provide sufficient protection for the primary target of young girls (excluding immunocompromised or HIV-infected people). Moving to a single‑dose schedule could provide various benefits, including cost-savings, simplified logistics and increased acceptability by the public.
Considering catch-up vaccination if and where needed: Catch-up vaccination targets individuals who have not received doses of the vaccine for which they are eligible. This can increase coverage, while improving the resilience of the programme against interruptions.
Addressing misinformation: Misinformation is a powerful threat to vaccination campaigns, including for HPV. To address this, comprehensive multimedia campaigns are needed, which address the specific concerns of parents; monitor and engage with social media; and benefit from wide and authoritative support.
Cancer prevention predominantly involves efforts to encourage behavioural changes such as quitting smoking, adopting a healthy diet and protecting oneself from harmful environmental exposures. While these behavioural changes are crucial, they can be challenging to implement and do not fully eliminate the risk of cancer. Beyond behavioural change, there are few healthcare interventions that prevent cancer. One notable exception is vaccination for human papillomavirus (HPV). With its high efficacy and safety, it offers a unique opportunity to protect future generations from cancer.
What is HPV and how does it cause cancer?
HPV is the most common viral infection of the reproductive tract, and it can be transmitted through sexual intercourse, including oral sex (WHO, 2022[1]). It is very prevalent: almost all sexually active people will be infected with HPV at some point in their lives, usually without symptoms (WHO, 2024[2]). It is more common among people living with HIV and in men who have sex with men (WHO, 2022[1]). While 70% to 90% of HPV infections exhibit no symptoms and resolve on their own within one to two years, persistent HPV infection can lead to the development of precancerous lesions that have the potential to advance into cancer in both men and women. This process can take 15‑20 years or longer.
The primary cancer associated with HPV is cervical cancer, accounting for 91% of all HPV-related cancers (WHO, 2022[1]). Cervical cancer is the fourth most common cancer in females and persistent, untreated HPV infection of the cervix (the lower part of the uterus or womb) causes 95% of all cervical cancers (WHO, 2024[3]). The remaining 9% of HPV-related cancers are cancer types that are generally less common, but still have a high relative burden due to HPV: HPV causes 90% of anal cancers, 70% of oropharyngeal (throat) cancers, 63% of penile cancers, 75% of vaginal cancers and 69% of vulvar cancers (National Cancer Institute, 2023[4]).
Vaccination against HPV
The first vaccine against HPV was licensed in 2006, and there are now six different vaccines available (WHO, 2022[1]). The HPV vaccines are deemed to be highly effective and safe. Consequently, almost all OECD and EU countries have included HPV vaccination in their national immunisation programmes (37 out of 38 and 26 out of 27 countries, respectively) (Figure 6.1). In addition, 19 EU MS also have HPV screening programmes (Box 6.1).
Number of countries that introduced HPV vaccination in their national immunisation programme, by year of introduction
Note: Date refers to the year when vaccine is included into the national immunisation schedule and accessible at no cost to primary target population cohorts in the country.
Source: WHO (2024[5]), WHO Immunization Data.
International efforts to eliminate cervical cancer rely on both vaccination and screening (WHO, 2020[6]) (European Commission, 2021[7]). In the EU, 19 countries have population-based cervical cancer screening in place, organised at the national or regional level. The design of these programmes varies, including the age groups they target (generally women over the age of 20, 25 or 30), and the frequency of testing (generally everyone, three or five years).
These programmes also differ in the type of test they use: cytology, HPV testing, or both. For cytology-based screening, cervical cells are collected and analysed to identify pre‑cancerous lesions (which can be treated to prevent progression to a more invasive disease) or early-stage cancer (allowing for earlier cancer treatment). However, cervical cytology has certain limitations. It is relatively insensitive in detecting pre‑cancerous lesions and cancer; it needs to be conducted frequently to achieve programme efficacy; and interpretation of results is subject to a high degree of subjectivity. Since persistent infection with high-risk HPV is strongly associated with cervical cancer, tests to detect DNA of high-risk HPV virus in cervical cells have been developed as an alternative to cytology-based screening. Most of the 29 EU+2 countries offer either high-risk HPV-based testing or a combination of cytology and HPV.
