HPV is one of 4 main oncogenic infectious pathogens, of which HPV types 16 and 18 are estimated to account for 72% of all HPV-attributable cancers. HPV is responsible for an estimated 690,000 cases of cancer diagnosed worldwide every year.1 HPV is the primary cause of cervical cancer and also oropharyngeal, vulval, penile, and anal cancers, and of genital warts.1-4 While women are more commonly affected by HPV cancers, almost one in three men worldwide are infected with at least one genital HPV type.5
HPV vaccination, along with cervical screening, is a cost-effective means of reducing cervical cancer incidence and need for associated treatment.6 It would already be having a significant impact in reducing the burden of HPV-related cancers in Australia.7
About this measure
Australia has adopted the World Health Organization (WHO) global goal of equitably eliminating cervical cancer as a public health problem by 2030 by achieving 90:70:90 targets with Human Papillomavirus (HPV) vaccination, cervical screening, and treatment, respectively.8 Aligned with the WHO aim of having 90% of girls fully vaccinated with HPV vaccine by 15 years of age by 2030 in each country, Australia has extended this HPV vaccination target to include both males and females by 2035.9
Since mid-2007, the National HPV Vaccination Program implemented under Australia’s National Immunisation Program has offered HPV vaccination free of charge to young females, with an additional catch-up extension for ages 12–26 years occurring to the end of 2009. From 2009, the National Program offered HPV vaccination routinely to females in the first year of high school (usually at 12–13 years of age) through the Secondary School Immunisation Program. From 2013, males were also offered HPV vaccination in their first year of high school (age 12–13 years), with an additional catch-up extension for males aged 14–15 years in 2013 and 2014.10-12
The current vaccine used in the Australian National Immunisation Program (NIP) is Gardasil9, 9vHPV, which protects against 9 HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58. Previously, from 2007, it was the quadrivalent HPV vaccine (Gardasil, 4vHPV) which can prevent infection and disease from 4 HPV types 6, 11, 16 and 18.10-12 Cervavix, the bivalent HPV vaccine (2vHPV), which protects against HPV types 16 and 18, is also available on the private market.
It is recommended that adolescents and young adults receive 9vHPV vaccination from nine years of age. The optimal age for HPV vaccination is considered to be around 12–13 years, in advance of HPV exposure through sexual activity. However, those who have not received HPV vaccine by 14 years of age can still receive the vaccine up to 25 years of age.9-10
From February 2023, Gardasil 9 has been administered as a single-dose rather than the previous two-dose course since 2018. The recommended HPV vaccination schedule for adolescents and young adults aged 9–25 years is now 1 dose.12 From January 2018, a 2-dose course of the 9vHPV, Gardasil 9, has replaced the previous 4vHPV Gardasil course.13
The jurisdiction-based (states & territories) National Human Papillomavirus Vaccination Program Register (HPV Register) ceased operation from December 31st 2018. All HPV vaccinations are now recorded by the Australian Immunisation Register (AIR) at the National Centre for Immunisation Research and Surveillance (NCIRS). Data from the AIR are used to monitor HPV population coverage at 15 years of age.14-15
Current status
In 2023, 85.9% of Australian girls had received at least one dose of HPV vaccine by 15 years of age and 83.4% of boys had received at least one dose.14 In 2022, 85.3% of Australian girls had received at least one dose of HPV vaccine by 15 years of age and 83.1% of boys had received at least one dose.15
Remoteness and socioeconomic disadvantage
In 2022, girls living in Major cities and Inner regional had a higher HPV vaccination coverage rate than those in Very Remote areas (85.4% and 85.7% compared with 80.2%, respectively).15-16
In 2022, girls living in the least socioeconomically disadvantaged areas had a higher HPV vaccination coverage rate (87.7%) than those living in the most disadvantaged areas (82.7%).15-16 This pattern was the same in boys. Boys living in Major cities and Inner regional had a higher HPV vaccination coverage rate than those in Very Remote areas (83.1% and 83.8% compared with 80.1%, respectively). Boys in the least socioeconomically disadvantaged areas had a higher HPV vaccination coverage rate (86.0%) than those living in the most disadvantaged areas (79.4%).15-16
Trends
Between 2021 and 2023, among girls turning 15 years of age, there was a marginal decrease in the percentage receiving at least one dose of HPV vaccine before their 15th birthday (from 86.2% in 2021 to 85.3% in 2022) and then a similar figure of 85.9% in 2023. The corresponding percentage coverage in boys was from 84.4% in 2021 to 83.1% in 2022 and 83.4% in 2023. The marginal decreases observed may reflect effects of the COVID-19 pandemic, The 2022 coverage would reflect vaccination activity in school-based programs before and during the COVID-19 pandemic, whereas 2021 coverage would reflect vaccinations predominantly administered before the pandemic. Pandemic disruption to school-based immunisation programs in 2020 and 2021 has resulted in a small decrease in the proportion completing the two-dose HPV vaccination schedule within this period. The administration of a single dose of HPV vaccine rather than a two-dose administration since February 2023 could have predisposed to a rise in complete vaccination rates.15
From 2022, the coverage rate was reported for adolescents receiving at least one dose of HPV vaccine, before 15th birthday, whereas in previous reports in 2021&2020, coverage rates were reported for dose 1 and course completion. Course completion was defined as receipt of 2 doses if dose 2 given ≥5 months after dose 1 or receipt of 3 doses if dose 2 given <5 months after dose 1.
