Expansion of HPV vaccination catch-up up to 26 in France: Is it relevant and feasible?

Abstract Background France has recommended HPV vaccination since 2007. The current strategy targets adolescents aged 11-14, with a catch-up program up to 19 years. In 2023, a nationwide school-based campaign was launched to improve HPV vaccination coverage (VC) among 11-year-olds. Despite these recommendations, VC remained below 30% for many years, leaving 3.6 million individuals aged 20-26 unprotected and at risk in 2025. Expanding catch-up vaccination to this cohort offers a key opportunity to close the immunization gap for the generation born in the early 2000s. Methods The French National Authority for Health (HAS) conducted a comprehensive assessment of HPV infection dynamics, the immunogenicity and efficacy of the nonavalent vaccine in individuals aged 20-26, and real-world effectiveness data in adults in countries with multi-cohort strategies. A bias assessment using the ROBINS-I tool was performed. The evaluation also included HPV VC in France and the cost-effectiveness of catch-up programs. Results Evidence shows that HPV prevalence peaks at 24 years, while 75% of individuals under 25 do not present active HPV infection, highlighting a critical window for catch-up vaccination. Clinical data demonstrate sustained immune protection against high-grade precancerous lesions in individuals aged 16-26, with efficacy estimates ranging from 50% to 100%. Although some bias was identified, real-world studies support these findings, suggesting that vaccination after age 20 remains beneficial. The vaccine presents a favorable safety profile. By the end of 2023, HPV VC (one dose at 15 years) was 54.6 % in girls and 25.9% in boys. International cost-effectiveness analyses further advocate for extending catch-up vaccination up to 26. Conclusions Expanding HPV catch-up vaccination to all adults up to 26 years is a relevant and feasible public health strategy. It complements school-based initiatives and offers a second opportunity for millions who missed early vaccination. Key messages • Extending HPV catch-up vaccination to adults aged 20–26 in France offers a second chance to protect a missed generation still at risk of HPV-related disease. • This strategy complements school-based programs and is supported by clinical, real-world, and cost-effectiveness evidence.