In the new EU Council Recommendation on cancer prevention through early detection, the possibility of self-sampling is suggested, where tests are sent to eligible women and performed at home (European Union, 2022[8]). This is of interest as it could reach non-responders and increase uptake. Mailing the eligible population self-sampling devices has been shown to increase uptake for both cervical and colorectal cancer screening (Camilloni et al., 2013[9]). Of the 29 EU+2 countries, 7 provide the option of self-sampling for HPV testing: Czechia, France, the Netherlands, Estonia, Norway, Sweden and Spain (in some regions).
In Estonia, an HPV self-sampling feasibility and pilot study was conducted in 2020 and 2021, followed by an implementation project (2022‑24). Since August 2022, women who did not participate in cervical cancer screening in the first half of the year will be able to choose between being provided with a test in a clinic or conducting self-sampling at home. The self-sampling kits can be ordered through an online platform. Additionally, a pilot project was carried out in the north-eastern region of Estonia in 2022, providing self-sampling kits in pharmacies. As of October 2023, the kits are available in pharmacies in five regions. From 2024, the HPV self-sampling option will be available to the target population throughout the year.
Source: OECD (2024[10]) Beating Cancer Inequalities in the EU: Spotlight on Cancer Prevention and Early Detection
Most national HPV vaccination programmes target both girls and boys, but six OECD countries only target girls (Figure 6.2) (Box 6.2). Around 90% of all countries aim to provide two doses of the vaccine, with the rest providing one dose. All aim to vaccinate teenagers before they become sexually activity, typically targeting people aged between 9 and 14 years old (WHO, 2024[5]).
Countries with HPV vaccination schemes targeting females only or both sexes, and using one dose or two doses
Source: WHO (2024[5]), WHO Immunization Data.
HPV vaccination is highly effective against HPV related cancers and other diseases when given to children before they become sexually active (aged 9 to 14 years) (WHO, 2022[1]), though policy on whether to vaccinate girls alone or girls and boys differs across countries. The World Health Assembly in 2020 adopted the Global Strategy for cervical cancer elimination, which included a goal to fully vaccinate 90% of girls with the HPV vaccine by age 15 (WHO, 2020[11]). Vaccination of boys is considered a secondary target population, to be covered if it is “feasible and affordable, and does not divert resources from vaccination of the primary target population or effective cervical cancer screening programmes” (WHO, 2022[1]). Europe’s Beating Cancer Plan also sets a 90% coverage target for girls, while recommending to “significantly increase the vaccination of boys” (European Commission, 2021[12]).
There are several ways in which vaccinating boys for HPV can help reduce the cancer burden:
While boys are partially protected from HPV infection if there is a high vaccination rate among girls, if coverage is low they remain at risk (Qendri, Bogaards and Berkhof, 2018[13]). HPV infection in boys can cause various types of cancers. In England there has been increasing numbers of anal cancers in men, 80% of which are caused by HPV (Powell, Hibbitts and Evans, 2018[14]). Globally, the incidence of HPV-related anal cancer and oropharyngeal cancer has increased among men between 1962 and 2015 (Varga et al., 2019[15]). While the number of tobacco and alcohol-related head and neck cancers has been declining, cases related to HPV infection are on the rise and now make up 70‑90% of all new cases (Sabatini and Chiocca, 2019[16]) (Young et al., 2015[17]).
There is also a high burden of HPV among men who have sex with men (MSM), who do not benefit from herd immunity from female‑only vaccination (Woestenberg et al., 2020[18]) (Díez-Domingo et al., 2021[19])
In addition to directly protecting boys, vaccinating boys can help provide additional protection for girls. Particularly when coverage rates among girls are low (e.g. below 60%), it is estimated that at least half of the gains from vaccinating boys are from preventing cervical cancer in girls (Qendri, Bogaards and Berkhof, 2018[13]).
