The Path to Cervical Cancer Eradication: Overcoming Barriers to HPV Vaccination

In 2025, an estimated 13,360 women in the US will be diagnosed with invasive cervical cancer, and more than 4300 will die from the disease. Globally, cervical cancer remains the fourth most common cancer among women, with approximately 660,000 new cases reported in 2022. The introduction of the human papillomavirus (HPV) vaccine marked a major turning point, contributing to nearly a 50% reduction in incidence rates and a 70% decrease in mortality since the 1950s.^1-3

Gardasil box next to syringes | Image Credit: © Unshu - stock.adobe.com

Despite this progress, significant challenges persist—particularly in low- and middle-income countries, where vaccine access and uptake remain limited. During the 2025 ASCO Annual Meeting, experts explored both the obstacles and opportunities surrounding HPV vaccination, emphasizing the urgent need for coordinated global efforts to eliminate cervical cancer and discussed how successful strategies could be adapted to prevent other HPV-related cancers.

Cervical Cancer and HPV

Persistent infection with high-risk types of HPV is the primary cause of nearly all cervical cancers, with HPV 16 and HPV 18 alone accounting for about 70% of cases worldwide. Almost all sexually active individuals will contract HPV at some point in their lives. The risk of acquiring a high-risk HPV type is higher among those who become sexually active at a young age, particularly those younger than 18 years or who have multiple sexual partners.^4,5

In most cases, HPV infections are short-lived and resolve on their own within 1 to 2 years, as the immune system clears the virus. These transient infections typically do not lead to cancer; however, when a high-risk HPV infection persists over time, it can cause cellular changes in the cervix that may develop into precancerous lesions. If left undetected and untreated, these lesions can progress to cervical cancer.^4,5

Traditional cervical cancer screening has relied on Pap smears, which detect abnormal cells in the cervix and are typically performed during routine pelvic exams. While Papanicolaou testing has been instrumental in reducing cervical cancer rates, it requires frequent screening and is less effective at identifying risk before cellular changes occur. Current recommendations suggest annual screening for many women, though this varies by age and clinical guidelines.⁵

Woman with highlighted uterus, expressing discomfort | Image Credit: © mi_viri - stock.adobe.com

The introduction of HPV testing offers several advantages over Papanicolaou tests. It is more sensitive in identifying high-risk HPV types, enabling earlier detection of potential cancer risk. HPV testing also allows for longer screening intervals, supports more personalized screening strategies, and is particularly effective in vaccinated populations where the prevalence of abnormal findings is lower. Additionally, self-sampling options have emerged as a promising tool, improving accessibility and patient adherence, especially in underserved communities.⁵

“So, HPV testing also opened the way to for full for such sampling, women can take a sample of cervical cancer or cervical cells that is suitable for a pCR-based HPV testing at their home by themselves, and this sample has the same sensitivity and specificity almost the same other clinicians have sampled test,” explained Philip E. Castle, PhD, MPH, from the National Cancer Institute.⁵

Compared with Papanicolaou tests, HPV testing provides a clearer picture of an individual’s cancer risk. It is associated with a 70% lower future cancer risk in HPV-negative women and can identify those at higher risk earlier, facilitating targeted follow-up care. When combined with triage methods, such as genotyping or reflex cytology, it supports risk-based management strategies and helps ensure that patients receive appropriate, timely care.⁵

Preventing HPV and Cervical Cancer

The HPV vaccine is the most effective and well-established method for preventing invasive cervical cancer. In countries with high vaccination coverage, it has led to significant reductions in HPV infections, high-grade cervical lesions, and ultimately, cervical cancer rates. Clinical research shows a more than 90% decrease in new infections with the HPV types targeted by the vaccine, particularly when administered before exposure.⁵

The vaccine is most effective when given in preteen or early teen years when the immune system is most responsive. It does not treat existing HPV infections but prevents new infections from occurring. Importantly, the vaccine is recommended for both females and males, helping to reduce transmission and protect against other HPV-related cancers.⁵

"There are 3 products on the market,” said Castle. “There were the first-generation vaccines, Gardasil and Cervarix, followed by Gardasil-9. And now, biosimilars are being developed in India and China, which will hopefully make vaccination more affordable and accessible globally, or at least that’s the hope when we look at the data.”⁵

Studies show that a single dose of the HPV vaccine may be just as effective—if not more effective—than the traditional 3-dose schedule, with a prolonged immune response and sustained protection. The vaccine also provides cross-protection against multiple high-risk HPV types beyond those directly targeted.⁵

