Under the WHO’s cervical cancer elimination strategy, which aims to reduce incidence below four cases per 100 000 women, achieving 90% human papillomavirus (HPV) vaccination coverage among adolescent girls by age 15 by 2030 is essential.1 Nearly two decades after the first vaccines were introduced, evidence has progressed beyond demonstrating effectiveness against HPV-related diseases.2 3 The central question is therefore shifting from whether HPV vaccination works to how vaccination programmes can translate vaccine effectiveness into sustained population-level cancer prevention.
Our 18-year register-based study in The BMJ following more than 900 000 girls and women showed that quadrivalent vaccination before age 17 provided durable, unwaning protection, reducing the risk of invasive cervical cancer by 79% (adjusted incidence rate ratio (IRR)=0.21, 95% CI 0.13 to 0.32).4 Crucially, school-based cohorts achieved a 72% lower incidence of invasive cervical cancer compared with opportunistic delivery cohorts (IRR=0.28, 95% CI 0.09 to 0.89); by contrast, older catch-up and subsidised vaccination programmes demonstrated comparatively lower effectiveness.4 These findings highlight three principles with broad relevance for HPV vaccination programmes: vaccinate early, achieve high and equitable coverage and deliver vaccination through organised public health systems.
With approximately one-fifth of the global cervical cancer burden occurring in China, progress towards elimination in China is indispensable to achieving the global goal.5 A major milestone was reached in November 2025, when China formally integrated bivalent HPV vaccination for 13-year-old girls into its National Immunization Program (NIP) as a nationwide, publicly funded service.5 Supported by the collaborative efforts across government, research institutions and global health partners, this policy marked a fundamental shift from predominantly self-paid vaccination towards state-funded primary prevention, substantially reducing financial barriers and creating the conditions for more equitable population coverage.6 Nationwide implementation of HPV vaccination was prioritised and scaled up throughout 2026. Under the NIP, eligible girls receive free bivalent HPV vaccination, while older women and individuals seeking higher-valent or imported options continue to have access through self-paid channels.6 7 By combining expanding domestic manufacturing capacity with school-linked delivery infrastructure, China has established the foundations for a sustainable operational model through an organised, publicly funded adolescent vaccination programme, with schools supporting identification, mobilisation and delivery.
Clinical trials in China have demonstrated robust efficacy for domestically developed bivalent HPV vaccines, conferring high protection against HPV-16/18-associated high-grade cervical lesions and persistent infections.8 9 However, evaluating the real-world impact of China’s national policy relies on long-term population data beyond clinical trial settings, an area where nationwide registries from Sweden provide strong supporting evidence. Beyond our 18-year follow-up study, our broader population studies in Sweden demonstrate that simplified two-dose and single-dose schedules facilitate high uptake while providing comparable protection against high-grade cervical lesions, ultimately generating herd effects that indirectly protect unvaccinated females.10 11 The long-term impact of early adolescent vaccination is further evidenced by recent findings from England, which observed zero cervical cancer deaths among young women vaccinated at ages 12–13.3 Taken together, these empirical insights strongly support China’s strategy of targeting 13-year-old girls through a centralised school health network as the optimal implementation pathway.
These population-level findings strongly reinforce China’s transition towards state-funded primary prevention for cervical cancer. Delivering HPV vaccination at scale across a population of 1.4 billion represents a major step towards global elimination. For other low- and middle-income countries, China’s experience may also illustrate how domestic manufacturing capacity and school-based health infrastructure can be leveraged to expand access rapidly and equitably. The biological effectiveness of HPV vaccination has been established; the critical question is how programme design determines the extent to which effectiveness translates into population-level benefit.