Human papillomavirus (HPV) vaccination is a highly effective strategy for preventing cervical cancer, yet more than 85% of the global disease burden occurs in low- and middle-income countries (LMICs). This scoping review, published in The Lancet Regional Health – Western Pacific, examined HPV vaccination policies and implementation in 84 LMICs that had incorporated HPV vaccination into their national immunization programs (NIPs) by July 2025. By synthesizing evidence from WHO, government documents, international organizations, and 24 implementation studies, the review evaluated vaccination policies, coverage, delivery strategies, and implementation experiences among adolescents aged 9–14 years.
The review found that HPV vaccination policies have become increasingly aligned across LMICs. Most countries provide free vaccination for girls aged 9–14 years, while school-based delivery and single-dose schedules are becoming more common following the 2022 WHO recommendation. Nevertheless, substantial variation remains in vaccination targets, vaccine products, financing mechanisms, and policies for boys and immunocompromised populations. Male vaccination is largely limited to upper-middle-income countries, and only a few countries have established specific vaccination schedules for immunocompromised individuals.
Despite policy expansion, vaccination coverage remains insufficient. Although nearly half of the included countries have adopted a single-dose schedule, descriptive comparisons did not reveal higher vaccination coverage compared to two-dose programs. Instead,
single-dose schedules reduce costs associated with subsequent doses, ease cold-chain requirements, and simplify logistics, thereby lowering the overall implementation burden. Overall, only 9.8% of countries achieved the WHO target of 90% complete vaccination coverage among females by age 15, while 44.3% remained below 50%.
School-based vaccination is the predominant delivery strategy and generally provides more stable coverage than facility-based programs. However, school-based services alone may fail to reach out-of-school adolescents and those living in remote or underserved areas. Few countries have implemented complementary strategies targeting these populations, and evidence on equity remains limited, highlighting the need to monitor disparities beyond overall vaccination coverage.
Implementation evidence suggests that successful HPV vaccination programs depend on coordinated health system support rather than a single intervention. Common enabling factors include strong government commitment, sustainable financing, reliable vaccine supply, collaboration between health and education sectors, community engagement, effective communication, and continuous workforce capacity building. Conversely, implementation barriers differ across settings. Upper-middle-income countries predominantly faced sociocultural and knowledge barriers, whereas lower-middle-income and low-income countries encountered more fundamental resource constraints.
Overall, the review concludes that school-based programs paired with complementary mixed approaches offer a promising option for advancing equitable population-level protection, while the WHO-recommended single-dose schedule provides a practical opportunity to simplify implementation and reduce costs. Successful implementation also requires robust policy frameworks, effective service delivery and collaboration, innovative communication strategies, and sustained capacity building.
Relevant Research:
Liu S, Wu D, Ye S, Xiao Y, Wu M, Chen S, Zhang X, Guo L, Zhang Q, Zhou Y, Wu X, Yang Q, Xiao R, Zhang J, Feng X, Wang J, Shi X, Zhang X, Xu J, Shao J, Tang S, Liu Q. HPV vaccination policies and implementation for adolescents in low- and middle-income countries: a scoping review. The Lancet Regional Health – Western Pacific. 2026;72:101919. doi:10.1016/j.lanwpc.2026.101919
https://doi.org/10.1016/j.lanwpc.2026.101919
Translating and summarizing: Tianyi Deng
Reviwer: Ziqi Liu
Page editor : Ruitong Li
