Variation in HPV Vaccination Coverage Across the European Union

Abstract

Human papillomavirus (HPV) is the most common sexually transmitted infection globally. While most infections resolve spontaneously, persistent infection with high-risk genotypes (HPV-16 and HPV-18) is causally linked not only to cervical cancer but to a broader spectrum of malignancies, including anal, oral, and oropharyngeal cancers, affecting both women and men. Since its introduction in 2006, the HPV vaccine has proven near-complete efficacy against cervical cancer and approximately 82.7% efficacy against oral and oropharyngeal cancers, establishing vaccination as a cornerstone of cancer prevention. In 2021, Europe’s Beating Cancer Plan set the target of 90% HPV vaccination coverage among girls by 2030, alongside the elimination of cervical cancer (fourth most common cancer in women). All EU/EEA member states now recommend the two-dose HPV vaccination for both adolescent girls and boys within national immunisation programmes, with three countries following the WHO 2022 one-dose regimen guideline (off-label use as the EMA still did not approve it). Five countries have already reached the 90% coverage threshold among girls by age 15. However, despite universal public funding of HPV vaccination across the European Union, the variation of vaccination rates between member states is striking. Uptake ranges from 4% in Bulgaria to 97% in Portugal (2024), with major economies such as France falling below 50%. This paper will try to investigate the current structural, cultural, and programmatic determinants of HPV vaccination differences across EU member states. It will mainly focus on the potential enablers and inhibitors of vaccination: vaccine hesitancy, cervical cancer prevalence, immigration, single-dose regimen adoption, parent support, physician recommendation practices, and school-based vaccination policy.