Up to 2017, reports of national 3 dose vaccination coverage were archived.17-18 The data indicate that from 2007 to 2013, 3-dose coverage ranged between 72% and 74%. Since 2013, uptake of all three doses (or dose completion) increased in 2014 (to 75%), in 2015 (to 79%), in 2016 (to 80%), and in 2017 (to 80%). For males aged 15 years, trend data for 3-dose vaccine (i.e., dose completion) are available from 2013, and for each individual dose number from 2014. Course-completion coverage increased from 62% in 2014 to 78% in 2020, and with annual increases of similar gradient observed for each individual dose from 2014 to 2016.17-18
About the data
Up to 2017, reports on national 3 dose vaccination coverage were archived.17-18 In 2022, HPV vaccination coverage by 15 years of age was calculated using the cohort method. In the cohorts of Medicare-registered adolescents turning 15 years of age during 2022 or 2021 (i.e., cohorts born in 2007 or 2006, respectively), the proportion who had received at least one dose of HPV vaccine after their 9th birthday (as HPV vaccine is registered from 9 years of age) and before their 15th birthday was calculated.15
In the 2020 and 2021 reports,19-20 HPV vaccination coverage was calculated in 2020 and 2019 as the proportion of girls and boys receiving dose 1 and having course completion defined as receipt of 2 doses (if dose 2 given ≥5 months after dose 1) or receipt of 3 doses (if dose 2 given <5 months after dose 1).
During 2007-17, vaccination coverage was calculated as doses administered and reported to the HPV Register for the Estimated Resident Population (ERP) (note: expressed as a percentage)provided by the Australian Bureau of Statistics (ABS) for the year. Both numerator and denominator data were regularly updated using latest Registry data and ABS estimates. Age is specified as age at date of ERP estimate (30th June) for the specified year.17-18
Data caveat
The 2020 NCIRS Annual Immunisation Report noted the impact on immunisation activity of the COVID-19 pandemic, particularly on adolescent HPV vaccination. This context should be considered when reviewing the 2020 data.
As the HPV coverage rates were reported differently due to changes in the HPV vaccination program, caution should be taken when interpreting corresponding statistical changes.
In 2007-2017, HPV Vaccination doses administered through general practice and in other community settings may be incompletely notified to the HPV Register. The extent of under notification is thought to differ by jurisdiction, with the Northern Territory and Queensland having the most complete notification.17-19
Data source:
Australia Government. Department of Health and Aged Care. 2012 – 2017 Archived HPV Immunisation Data. Available at https://www.health.gov.au/resources/collections/historical-data-from-the-national-hpv-vaccination-program-register
Australia Government. Department of Health and Aged Care. National HPV 3 dose vaccination coverage for all adolescents turning 15 years of age from year of program commencement. 2007-2017. Available at https://www.health.gov.au/resources/publications/national-hpv-3-dose-vaccination-coverage-for-all-adolescents-turning-15-years-of-age-from-year-of-program-commencement?language=en
National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports. 2020 onwards. Available at https://ncirs.org.au/reports?field_archive_value=2018&field_publication_category_target_id=48&combine=
Australian Government. Department of Health and Aged Care. Human Papillomavirus (HPV) immunisation data. 2020 onwards. Available at https://www.health.gov.au/topics/immunisation/immunisation-data/human-papillomavirus-hpv-immunisation-data
References
Data:
Australia Government. Department of Health and Aged Care. 2012 – 2017 Archived HPV Immunisation Data. Available at https://www.health.gov.au/resources/collections/historical-data-from-the-national-hpv-vaccination-program-register
Australia Government. Department of Health and Aged Care. National HPV 3 dose vaccination coverage for all adolescents turning 15 years of age from year of program commencement. 2007-2017. Available at https://www.health.gov.au/resources/publications/national-hpv-3-dose-vaccination-coverage-for-all-adolescents-turning-15-years-of-age-from-year-of-program-commencement?language=en
National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports. 2020 onwards. Available at https://ncirs.org.au/reports?field_archive_value=2018&field_publication_category_target_id=48&combine=
Australian Government. Department of Health and Aged Care. Human Papillomavirus (HPV) immunisation data. 2020 onwards. Available at https://www.health.gov.au/topics/immunisation/immunisation-data/human-papillomavirus-hpv-immunisation-data
Policy:
Australian Government. Department of Health and Aged Care. National Strategy for the Elimination of Cervical Cancer in Australia. https://www.health.gov.au/sites/default/files/2023-11/national-strategy-for-the-elimination-of-cervical-cancer-in-australia.pdf
Australian Immunisation Handbook. Human papillomavirus (HPV). https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/human-papillomavirus-hpv
National Centre for Immunisation Research and Surveillance. HPV vaccines for Australians: https://www.ncirs.org.au/sites/default/files/2018-12/HPV%20Factsheet_2018%20Aug%20Update_final%20for%20web.pdf
References:
- de Martel C, Georges D, Bray F, et al. Global burden of cancer attributable to infections in 2018: a worldwide incidence analysis. Lancet Glob Health. 2020 Feb;8(2): e180-e190.
