HPV vaccination trends from 2016 to 2025: Progress and missed opportunities

Human papillomavirus (HPV) is one of the most common sexually transmitted infections in the United States. Almost all sexually active individuals are exposed to HPV at some point in their lifetime. Although most infections are asymptomatic and self-limited, persistent infection with high-risk HPV types can lead to cervical cancer and other malignancies, including anal, oropharyngeal, vulvar, vaginal and penile cancers.¹ Approximately 13,000 women are diagnosed with cervical cancer each year in the U.S., and nearly all of these cases are attributable to persistent HPV infection.^2,3

Many HPV-related cancers are preventable through timely vaccination. Yet national coverage rates remain below public health targets, leaving preventable cancer risk on the table. March 4th marks International HPV Awareness Day, a global initiative dedicated to raising awareness about HPV and promoting vaccination, screening, and education to prevent HPV-related cancers.

The role of Gardasil®, the first HPV vaccine

Gardasil® was approved in 2006 for use in adolescent females to prevent cervical cancer. Today, HPV vaccination is recommended for both girls and boys beginning at age 9, with routine vaccination ideally at ages 11–12 and catch-up vaccination recommended through age 26.⁴ As vaccination programs have matured, national guidelines have increasingly emphasized vaccination at younger ages to maximize pre-exposure protection.⁵ Gardasil is currently the only active HPV vaccine in the U.S.

Studies have demonstrated substantial reductions in HPV infection and precancerous cervical lesions, as well as a significant decline in cervical cancer incidence among young U.S. women following the introduction of HPV vaccine.^6,7

HPV vaccine initiation trends shifting towards younger patients

Using longitudinal closed medical and pharmacy claims data, we evaluated real-world trends in HPV vaccine initiation and completion from 2016 through 2025 among patients aged 9–26. Figure 1 shows the age distribution of new HPV vaccine initiators over time.

Since 2016, the proportion of initiators in the recommended 11–12 age group has increased substantially from approximately 32% of initiators in 2016 to nearly 49% in 2025. At the same time, initiation among older adolescents and young adults has declined as a share of total initiators. This shift reflects alignment with clinical guidance emphasizing vaccination at ages 11–12 and suggests improving uptake at the recommended age window.

Figure 1: Percentage of HPV vaccine initiators by age group (2016–2025).

Gender gaps narrowing in HPV vaccination

HPV vaccination was initially recommended only for females and later expanded to include males in 2011. In our closed claims population, initiation patterns between males and females have been broadly similar since 2016.

Figure 2 shows that females consistently account for a slight majority of initiators (approximately 51%), with males comprising about 49%. These proportions have remained relatively stable over time since 2016.

Figure 2: Percentage of HPV Vaccine Initiators by Gender and Year (2016–2025).

Across most age groups, the difference between male and female initiators is modest, typically within 1–2 percentage points. However, among patients aged ≥17 years, females represent a somewhat higher share of initiators relative to younger age groups. This pattern may reflect historical female-focused recommendations, as well as more frequent preventative reproductive health visits among adolescent girls and young women.

Figure 3: Percentage of HPV Vaccine Initiators by Gender Among Patients Aged ≥17 Years.

Overall, these trends suggest that HPV vaccine initiation is largely comparable between males and females in recent years, although modest differences remain.

HPV vaccination coverage remains a public health challenge

Healthy People 2030, led by the U.S. Department of Health and Human Services, sets measurable national objectives to improve population health and reduce disparities. One objective is to increase the percentage of adolescents aged 13–15 who received the recommended doses of the HPV to 80% by 2030, from a baseline of 48.0% in 2018.⁸

CDC guidelines⁹ recommend:

• A two-dose series for individuals initiating vaccination at ages 9–14
  
• A three-dose series for those initiating at age 15 or older

To evaluate HPV vaccination coverage, we examined adolescents aged 13–15 in 2024 with continuous medical and pharmacy insurance enrollment from the year they turned age 9 through the end of 2024 (Figure 4). Continuous enrollment was required to ensure comprehensive capture of vaccination history. These estimates reflect a population with a mix of commercial and Medicaid coverage.

Overall:

• 65% initiated the HPV vaccine series
  
• 47% completed the recommended series, according to CDC guidelines
  

Figure 4 presents initiation and completion rates by race and ethnicity.

