Where Girls Were Vaccinated Young, Cervical Cancer Is Falling Steeply

In countries that started vaccinating girls against HPV more than a decade ago, cervical cancer is now falling fastest in the generations who were vaccinated youngest. In England, rates were 87% lower in women offered the vaccine at 12 or 13 than in earlier, unvaccinated cohorts. In Scotland, no invasive cervical cancer had been recorded in women vaccinated at that age. Worldwide, though, first-dose coverage among girls was only about one in three in 2025, and the countries with the highest rates are largely those where screening reaches the fewest women.

Behind these figures are women who may be raising children, working and caring for others when they are diagnosed, and families who share what follows. The toll is concentrated in places where screening and treatment are hardest to reach. Unusually among cancers, almost all cases trace back to one infection that a vaccine can prevent, and to precancerous changes that screening can find. That is why the World Health Organization treats it as a cancer that can be eliminated as a public health problem. This piece sets out what the population evidence now shows and where the gaps lie.

Almost all cervical cancer is linked to one preventable infection

The World Health Organization estimates that persistent infection with human papillomavirus (HPV) is behind about 95% of cervical cancers, and that two types, HPV 16 and 18, cause around 76% of them^[4]. HPV is common and in most cases the immune system clears it; cancer develops only when a high-risk type persists and precancerous changes go undetected and untreated, usually over many years^[4]. That long, visible pathway is what makes the disease unusually open to prevention, and it is why our overview of how much cancer is linked to modifiable risk factors counts HPV among the largest infection-related causes of cancer worldwide.

The most detailed global baseline, produced for the WHO elimination initiative from GLOBOCAN data, estimated 604,127 new cases of cervical cancer and 341,831 deaths worldwide in 2020. The world age-standardised incidence rate was 13.3 cases per 100,000 women-years, and the mortality rate 7.2 per 100,000^[3]. WHO's current fact sheet gives around 604,000 new cases and around 280,000 deaths for 2024^[4]. The two sets of figures come from different estimation rounds and methods and are not comparable; in particular, the lower death figure for 2024 does not show that deaths have fallen.

The averages hide very large differences. Estimated incidence ranged from 2.2 per 100,000 in Iraq to 84.6 in Eswatini, and mortality from 1.0 per 100,000 in Switzerland to 55.7 in Eswatini. Incidence was three times higher, and mortality six times higher, in countries with a low Human Development Index than in those with a very high one^[3]. WHO also estimates that women living with HIV are six times more likely to develop cervical cancer than women without HIV, and that about 5% of all cases are attributable to HIV^[4], which helps explain why rates are highest in parts of eastern and southern Africa. The wider picture is in our piece on the global cancer gap.

Where girls were vaccinated young, cervical cancer has fallen steeply

Because cervical cancer takes years to develop, evidence on cancer itself, rather than precancer, has only recently arrived, from countries whose national registers link vaccination records to diagnoses.

England. England's programme offered the bivalent vaccine routinely to girls aged 12-13, with catch-up for older teenagers. A register-based study of women aged 20-64, with diagnoses from January 2006 to June 2019, compared vaccinated birth cohorts with earlier, unvaccinated ones. Cervical cancer rates were an estimated 87% lower in women offered the vaccine at 12-13, 62% lower in those offered it at 14-16 and 34% lower at 16-18. Rates of grade 3 cervical intraepithelial neoplasia (CIN3, a precancerous change) were 97%, 75% and 39% lower. By mid-2019 the authors estimated 448 fewer cervical cancers and 17,235 fewer cases of CIN3 than expected in the vaccinated cohorts^[1].

A 2026 analysis of national mortality data has now taken the evidence from diagnoses to deaths. Among women aged 20-24 in England in 2020-24, a cohort with vaccine coverage of around 88-90% at age 12-13, no cervical cancer deaths occurred, against 23.1 expected from historical rates. For women aged 25-29 in the same period, deaths were 69% lower than expected. The authors estimate that vaccination was associated with around 200 fewer cervical cancer deaths in England up to 2024^[5].

