Human Papillomavirus (HPV) Vaccination Among Adolescent Girls: A Narrative Review of Global Coverage, Determinants, and Strategies for Improvement

Abstract

Cervical cancer remains one of the most preventable yet persistently fatal cancers affecting women worldwide, largely because persistent infection with High-Risk Human Papillomavirus (HPV) genotypes is now recognized as a necessary precursor in nearly all cases. Vaccinating adolescent girls against HPV before sexual debut is the most effective form of primary prevention available and forms the first pillar of the World Health Organization's (WHO) 90–70–90 strategy for eliminating cervical cancer as a public health problem. Objective: This narrative review synthesizes current global and regional evidence on HPV vaccine uptake among adolescent girls, examines the individual, sociocultural, and health-system determinants of uptake, and outlines evidence-supported strategies for narrowing persistent coverage gaps. Design: This is not a systematic review, meta-analysis, or empirical primary-data study; no new field or clinical data were collected, and no meta-analytic statistical pooling was performed. Methods: Peer-reviewed literature (PubMed and related biomedical databases), national immunization survey data (notably the U.S. National Immunization Survey-Teen), and technical reports from WHO, UNICEF, Gavi, the Pan American Health Organization, and national public health agencies, published through February 2026, were reviewed narratively. Eligible sources addressed HPV vaccine uptake, program delivery, or coverage among adolescent girls aged 9–14 years (or national schedules targeting this age band); sources confined to adult cervical screening or treatment, or to therapeutic (non-preventive) HPV vaccines, were excluded. Results: Global first-dose coverage among 15-year-old girls rose from roughly 16% (2020) to 21% (2024), with the WHO African Region improving from 17% to 28% over the same interval. A wide introduction gap persists, with 98% of high-income countries but only 46% of low-income countries having added the vaccine to national programs. In the United States, on-time initiation before age 13 nearly doubled across birth cohorts, from about 37% (1999) to 73% (2009), though full series completion lags well behind. India's launch of a nationwide free single-dose campaign for 14-year-old girls on 28 February 2026, targeting approximately 11.5 million girls annually, marks a major recent development given the country's share of roughly one-quarter of global cervical cancer deaths. Principal barriers include limited caregiver and provider knowledge, safety misconceptions, sociocultural discomfort, missed clinical opportunities, cost and access constraints, and vaccine supply shortages. Conclusion: Meaningful progress toward global elimination targets is achievable through school-based delivery, single-dose schedules, stronger provider recommendation practices, and sustained community engagement, but reaching the 2030 targets will require continued political commitment and financing.