Case Summary:
Brazil introduced the quadrivalent human papillomavirus vaccine (4vHPV) into its National Immunization Program (PNI) in 2014, adopting a dual delivery strategy through both schools and health facilities. The program initially targeted girls aged 11-13 years, later expanding to 9–14 years, and became gender-neutral in 2017, while also including immunocompromised individuals. Currently, girls and boys aged 9-14 years and immunocompromised individuals aged 9-45 years (three-dose schedule) are eligible for free 4vHPV vaccination.
In the first year of introduction, Brazil achieved a 94.4% national first-dose (D1) coverage, with 87% of municipalities reaching the recommended 80% target. School-based delivery played a central role, marking Brazil’s first large-scale attempt to integrate routine immunization into schools. However, vaccine uptake declined sharply after 2016. Although first-dose coverage was high, national second-dose coverage fell to 40.8%, with only 32% of municipalities meeting coverage targets. A cluster of neurologic events temporally associated with HPV vaccination in 2014, later classified as immunization stress-related responses (ISRR), received widespread attention on social media and undermined public confidence. In the affected state, second-dose coverage declined to 44.6%, despite full recovery of all affected girls. In 2015, Brazil shifted HPV vaccination service from school-based approach to the primary healthcare provision, further reducing its accessibility and convenience. Combined with regional infrastructure disparities and the COVID-19 pandemic, national coverage dropped below 60% by 2020.
To reverse these trends, Brazil implemented multiple corrective measures. From 2017, eligibility was expanded to boys and immunocompromised individuals, and from 2024, a single-dose schedule was adopted for those aged 9-14 years. A nationwide catch-up campaign was launched to reach adolescents under 19 years who missed vaccination during the pandemic, with eligibility extended to December 2025. Authorities also renewed efforts to restore school-based vaccination, strengthened communication campaigns, and addressed vaccine-related misinformation online.These measures contributed to a recovery in coverage. By 2024, HPV vaccination coverage reached 82.8% among girls aged 9-14 years and 67.2% among boys in the same age group.
Brazil’s experience highlights challenge common to many middle-income countries: early success with school-based vaccination, followed by declines driven by misinformation, system-level changes, and external shocks. Evidence from Brazil suggests that restoring school-based delivery, simplifying schedules, maintaining gender-neutral programs, initiating vaccination at age 9, and investing in vaccine confidence are critical to achieving sustainable HPV vaccination coverage and preventing long-term setbacks in cervical cancer prevention.
Recommended Studies:
1. Piorelli, R. O., Sato, H. K., Araújo, N. V. D. L., Braga, P. E., Miyaji, K. T., & Sartori, A. M. C. (2025). School-based HPV vaccination program implementation in municipalities of the São Paulo State, Brazil, from 2015 to 2018. Cadernos de saude publica, 41(2), e00127423. https://doi.org/10.1590/0102-311XEN127423
2. Braga A, Martins CAdO, Paiva G, Barboza ÉdA, Chagas M, Callado GY, Araujo Júnior E, de Rezende-Filho J, Guimarães ICCdV, Granese R, et al. Global Perspectives on HPV Vaccination: Achievements, Challenges, and Lessons from the Brazilian Experience. Vaccines. 2025; 13(11):1106. https://doi.org/10.3390/vaccines13111106
3. Rosso, O. (2025, August 23). Brazil expands HPV vaccination campaign and surpasses the global average. Brasil 247. https://en.brasil247.com/saude/brasil-amplia-vacinacao-contra-hpv-e-supera-a-media-global#google_vignette
Content Editor: Xinyue Zhou
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