There are also ethical considerations to vaccinating both boys and girls. First, only vaccinating girls may reinforce the impression that sexual health is primarily a female responsibility (Powell, Hibbitts and Evans, 2018[14]). Second, targeting MSM specifically requires discussions around sexual orientation with boys at a young age. This could produce highly unreliable results, because orientation is not yet firmly established, taboo or parental objection (Stanley, 2012[20]).
While on average gender-neutral vaccination is less cost-effective than vaccination of girls only (WHO, 2022[1]), there are situations and settings where it is cost-effective. Gender-neutral vaccination was evaluated to be cost-effective for Belgium (Simoens et al., 2021[21]). For Spain, it was estimated to be cost-effective if protection against oropharyngeal or penile cancers was included (Linertová et al., 2022[22]). In the United Kingdom, the Joint Committee on Vaccination and Immunisation advised expanding vaccination from previously recommended females and MSM in 2015 to gender-neutral vaccination in 2018, based on the increasing incidence of HPV cancers in men and cost-effectiveness (Powell, Hibbitts and Evans, 2018[14]).
However, adequate vaccine supply remains a key issue in the debate. Demand for the HPV vaccine is expected to grow in the next ten years, and countries that have not yet implemented a vaccine programme, including countries with a high burden of disease, may have to wait until supply can meet demand (Logel et al., 2022[23]). To mitigate the vaccine shortage, the Strategic Advisory Group of Experts on Immunization (SAGE) in 2019 advised the WHO that “countries should temporarily pause implementation of boy, older age group (>15 years) and multi‑age cohort (MAC) HPV vaccination strategies until vaccine supply allows equitable access to HPV vaccine by all countries” (WHO, 2019[24]). Fortunately, a recent study estimates that the risk of HPV shortages has now significantly decreased, and global supply is, under normal circumstances, sufficient to meet global demand (Malvolti et al., 2023[25]).
But while many countries have introduced HPV vaccination, the population coverage remains low. The WHO and EU both recommend that countries vaccinate 90% of girls to achieve the goal of cervical cancer elimination (WHO, 2020[6]) (European Commission, 2021[7]). However, only four OECD countries (Spain, Portugal, Chile and Norway) achieved this target in 2022 (Figure 6.3). The average coverage in the OECD was 69% in 2022 (EU 56%), but this varied immensely across countries: from 8% in Japan to 96% in Norway. Some countries saw a drop in coverage between 2017 and 2022, which can be the result of COVID‑19 disruptions to routine care (UK Health Security Agency, 2024[26]) (NCIRS, 2024[27]) (Cruz-Valdez et al., 2023[28]).
HPV vaccination programme coverage, first dose, females, in 2017 and 2022
Note: Averages for 2017 covers 20 EU countries and 31 OECD countries, while the 2022 average includes 22 EU and 34 OECD countries.
Source: WHO (2024[5]), WHO Immunization Data.
Optimally implemented vaccination schemes, where a high coverage rate provides enough herd immunity to eliminate all infections by the targeted HPV types, could prevent between 84% and 92% of all cervical cancer cases from occurring (Bonjour et al., 2021[29]) (for more information on the methodology, which is based on the ATLAS model from the International Agency for Research on Cancer (IARC), see Annex 6.A). While this is only one type of cancer, affecting only females, the high efficacy of this intervention means that the impacts1 are substantial.
By preventing cervical cancer cases, HPV vaccination could prevent 113 000 premature deaths per year across the 51 countries, of which nearly 20 000 in OECD countries and over 6 000 in the EU. This is 89% of all premature mortality due to cervical cancer. Per 100 000 population, the impact on premature mortality would be greatest in Central and Eastern European and Latin American countries (Figure 6.4). These countries have a relatively high baseline incidence of cervical cancer, and the impact of vaccination would therefore be considerable.
Impact of HPV vaccination on premature mortality (deaths in people aged under 75) due to cervical cancer, per 100 000 population and as a percentage of total premature mortality due to cervical cancer, per year, average over 2023‑50*
Note: *Estimates cover the period 2023‑50, but they assume optimal coverage and protection from cervical cancer from the beginning. In other words, they reflect the maximum potential impact of HPV vaccination, and not a scenario where optimal vaccine uptake is achieved over time, and where the protective effect against cervical cancer is observed down the line. For more information on the methodology, see Annex 6.A.