Barriers to HPV Vaccine Uptake

Despite the proven efficacy of existing vaccines on the market, challenges remain in low- and middle-income countries, where access to vaccination is limited. The World Health Organization (WHO) has set a global goal to have 90% of girls fully vaccinated with the HPV vaccine by 2030. Achieving this target could prevent an estimated 74 million new cases of cervical cancer and 62 million deaths worldwide, highlighting the urgent need for coordinated global efforts and equitable vaccine distribution.⁵

Vial of HPV vaccine | Image Credit: © Sherry Young - stock.adobe.com

Studies show that high-income countries have significantly higher HPV vaccine uptake rates at approximately 40% compared with upper-middle-income (about 23%) and lower-middle-income countries, which have the lowest uptake rates. There is also a large gap in vaccine uptake in men and women, in which women are more likely to be vaccinated.⁵

Multiple factors influence vaccine uptake in these lower-middle-income countries. Financially, these vaccines are expensive, and there is limited support under Gavi, a public-private partnership that helps vaccinate children around the world.⁵

"At the lowest income, we have Gavi, and, of course, at the high income, we can just buy it,” explained Castle. “But there's nothing in the middle here for those countries that are, you know, essentially emerging economies, but can't afford vaccination, at least not off the shelf."⁵

There are also significant logistical and systemic challenges to widespread HPV vaccination, mainly in low- and middle-income countries. Many regions lack an established adolescent health platform, and limited health care infrastructure makes it difficult to implement effective vaccination delivery systems. Social and behavioral factors further complicate uptake. These include competing health care priorities, lack of public awareness, cultural resistance to discussing sexual health, and persistent social stigma surrounding sexually transmitted infections.⁵

Moreover, the complexity of multidose vaccination programs and logistical hurdles in cold-chain storage and distribution add to the burden on already strained health systems. Addressing these challenges requires not only investment in infrastructure and training but also community engagement and culturally sensitive public health messaging.

"Most places in the world—including the United States—don’t really have a structured adolescent health platform for delivering vaccinations,” said Castle. “It’s a bit disorganized—sometimes it’s done through campaigns, other times through school-based programs. But especially in low- and middle-income countries, not everyone is still in school by the time vaccination is recommended."⁵

Overcoming Vaccine Uptake Barriers

The speakers discussed a range of strategies to increase HPV vaccine uptake in low- and middle-income countries. Castle suggested exploring the expansion of Gavi eligibility to close gaps in vaccination and make it more accessible for at-risk or high-risk populations.⁵

"I would propose expanding Gavi eligibility for low-middle income countries and include Gardasil-9, which is not currently covered by Gavi, and the use of low-cost biosimilars, which should balance the market out for competition," Castle suggested.⁵

Child in Africa getting vaccinated | Image Credit: © Media Lens King - stock.adobe.com

In addition to expanding Gavi eligibility and incorporating biosimilars, other approaches included integrating HPV vaccination into existing infant or toddler immunization schedules to take advantage of established delivery systems. Speakers also highlighted the need to develop adolescent health platforms, train community health workers to improve vaccine education and outreach, and invest in cold chain infrastructure to ensure reliable vaccine storage and distribution. These efforts would help close the access gap and support global goals for cervical cancer prevention.⁵

"We need a whole-systems approach,” said Clement Adebamowo, FACS, FWACS, MBChB, ScD, from Marlene and Stewart Greenebaum Cancer Center in Baltimore. “With health education, provision of infrastructure, better communication, and integration into mobile health (mHealth), we can help improve both screening and vaccination in low- and middle-income countries."⁵

REFERENCES

1. Key statistics for cervical cancer. American Cancer Society. January 16, 2025. Accessed June 11, 2025. https://www.cancer.org/cancer/types/cervical-cancer/about/key-statistics.html

2. Cervical cancer. World Health Organization. March 5, 2024. Accessed June 11, 2025. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer

3. Cervical cancer leads cancer deathsfor women in 37 countries. American Cancer Society. July 29, 2024. Accessed June 11, 2025. https://www.cancer.org/research/acs-research-news/cervical-cancer-leads-cancer-deaths-37-countries.html

4. Cervical cancer causes, risk factors, and prevention. National Cancer Institute. August 2, 2024. Accessed June 11, 2025. https://www.cancer.gov/types/cervical/causes-risk-prevention

5. Castle P, Adebamowo C, Rossi P. Challenges and opportunities for global cervical cancer elimination: How can we build a model for other cancers. 2025 ASCO Annual Meeting. May 30, 2025, to June 3, 2025. Chicago, IL.