Scotland. A Scottish study of the bivalent vaccine followed women born between January 1988 and June 1996. No cases of invasive cervical cancer were recorded in women immunised at 12 or 13, whatever the number of doses they had. Among women vaccinated at 14-22, those who had three doses had an incidence of 3.2 per 100,000 compared with 8.4 per 100,000 in unvaccinated women. The authors concluded that even one or two doses conferred benefit when given at 12-13^[2].

Sweden. A Swedish study followed 1,672,983 girls and women aged 10-30 who had or had not received the quadrivalent vaccine. Cervical cancer was diagnosed in 19 vaccinated and 538 unvaccinated women. After adjustment, the incidence rate ratio was 0.12 for those vaccinated before 17, an 88% lower rate, and 0.47 for those vaccinated at 17-30^[6].

Three countries, two vaccines and different study designs point the same way: the earlier the vaccine is given, before most people are exposed to HPV, the larger the fall. All three are observational studies, not trials.

The benefit reaches the most deprived areas, where rates were highest

One question when vaccination began was whether it would widen health inequalities. The evidence so far is more encouraging than that, with caveats.

An update of the England study, extending diagnoses to June 2020, estimated that cervical cancer incidence was 83.9% lower in the cohort offered routine vaccination at 12-13 than in the unvaccinated reference cohort, and CIN3 94.3% lower, with an estimated 687 cervical cancers and 23,192 cases of CIN3 prevented^[7]. By area deprivation, the programme had a large effect at all five levels, and the steep gradient in cervical cancer incidence from the most to the least deprived areas seen in unvaccinated women was no longer present among those offered the vaccine. Two caveats remain: across all women the highest rates were still in the most deprived areas, and in the catch-up cohorts the falls in CIN3 were somewhat smaller in the most deprived areas than in the least deprived, 29.6% against 40.6% for women offered the vaccine at 16-18 and 67.7% against 72.8% at 14-16^[7].

The Scottish data point the same way on protection, and further on who gains most. Before adjustment, incidence was 10.1 per 100,000 in women from the most deprived areas against 3.9 in the least deprived. Among women from the most deprived areas, three doses were associated with a significant reduction in incidence, and the authors conclude that women from more deprived areas benefit more from vaccination than those from less deprived areas^[2]. The remaining question is whether the vaccine, and screening, reach them.

One girl in three worldwide had a first dose in 2025, and coverage in some high-income countries has fallen or stalled

Global coverage is rising from a low base. WHO estimates that 33% of girls worldwide received a first dose of HPV vaccine in 2025, up from 17% in 2019. The vaccine was provided through national programmes in 162 countries in 2025, including 15 that introduced it that year. By the end of 2025, 93 countries were using a one-dose schedule, and more than 85% of girls aged 9-14 vaccinated that year received a single-dose schedule^[8].

A first dose is not the same as the elimination target of 90% of girls fully vaccinated by 15, and introduction is not the same as coverage: a national programme can exist on paper while reaching a minority of girls. WHO publishes country-by-country coverage estimates each year; this piece uses the global figure and the detailed national statistics published for England and the United States.

Coverage is not only a problem for countries that have just started. In England, coverage of the now single-dose vaccine among girls in school Year 8 was 71.7% in 2024-25, down from 72.9% the year before and well below the 88.0% recorded before the pandemic in 2018-19. Among boys, who have been offered the vaccine since 2019-20, it was 67.0%. By Year 10, 75.5% of girls and 70.5% of boys had been vaccinated. Behind the national figure, Year 8 coverage among girls ranged from 39.8% in Bradford to 89.8% in the East Riding of Yorkshire^[9]. In the United States, 78.2% of adolescents aged 13-17 had received at least one dose in 2024 and 62.9% were up to date with the series^[10]; the 2025 survey reported that HPV coverage had not increased for the fourth year in a row^[11].

Coverage measures differ between countries (dose, age, sex and survey method), so the rows are not directly comparable with each other.

