An Estimate of Global Human Papillomavirus Vaccination Coverage: Analysis of Country-Level Indicators Reported to WHO-UNICEF

Abstract

Background: Mortality rates from cervical cancer are evidence of health inequality. Over 310,000 women died of this preventable disease in 2018, mostly in low- and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunization against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunization strategies. Methods: Using data from the Global Cancer Observatory and WHO/Unicef, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorized by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global immunization coverage is calculated and its effect on cervical cancer mortality estimated. Findings: Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high income countries, coverage varies widely. In upper-middle income countries there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunization coverage for 2018 is estimated at 12·2%. Of the global cohort of 61 million 15 year-old girls in 2018, 7,000 are likely to die from cervical cancer, almost all in LMICs. Interpretation: Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunization. For all but the richest, affordability remains a barrier. Funding Statement: No external funding. Declaration of Interests: None to declare.