A new modelling analysis in The Lancet Global Health explores how low- and lower-middle-income countries can get the most cervical cancer prevention out of every HPV vaccine dose, now that one-dose schedules and expanding supply are on the table. Using the HPV-ADVISE model calibrated to 67 countries, the authors compare 162 strategies that vary target groups (girls only vs gender-neutral), age ranges (up to 35 years), number of doses, and coverage levels, ranking them by number needed to vaccinate (doses per cervical cancer averted) over 100 years. After introducing routine one-dose vaccination for 9-year-old girls, the most efficient next steps are one-dose multi-age cohort campaigns for girls aged 10–14 years (NNV 48) and then 15–20 years (NNV 64), which add only 4–5% more doses but avert an additional 5–6% of cervical cancers.
For immunization programmes operating under fiscal and supply constraints, the results send a clear message: in LICs and LMICs, the highest-value use of HPV doses is to achieve and sustain high one-dose coverage for girls up to age 20 before adding boys or giving second doses. Once this core is in place, the most efficient expansions differ by context—at 80% coverage and above, two-dose catch-up for women 21–25 years is ranked ahead of vaccinating boys; at lower coverage (≤70%) and where coverage cannot realistically be increased, vaccinating boys and young men 9–20 years becomes a more efficient way to boost herd protection. The authors emphasise that these efficiency rankings have directly fed into WHO’s framework for prioritising secondary HPV target groups and can guide countries and partners as they decide how to allocate scarce HPV doses to move faster toward cervical cancer elimination.
Thumbnail image credit: Gavi / 2025 / Wilson Photographer
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