Elimination needs vaccination, screening and treatment together

In November 2020 WHO published its global strategy to accelerate the elimination of cervical cancer as a public health problem, defined as incidence below a threshold of 4 new cases per 100,000 women-years. It sets three targets for countries to reach by 2030, known as 90-70-90^[12]:

• 90% of girls fully vaccinated with HPV vaccine by age 15;
• 70% of women screened with a high-performance test by age 35 and again by 45;
• 90% of women identified with cervical disease receiving treatment.

WHO's modelling for low- and lower-middle-income countries projected that meeting these targets would cut median cervical cancer incidence by 42% by 2045 and 97% by 2120, avert more than 74 million new cases, and avert 300,000 deaths by 2030, more than 14 million by 2070 and more than 62 million by 2120^[12]. These are model projections made in 2020, and they depend on the targets actually being met and sustained.

Vaccination alone cannot get there in time, because it protects future generations while today's adult women were mostly never offered it. That makes screening and treatment the route to fewer deaths in the coming decades, and screening is where the global gap is starkest. An analysis of 202 countries and territories estimated that in 2019 only 36% of women aged 30-49 worldwide had ever been screened for cervical cancer, and 32% in the previous five years. In high-income countries 84% had ever been screened; in low-income countries, 11%^[13]. Screening participation and who misses out are covered in more depth in our piece on cancer screening uptake.

Where all three elements are strong, elimination looks reachable within a generation. A 2019 modelling study for Australia (Policy1-Cervix) projected that age-standardised incidence would fall below 6 per 100,000 women by 2020 and below 4 per 100,000 by 2028 (range 2021-35), with the exact year depending on the standard population used and on future screening behaviour^[14]. That projection is for one well-resourced country; the highest-incidence countries in the chart above would need a large expansion of vaccination, screening and treatment to follow it.

What the evidence asks of us

The real-world evidence has answered the question of whether HPV vaccination programmes reduce cervical cancer at population level: in England, Scotland and Sweden they have, and in England the fall now shows in deaths as well as diagnoses^[1][5]. The open questions are about reach. The figures point to five things for governments, health services and funders:

• Close the coverage gap to the 90% target. With global first-dose coverage at 33% in 2025^[8], WHO's 2030 target of 90% of girls fully vaccinated by 15^[12] requires sustained funding and supply, above all in the countries with the highest incidence.
• Recover lost ground where coverage has fallen. Year 8 coverage among girls in England is about 16 percentage points below its pre-pandemic level, with a 50-point gap between local authorities^[9]. Catch-up offers and investment in school immunisation teams in the lowest-coverage areas are what these figures call for.
• Do not let vaccination replace screening and treatment. Most women alive today were never offered the vaccine. WHO's strategy depends on screening 70% of women with a high-performance test and treating 90% of those with disease^[12], yet in 2019 only 11% of women aged 30-49 in low-income countries had ever been screened^[13].
• Integrate cervical cancer prevention with HIV care. Given WHO's estimate that women living with HIV are six times more likely to develop cervical cancer^[4], services for women living with HIV are a natural place to offer screening and treatment.
• Measure equity, not just averages. The England and Scotland studies could show who was benefiting because their registers can be broken down by deprivation^[2][7]. Countries without linked, population-based cancer and vaccination registers cannot yet see whether progress is reaching everyone; building that data is part of the job.

Charities working with women affected by gynaecological cancers can use this evidence to press for all three pillars, not only the vaccine. Our article on ovarian, womb and other gynaecological cancers covers the cancers that HPV vaccination does not prevent, and the full cancer research library brings the evidence together.

Language: this piece says "people with cancer" and "people living with and after cancer", and describes the illness and its treatment plainly, without combat metaphors. Clinical terms such as "stage", "incidence" and "net survival" are used in the sense the cited source defines them.

Why we're publishing this

Cervical cancer is one of the clearest cases in cancer where the gap between what is possible and what happens is a matter of services, not science. The women most affected are those living where vaccination, screening and treatment have not yet arrived, or where they have quietly fallen away. Charities, support groups and hospices working with women affected by cervical cancer, and with their families, deserve evidence they can cite with confidence when they ask governments and health services to close those gaps. The case here is theirs; our part is to set the figures out plainly and source every one.

