Human papillomavirus (HPV) vaccines are vaccines intended to provide acquired immunity against infection by certain types of human papillomavirus. The first HPV vaccine became available in 2006. Currently there are six licensed HPV vaccines: three bivalent (protect against two types of HPV), two quadrivalent (against four), and one nonavalent vaccine (against nine). All have excellent safety profiles and are highly efficacious, or have met immunobridging standards. All of them protect against HPV types 16 and 18, which are together responsible for approximately 70% of cervical cancer cases globally. The quadrivalent vaccines provide additional protection against HPV types 6 and 11. The nonavalent one provides additional protection against HPV types 31, 33, 45, 52 and 58. It is estimated that HPV vaccines may prevent 70% of cervical cancer, 80% of anal cancer, 60% of vaginal cancer, 40% of vulvar cancer, and show more than 90% effectiveness in preventing HPV-positive oropharyngeal cancers. They also protect against penile cancer. They additionally prevent genital warts (also known as anogenital warts), with the quadrivalent and nonavalent vaccines providing virtually complete protection. The World Health Organization (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 six-month interval for women older than 21 years. The vaccines provide protection for at least five to ten years.
The primary target group in most of the countries recommending HPV vaccination is young adolescent girls, aged 9–14. The vaccination schedule depends on the age of the vaccine recipient. As of 2025, an estimated 33% of girls aged 9–14 years worldwide received at least one dose (93 countries were implementing the single-dose schedule, 85% of girls aged 9–14 years old vaccinated in that year). As of the end of 2025, 93 countries are implementing the single-dose schedule. At least 162 countries provide the HPV vaccine in their national immunization programs as of 2025. Vaccinating a large portion of the population may also benefit the unvaccinated by way of herd immunity.
The HPV vaccine is on the World Health Organization's List of Essential Medicines. The World Health Organization (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. Of cervical cancers, 88% (2020 figure) occur and 90% of deaths occur in low- and middle-income countries and 2% (2020 figure) in high-income countries. The WHO-recommended primary target population for HPV vaccination is girls aged 9–14 years before they become sexually active. It aims the introduction of the HPV vaccine in all countries and has set a target of reaching a coverage of 90% of girls fully vaccinated with HPV vaccine by age 15 years. Females aged ≥15 years, boys, older males or men who have sex with men (MSM) are secondary target populations. HPV vaccination is the most cost-effective public health measure against cervical cancer, particularly in resource-constrained settings. Cervical cancer screening is still required following vaccination.
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. In 2025, a randomized trial's 5-year extension reported that among Tanzanian girls vaccinated at ages 9–14, ≥99% remained seropositive for HPV-16 and 93–98% for HPV-18 at month 60 after a single dose, while antibody concentrations were stable from months 12–60. Not much is known about the efficacy and protective duration of the simplified schedule in boys and men.
Background Cervical cancer The large majority of cervical cancer cases in 2020 (88%) occurred in LMICs, where they account for 17% of all cancers in women, compared with only 2% in high-income countries (HICs). In sub-Saharan Africa, the region with the highest rates of young WLWH (Women Living With HIV), approximately 20% of cervical cancer cases occur in WLWH [women living with HIV]. HPV infection is more likely to persist and to progress to cancer in WLWH.33 Mortality rates vary 50-fold between countries, ranging from <2 per 100 000 women in some HICs to >40 per 100 000 in some countries of sub-Saharan Africa.
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 2025, Nepal launched a nationwide human papillomavirus (HPV) vaccination campaign aimed at eliminating cervical cancer. Supported by the World Health Organization, UNICEF, and Gavi, the Vaccine Alliance, the initiative targets more than 1.6 million girls aged 10 to 15 years. The campaign addresses a major health concern in Nepal, where hundreds of women are diagnosed with the virus-caused disease each year and aims to eliminate cervical cancer by 2030.
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. It is thought that booster vaccines will not be necessary.
As of September 2024, 57 countries are implementing the single-dose schedule. A growing number of vaccine products initially prequalified for use in a 2-dose schedule can now be used in a single-dose schedule. Before, it was unsure whether two doses of the vaccine may work as well as three doses. 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. Evidence suggests that HPV vaccines are effective in preventing cervical cancer for women up to 45 years of age. 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