Acoustic surveys for sperm whales (Physeter macrocephalus) were conducted in the Mediterranean Sea in summer 2018 as part of the vessel-based component of the ACCOBAMS Survey Initiative (ASI). Equal-spaced zigzag transects provided uniform coverage of key sperm whale habitats and were surveyed using a towed hydrophone array deployed from a research vessel at speeds of 5-8 knots. A total of 14,039 km of tracklines were surveyed in the western basin, Hellenic Trench and Libyan waters, with an acoustic coverage of 10% realised for sperm whales. During these surveys, 254 individual sperm whales were detected on the trackline, with an additional 66 individuals off-track. Sperm whales were only seen ten times on-track, with an additional 16 off-track sightings. Estimates of slant range to echolocating whales were used to derive density estimates through both design- and model-based distance sampling methodologies. An acoustic availability of 0.912 (sd = 0.036) was derived from via published models. When correcting for availability bias, a design-based abundance estimates of 2,673 individuals (95% CI 1,739-4,105; CV = 0.21) was derived for the surveyed blocks, which incorporated most known sperm whale habitat in the Mediterranean Sea. The equivalent model-based estimate was 2,825 whales (2,053-3,888; CV = 0.16). Over 97% of detected whales were in the western basin, with highest densities in the Algerian and Liguro-Provencal Basins between Algeria and Spain/France. In the eastern basin, detections were sparse and concentrated along the Hellenic Trench. A density surface modelling (DSM) exercise identified location and benthic aspect as being the most instructive covariates for predicting whale abundance. Distance sampling results were used in a power analysis to quantify the survey effort required to identify population trends. In the most extreme scenario modelled (10% per annum decline with decennial surveys), the population could have dropped by 90% before the decline was identified with high statistical power. Increasing the regularity of surveys would allow population trends to be detected more expediently. Mediterranean sperm whales are listed as Endangered on the IUCN’s Red List and the need for urgent conservation measures to reduce injury and mortality remains paramount for this unique sub-population.