Gender-neutral human papillomavirus vaccination: an equitable and cost-effective public health investment

Human papillomavirus (HPV) drives a substantial cancer burden across all genders. This perspective argues that gender-neutral HPV vaccination is an equitable and cost-effective public health investment when designed for scale. Rather than presenting methods in detail, we synthesize recent epidemiology, policy positions, and economic evaluations to propose a simplicity-first pathway-a pragmatic model that, where permitted, prioritizes single-dose schedules, school-based delivery for adolescents aged 9-14, small, computable set of key performance indicators (KPIs) set (coverage, timeliness, series completion, and equity gaps), routine adverse events following immunization (AEFI) monitoring, and phased expansion as system capacity grows. The simplicity-first pathway advances global equity by protecting boys and girls alike, reducing stigma, and delivering both direct and indirect benefits to underserved groups, including sexual minority populations. In resource-constrained settings, single-dose policies (where adopted), integration with existing school-based platforms, and pooled multi-year procurement can reduce delivery complexity and improve value for money. Cost-effectiveness remains context-specific and is sensitive to vaccine price, achievable coverage, and which outcomes are included in the analysis. Policy implications: Countries should strongly consider gender-neutral vaccination as the default program design to accelerate population-level protection and close avoidable equity gaps, while adapting schedules and financing to national regulations, fiscal space, and information-system readiness. This simplicity-first framing offers a practical bridge between policy intent and sustainable routine implementation.