Is It Time to Reassess the Target Age of Human Papillomavirus (HPV) Vaccination Globally?

In 2022, 464,000 people died from HPV-related cancer. Despite the availability of safe and highly effective HPV vaccinations, global coverage is just 20% for girls and 7% for boys. We summarise the evidence for target vaccination age and find that vaccinating at age 9-10 years, the youngest end of WHO's recommended age range, has multiple advantages. Earlier vaccination increases the likelihood of vaccinating prior to HPV exposure; may reduce the impact of sex-associated stigma; and is logistically advantageous through enabling primary-school immunisation and program resilience. Furthermore, we systematically review published immunogenicity data of children aged 9 to 15 years and identify that vaccination at age 9 is immunologically robust. Globally, most countries target ages 11 years or older for HPV vaccination. Our findings indicate an urgent need to target earlier ages to help achieve the WHO goal to vaccinate 90% of girls against HPV by age 15.