Opportunities and challenges for human papillomavirus vaccination in cancer

Key Points Cervical cancer is potentially a completely preventable disease The licensed vaccines are safe and highly effective against the most common human papillomavirus (HPV) types found in cervical and other anogenital cancers and are likely to prevent HPV + oropharyngeal cancers Implementation of HPV vaccination is lagging where it is most needed: in the poorest and most at-risk communities that lack screening programmes and have the highest rates of HIV Local production of biosimilar HPV vaccines is progressing, especially in China, but acceptance of virological end points and/or immunological non-inferiority by regulators could speed access The current HPV vaccines do not cover all oncogenic types, and efforts are underway to increase the breadth of protection, including targeting of L2 HPV vaccination affects the cost and benefits of screening by reducing the prevalence of high-grade intraepithelial neoplasia associated with vaccine-targeted types Effective communication to policymakers, physicians, patients and their families of the safety and benefits of HPV vaccination is critical to promote global implementation and fully realize the potential for prevention of cervical and other HPV-related cancers In current populations with a high prevalence of HPV, the application of mathematical modelling is critical to optimize cervical cancer prevention and to balance the use of limited public resources for both HPV vaccination and screening programmes To efficiently prevent cancers associated with human papillomavirus (HPV) infection, especially cervical cancer, effective vaccines and high vaccination coverage are required. This Review provides insight into virological, immunological and strategical progress in HPV vaccines as well as implementation and potential advances. The discovery of genotype 16 as the prototype oncogenic human papillomavirus (HPV) initiated a quarter century of laboratory and epidemiological studies that demonstrated their necessary, but not sufficient, aetiological role in cervical and several other anogenital and oropharyngeal cancers. Early virus-induced immune deviation can lead to persistent subclinical infection that brings the risk of progression to cancer. Effective secondary prevention of cervical cancer through cytological and/or HPV screening depends on regular and widespread use in the general population, but coverage is inadequate in low-resource settings. The discovery that the major capsid antigen L1 could self-ass