Source: OECD SPHeP NCDs model, 2024, using inputs from the ATLAS model by Bonjour, M. et al. (2021[29]), “Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis”, https://doi.org/10.1016/S2468-2667(21)00046-3.
A total of EUR PPP 6.9 billion could be saved yearly in terms of cancer treatment cost if HPV vaccination was optimally implemented across the 51 countries, with EUR PPP 5.8 billion in OECD countries and EUR PPP 1.5 billion in the EU (not including cost associated with the vaccination programme). This equates to 1.3% of the total burden on cancer on health expenditure in the OECD (1.6% in the EU). Countries with higher health expenditure also see greater per capita savings from HPV vaccination (Figure 6.5).
The impact of HPV vaccination on cancer-specific health expenditure, in EUR PPP per capita, per year, average over 2023‑50*
Note: *Estimates cover the period 2023‑50, but they assume optimal coverage and protection from cervical cancer from the beginning. In other words, they reflect the maximum potential impact of HPV vaccination, and not a scenario where optimal vaccine uptake is achieved over time, and where the protective effect against cervical cancer is observed down the line. For more information on the methodology, see Annex 6.A.
Source: OECD SPHeP NCDs model, 2024, using inputs from the ATLAS model by Bonjour, M. et al. (2021[29]), “Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis”, https://doi.org/10.1016/S2468-2667(21)00046-3.
In Europe, North America and Oceania, approximately 70% of all cervical cancer cases will occur before 60 years of age (in the absence of vaccination) (Bonjour et al., 2021[29]). This constitutes a significant burden on the working age population, and thus on workforce productivity and participation. Optimal implementation of HPV vaccination could add the equivalent of 120 000 full-time workers to the OECD workforce, and 40 000 to the EU. In monetary terms, this equates to an output of EUR PPP 5.7 billion per year in the OECD, roughly equivalent to the monthly GDP of Latvia (EUR PPP 1.6 billion in the EU).
Workforce output increases by EUR PPP 6.4 per person of working age per year in the OECD on average (Figure 6.6). Countries with high average wages see greater impacts, as do countries with high baseline cervical cancer incidence. As cancer is more likely to affect older people, it reduces the number of people at early retirement age. Consequently, reducing cervical cancer actually increases the rate of early retirement.
The impact of HPV vaccination on the workforce through absenteeism, early retirement, employment (combining unemployment and part-time work) and presenteeism, in EUR PPP per capita (working age), per year, average over 2023‑50*
Note: Reducing cervical cancer increases the rate of early retirement as more people are alive towards the end of their working life, at which point they may retire early. *Estimates cover the period 2023‑50, but they assume optimal coverage and protection from cervical cancer from the beginning. In other words, they reflect the maximum potential impact of HPV vaccination, and not a scenario where optimal vaccine uptake is achieved over time, and where the protective effect against cervical cancer is observed down the line. For more information on the methodology, see Annex 6.A.
Source: OECD SPHeP NCDs model, 2024, using inputs from the ATLAS model by Bonjour, M. et al. (2021[29]), “Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis”, https://doi.org/10.1016/S2468-2667(21)00046-3.
In many countries, there remains significant scope to improve the coverage rate of HPV vaccination and reap the full benefits in terms of population health, healthcare expenditure and workforce productivity. To increase uptake and coverage, countries can consider the implementation of a single‑dose scheme based, after having evaluated benefits and challenges, consider catch-up vaccination campaigns if and where needed, and evaluate and address misinformation.
Evaluate the benefits and challenges of adopting a single‑dose scheme and consider its implementation based on the national circumstances
When HPV vaccines were first introduced, they were licensed under a three‑dose vaccination schedule (WHO, 2022[1]). Subsequently a two‑dose schedule was approved based on positive effectiveness data. Currently, almost all OECD and EU countries have a two‑dose schedule (WHO, 2024[5]).