How to read this data

The vaccine-impact studies from England, Scotland and Sweden are observational: they compare birth cohorts or vaccinated and unvaccinated women using national registers, not randomised groups. The authors use statistical models to account for other differences between groups and over time as far as their data allow, but some residual difference between groups is possible. Their results apply to those countries, those vaccines and those schedules, and to women still in their twenties and early thirties; the long-term effect at older ages is not yet observed. The percentage reductions are relative: a large relative fall in a cancer that is already uncommon at young ages translates into smaller absolute numbers, which is why the counts of cancers and deaths averted are also given.

Global incidence and mortality figures are estimates. Many countries, including several with the highest rates, have limited registry coverage, so their figures are modelled. The 2020 baseline and WHO's 2024 figures come from different estimation rounds and are not a trend. Vaccine coverage measures differ by dose, age and method from country to country. WHO's elimination projections and the Australian timeline are models, made in 2020 and 2019, whose results depend on their assumptions being met.

Use this data

Free to cite with attribution to Better Health For Everyone. Charities, campaigners and journalists are welcome to reuse these figures and charts. For the underlying figures as a spreadsheet, get in touch.

Important: This article summarises published research for general information. It is not medical advice and cannot be used to diagnose, treat or predict anything about an individual. If you have concerns about your own or someone else's health, please speak to a qualified health professional.

Sources

1. Falcaro M, Castañon A, Ndlela B, Checchi M, Soldan K, Lopez-Bernal J, Elliss-Brookes L, Sasieni P. The effects of the national HPV vaccination programme in England, UK, on cervical cancer and grade 3 cervical intraepithelial neoplasia incidence: a register-based observational study. The Lancet, 2021. europepmc.org/article/MED/34741816
2. Palmer TJ, Kavanagh K, Cuschieri K, Cameron R, Graham C, Wilson A, Roy K. Invasive cervical cancer incidence following bivalent human papillomavirus vaccination: a population-based observational study of age at immunization, dose, and deprivation. Journal of the National Cancer Institute, 2024. europepmc.org/article/MED/38247547
3. Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cervical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Initiative. The Lancet Global Health, 2023. europepmc.org/article/MED/36528031
4. World Health Organization. Cervical cancer (fact sheet). WHO, 2026. who.int/news-room/fact-sheets/detail/cervical-cancer
5. Sasieni P, Falcaro M. Cervical cancer mortality trends following HPV vaccination in England, 2001-24: an analysis of population-based mortality data. The Lancet, 2026. europepmc.org/article/MED/42309117
6. Lei J, Ploner A, Elfström KM, et al. HPV vaccination and the risk of invasive cervical cancer. New England Journal of Medicine, 2020. europepmc.org/article/MED/32997908
7. Falcaro M, Soldan K, Ndlela B, Sasieni P. Effect of the HPV vaccination programme on incidence of cervical cancer and grade 3 cervical intraepithelial neoplasia by socioeconomic deprivation in England. BMJ, 2024. europepmc.org/article/PMC/PMC11094700
8. World Health Organization. Immunization coverage (fact sheet). WHO, 2026. who.int/news-room/fact-sheets/detail/immunization-coverage
9. UK Health Security Agency. Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2024 to 2025. GOV.UK, 2026. gov.uk/government/statistics/human-papillomavirus-hpv-vaccine-coverage-in-england-2024-to-2025
10. Pingali C, Yankey D, Elam-Evans LD, et al. Vaccination coverage among adolescents aged 13-17 years: National Immunization Survey-Teen, United States, 2024. MMWR Morbidity and Mortality Weekly Report, 2025. europepmc.org/article/MED/40811113
11. Pingali C, Yankey D, Elam-Evans LD, et al. Vaccination coverage among adolescents aged 13-17 years: National Immunization Survey-Teen, United States, 2025. MMWR Morbidity and Mortality Weekly Report, 2026. europepmc.org/article/MED/42691006
12. World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. WHO, 2020. who.int/publications/i/item/9789240014107
13. Bruni L, Serrano B, Roura E, et al. Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis. The Lancet Global Health, 2022. europepmc.org/article/MED/35839811
14. Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. The Lancet Public Health, 2019. europepmc.org/article/MED/30291040