- Brotherton JM. How much cervical cancer in Australia is vaccine preventable? A meta-analysis. Vaccine. 2008 Jan 10;26(2):250-6.
- Hartwig, S., Syrjänen, S., Dominiak-Felden, G et al. Estimation of the epidemiological burden of human papillomavirus-related cancers and non-malignant diseases in men in Europe: a review. BMC Cancer 12, 30 (2012).
- Grulich AE, Jin F, Conway EL, et al. Cancers attributable to human papillomavirus infection. Sex Health. 2010;7(3):244-52. 10.1071/SH10020.
- Bruni L, Albero G, Rowley J, et al. Global and regional estimates of genital human papillomavirus prevalence among men: a systematic review and meta-analysis. Lancet Glob Health. 2023 Sep;11(9):e1345-e1362
- Kulasingam S, Connelly L, Conway E, et al. A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sex Health. 2007 Sep;4(3):165-75.
- Patel C, Brotherton JM, Pillsbury A, et al. The impact of 10 years of human papillomavirus (HPV) vaccination in Australia: what additional disease burden will a nonavalent vaccine prevent? Euro Surveill. 2018 Oct;23(41):1700737.
- WHO. Cervical Cancer Elimination Initiative. Accessed May 2024; https://www.who.int/initiatives/cervical-cancer-elimination-initiative#cms
- Australian Government. Department of Health and Aged Care. National Strategy for the Elimination of Cervical Cancer in Australia. Accessed May 2024; https://www.health.gov.au/sites/default/files/2023-11/national-strategy-for-the-elimination-of-cervical-cancer-in-australia.pdf
- Australian Immunisation Handbook. Human papillomavirus (HPV). Accessed May 2024; https://immunisationhandbook.health.gov.au/contents/vaccine-preventable-diseases/human-papillomavirus-hpv
- National Centre for Immunisation Research and Surveillance. HPV vaccines for Australians. Accessed May 2024; https://ncirs.org.au/sites/default/files/2023-02/HPV-Factsheet_February-2023.pdf
- Australian Government. Department of Health and Aged Care. HPV vaccine – Fact sheet outlining changes under the National Immunisation Program in 2023. Accessed May 2024; https://www.health.gov.au/resources/publications/hpv-vaccine-fact-sheet-outlining-changes-under-the-national-immunisation-program-in-2023?language=en
- National Centre for Immunisation Research and Surveillance. HPV vaccines for Australians. Accessed May 2024; https://www.ncirs.org.au/sites/default/files/2018-12/HPV%20Factsheet_2018%20Aug%20Update_final%20for%20web.pdf
- Australian Government. Department of Health and Aged Care. Human papillomavirus (HPV) immunisation data. Accessed May 2024; https://www.health.gov.au/topics/immunisation/immunisation-data/human-papillomavirus-hpv-immunisation-data
- National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports 2022. Accessed May 2024; https://ncirs.org.au/sites/default/files/2024-01/NCIRS%20Annual%20immunisation%20coverage%20report%202022.pdf
- Machalek D, Smith M, Brotherton J. et al. Cervical Cancer Elimination Progress Report: Australia’s progress towards the elimination of cervical cancer as a public health problem. HPV Vaccine Coverage by Age 15 Years. Accessed May 2024; https://report.cervicalcancercontrol.org.au/vaccine-coverage-indicators/
- Australia Government. Department of Health and Aged Care. National HPV 3 dose vaccination coverage for all adolescents turning 15 years of age from year of program commencement. Accessed May 2024; https://www.health.gov.au/resources/publications/national-hpv-3-dose-vaccination-coverage-for-all-adolescents-turning-15-years-of-age-from-year-of-program-commencement?language=en
- Australia Government. Department of Health and Aged Care. 2012 – 2017 Archived HPV Immunisation Data; Accessed May 2024; https://www.health.gov.au/resources/collections/historical-data-from-the-national-hpv-vaccination-program-register
- National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports 2021. Accessed May 2024; https://ncirs.org.au/sites/default/files/2022-12/NCIRS%20Annual%20Immunisation%20Coverage%20Report%202021_FINAL.pdf
- National Centre for Immunisation Research and Surveillance Australia. Annual Immunisation Coverage Reports 2020. Accessed May 2024; https://ncirs.org.au/sites/default/files/2022-07/NCIRS%20Annual%20Immunisation%20Coverage%20Report%202020.pdf