A recent position paper by the WHO however found that a single dose of HPV vaccine is sufficient to elicit an immune response that provides similar protection as a multidose regimen against initial and persistent HPV infection (WHO, 2022[1]). WHO now advises that countries choose between a one‑ or two‑dose schedule for girls aged 9‑14 years (excluding immunocompromised or HIV-infected people).
A single‑dose scheme can provide various benefits over two‑dose schemes, which can help both the provision and uptake of HPV vaccination (IARC, 2023[30]):
The HPV vaccine is one of the most expensive vaccines to be introduced in national immunisation programmes. Moving to a single‑dose scheme would automatically cut the variable cost in half.
A single‑dose scheme would also simplify the logistics of the vaccination scheme, saving cost and facilitating expansion.
A single dose may be more acceptable to the population, increasing uptake.
With the three or two doses previously used on girls alone, boys and girls could be vaccinated, increasing the herd effect and improving programme resilience.
As with any immunisation programme, modifying the vaccination schedule may pose some practical challenges that need to be assessed and addressed before moving forward with the implementation of the new scheme. For example, healthcare providers may need to be trained in the new schedule to ensure that they administer the vaccines correctly and are able to address any concerns that patients may have. Additional public awareness and acceptance activities may also be needed to further reduce public confusion and hesitation.
Based on the change in WHO recommendation, Australia, Ireland, England and Scotland switched from a double to a single dose HPV vaccine schedule (Department of Health and Aged Care, 2023[31]) (Public Health Agency, 2023[32]) (UK Health Security Agency, 2023[33]). In Estonia, the move to a single dose in 2024 was combined with an expansion of the HPV vaccination scheme to boys and free catch-up vaccination (see next section), with the aim of significantly increasing the coverage of young people (Ministry of Social Affairs, 2023[34])
Consider catch-up vaccination if and where needed
Catch-up vaccination targets individuals who, for whatever reason, have not received doses of vaccines for which they are eligible. Due to larger direct protection and stronger herd effects, catch-up immunisation targeting people between 9 and 18 years can result in faster and larger population impact than vaccinating single age‑cohorts (SAGE, 2017[35]). Catch-up vaccination also offers opportunities for economies of scale in delivery. Finally, it can make programmes more resilient to any interruptions in vaccination, as it provides a system to administer missed doses later (WHO, 2022[1]).
In many OECD countries catch-up vaccinations are already part of the standard vaccination programme. For example, in Australia anyone aged 12 to 25 who missed out on the main school-based HPV vaccination programme can receive a catch-up vaccination for free at the doctors, pharmacy or local immunisation clinic (Cancer Council, 2023[36]). Catch-up vaccinations can also be organised as a one‑off campaign to compensate for interruptions. After an eight‑year suspension of the HPV vaccination programme, in 2022 Japan started a three‑year catch-up campaign to vaccinate females aged 17‑25 who missed out due to the suspension (University of Tokyo Health Services Center, 2023[37]) (Sekine et al., 2022[38]).
Address misinformation with informed and authoritative multimedia campaigns
Misinformation is a powerful threat to vaccination campaigns, including for HPV. In Demark, social media, news reports and a documentary about adverse reactions to the HPV vaccine between 2013 and 2015 lead to a dramatic fall in vaccination rates (Bigaard and Franceschi, 2021[39]). These reports were later investigated by the European Medicines Agency which did not support a causal link between the suspected adverse reactions and the HPV vaccination (Agergaard et al., 2023[40]). In Ireland, HPV vaccination rates decreased sharply following social media campaigns from lobby groups established by parents in 2015 about vaccine safety (Corcoran, Clarke and Barrett, 2018[41]). Other OECD countries such as France, Romania, Japan and Colombia have also experienced mistrust against the HPV vaccine (Bigaard and Franceschi, 2021[39]; Karafillakis et al., 2019[42]; Larson, 2020[43]; Simas et al., 2019[44]).