Among racial groups:

• Asian adolescents had the highest initiation (72%) and completion (54%) rates
• Black adolescents and those categorized as “Other” race demonstrated higher coverage, with initiation and completion rates of 70% and 47%, and 69% and 51%, respectively
• White adolescents had the lowest initiation (63%) and completion (45%) rates
  

By ethnicity:

• Hispanic adolescents showed higher initiation (75%) and completion (55%) rates
• Non-Hispanic adolescents had lower initiation (62%) and completion (44%) rates
  

These patterns are broadly consistent with findings from CDC’s National Immunization Survey–Teen (NIS-Teen), which has reported higher HPV vaccination coverage among Hispanic adolescents and some non-White racial groups compared to non-Hispanic White adolescents.¹⁰ Reasons for these differences are likely multifactorial, and may reflect differences in insurance payer type, access to vaccination programs, and provider recommendation patterns.

HPV series completion remains lower than initiation rates across all groups, underscoring the need for public health programs and provider efforts to ensure adolescents receive all recommended doses of the vaccine.

Figure 4: HPV Vaccination Initiation and Completion Among Adolescents Aged 13–15 by Race and Ethnicity, 2024.

Vaccine coverage measurement considerations for public health

Claims data may not capture vaccinations administered outside billable medical or pharmacy settings. Continuous enrollment criteria improve comprehensive vaccination capture but may bias the cohort toward individuals with stable insurance coverage. Despite these limitations, longitudinal claims data provide detailed insight into vaccination timing and adherence patterns at scale.

Translating real-world data insights into impact

While initiation trends show encouraging movement toward vaccination at recommended ages and gender gaps appear to be narrowing, completion rates remain below national targets. HPV vaccination coverage remains lower than coverage for other routine adolescent vaccines, such as Tdap and MenACWY.¹⁰ On International HPV Awareness Day and beyond, promoting timely vaccination remains critical to preventing HPV-related cancers.

The value of real-world evidence in HPV vaccination

Understanding vaccine initiation and completion patterns requires more than cross-sectional survey data. Longitudinal claims data enable precise measurement of vaccination timing and verification of series completion. These findings highlight how real-world data can support ongoing monitoring of vaccine coverage, identify gaps, and inform evidence-based public health strategies to advance cancer prevention.

References

1. National Cancer Institute. HPV and cancer. https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-and-cancer
2. Centers for Disease Control and Prevention. Cervical cancer statistics. https://www.cdc.gov/cervical-cancer/statistics/index.html
3. World Health Organization. Cervical cancer. https://www.who.int/news-room/fact-sheets/detail/cervical-cancer
4. Markowitz LE, Gee J, Chesson H, Stokley S. Ten Years of Human Papillomavirus Vaccination in the United States. Acad Pediatr. 2018. https://pmc.ncbi.nlm.nih.gov/articles/PMC11331487/
5. Saxena K, Kathe N, Sardana P, Yao L, Chen YT, Brewer NT. HPV vaccine initiation at 9 or 10 years of age and better series completion by age 13 among privately and publicly insured children in the US. Hum Vaccin Immunother. 2023 Dec 31. https://pmc.ncbi.nlm.nih.gov/articles/PMC9980633/
6. Centers for Disease Control and Prevention. HPV vaccine safety and effectiveness data. https://www.cdc.gov/hpv/hcp/vaccination-considerations/safety-and-effectiveness-data.html
7. American Cancer Society. Declines in cervical cancer following HPV vaccine introduction. https://pressroom.cancer.org/declines-in-cervical-cancer-hpv-vaccine.
8. Office of Disease Prevention and Health Promotion. Increase the proportion of adolescents who get recommended doses of the HPV vaccine (IID-08). https://odphp.health.gov/healthypeople/objectives-and-data/browse-objectives/vaccination/increase-proportion-adolescents-who-get-recommended-doses-hpv-vaccine-iid-08
9. Centers for Disease Control and Prevention. HPV vaccination recommendations. https://www.cdc.gov/hpv/hcp/vaccination-considerations/index.html
10. Pingali C. HPV vaccination coverage among adolescents (NIS-Teen) [ACIP presentation]. https://www.cdc.gov/acip/downloads/slides-2025-04-15-16/04-Pingali-HPV-508.pdf