Both Ireland and Denmark implemented targeted multisectoral interventions to restore trust and increase uptake. These strategies had several elements in common:
Understanding parental attitudes and concerns: In Denmark, analysis showed that mothers often decided about vaccination. Focus groups were therefore organised with mothers to gather insights into the barriers to HPV vaccination, which included a lack of clear information about the vaccine from health authorities and other trusted organisations (Bigaard and Franceschi, 2021[39]). Ireland also held focus groups on parental attitudes to HPV vaccination (Corcoran, Clarke and Barrett, 2018[41]).
Monitoring and use of social media: Public health authorities need to monitor and be present on social media channels, to identify and respond to misinformation around vaccines (European Centre for Disease Prevention and Control, 2021[45]). Both the Danish and Irish approached included a strong presence on social media, informed by analysis (Corcoran, Clarke and Barrett, 2018[41]) (Bigaard and Franceschi, 2021[39]). In Denmark, specific social media channels were used to reach target audiences, with mothers more likely to use Facebook for information, while teenage girls interacted more on Instagram. However, substantial manpower was needed to answer questions and to prevent misinformation from dominating the digital channel. Students were employed for daily monitoring and prompt responses, supervised by experienced campaign staff (Bigaard and Franceschi, 2021[39]).
Wide and authoritative support of HPV vaccination: In Denmark, multiple actors, including professional doctor and nurse organisations, sexual health organisations, and patient organisations were involved in backing up the campaign (Bigaard and Franceschi, 2021[39]). Ireland launched the HPV Vaccination Alliance, a group of over 35 different organisations working in the areas of health, women’s rights, child welfare, and wider civil society committed to raising awareness of HPV vaccination, which supported the media campaign (Corcoran, Clarke and Barrett, 2018[41]).
The campaigns to address misinformation around HPV vaccination seem to have been successful. After both countries saw coverage reach a low in 2016, of 55% in Ireland and 47% in Denmark, uptake increased in the following years to reach 83% in Ireland and 89% in Denmark by 2022 (though Ireland saw a temporary drop in coverage in 2020, when its school-based HPV campaign was disrupted by COVID‑19‑related school closures and redeployment of school vaccination teams (Health Service Executive, 2021[46])) (Figure 6.7).
HPV vaccination programme coverage, first dose, females, over time in Ireland and Denmark
Note: Ireland saw a temporary drop in coverage in 2020, when its school-based HPV campaign was disrupted by COVID‑19‑related school closures and redeployment of school vaccination teams.
Source: WHO (2024[5]), WHO Immunization Data.
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To model the impact of HPV vaccination on cervical cancer incidence, the ATLAS model from the International Agency for Research on Cancer (IARC) was used (Bonjour et al., 2021[29]). This model uses age‑specific incidence rates from GLOBOCAN 2018 and cohort-specific mortality rates by age from UN demographic projections to establish a baseline of expected cervical cancer cases in the absence of vaccination. It estimates the number of vaccine‑preventable cancers using the country-specific relative contribution of each HPV type to cervical cancer incidence, and an assumed effectiveness of the vaccination programme in reducing the prevalence of these HPV types. This latter variable combines various factors that affect the effectiveness of vaccination programmes, such as the immunisation schedule and coverage, the targeted sex and age groups, and population-specific sexual behaviour.
Data from the IARC model was used to model the burden of vaccine‑preventable cervical cancer in the OECD SPHeP-NCDs model. The burden scenario is based on a vaccine that targets all possible HPV types (16, 18, 31, 33, 45, 52, and 58), and is 100% effective in eliminating them. In this scenario countries see on average an 88% decrease in cervical cancer cases (Annex Figure 6.A.1). This reduction in incidence was applied evenly across age bands, and instantaneously. This hypothetical scenario reflects the total potential impact, and does not consider the time it takes to see the impact of vaccinating young people on future cancer burden and mortality.
Percentage of all cervical cancer cases prevented
Source: Bonjour, M. et al. (2021[29]), “Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis”, https://doi.org/10.1016/S2468-2667(21)00046-3.
← 1. Note that these results are comparing a no-vaccine scenario to a scenario where vaccination has been fully successful in eliminating the targeted HPV types and its full impact has been reached. In reality, due to the lags between vaccination, sexual activity, infection and cancer development, the maximum impact of the intervention may take several decades to be reached.