Vaccine Coverage Indicators

A high level of vaccine coverage sustained over many years is required to achieve population level control of vaccine targeted HPV types, and in the long-term, cervical cancer elimination (1,2). For the purposes of monitoring coverage over time and comparing across countries, which vary in their age of vaccination within the range 9-14 years, WHO recommends measuring ‘HPV vaccination coverage achieved by age 15 years' (3).

This indicator measures the proportion of the population turning 15 years in the reporting year who have received one (or more) HPV vaccine doses by age 15, noting that Australia moved to a single dose program in 2023 based on evidence of strong protection from one dose. Prior to 2023, the recommended schedule in Australia was either two (2018-2022) or three correctly spaced doses (2007-2017).

The WHO target relates to female-only programs, which are the most cost-effective option. Australia vaccinates both girls and boys and has adopted a 90% target for both sexes (4). Modelling suggests the same impact on HPV burden as achieving 90% coverage in girls only could be achieved with 80% coverage of both sexes (5).

Nationally, in the cohort who turned 15 years old in 2024, HPV vaccination coverage was 79.5% (81.1% in females and 77.9% in males). This represents a substantial decline from the historical peak in the 2020 cohort (85.7%, female 86.6%, male 84.9%). Coverage was lower amongst Indigenous adolescents, falling to 72.9% (females 76.7%, males 69.2%) (reduced from 2023 cohort by 5.0% (female 4.2%, male 5.8%)) than non-Indigenous adolescents (79.8% overall; female 81.3%, male 78.4%) (reduced from 2023 cohort by 3.4% (female 3.1%, male 3.7%)). This was a decline from the historical peak in Indigenous adolescents, also achieved in the 2020 cohort of 85.4% (females 87.8%, males 83.0%) (Figure 5.1).

There was a continuing increase in disparity of coverage in 2024 between those residents in the lowest socioeconomic quintile areas compared to those in the highest quintile, growing to 9.7 percentage points (increased from 2023 when it was 6.5 percentage points), driven by larger falls in coverage in the lowest socioeconomic areas than in the highest although declines were seen in every quintile. For this 2024 (15 year old) cohort, who turned 13 years in 2022, a year that recorded the lowest school attendance data on record (6), the disparity was wider in boys (11.9 percentage points) than in girls (7.9 percentage points) (noting the disparity was only 1.2 in the 15 year old female 2020 cohort and 2.2 in the 15 year old male 2020 cohort).  

In 2024, overall coverage fell below 80% across every remoteness area classification. Coverage remained above 80% in both sexes only in NSW (80.2%), Victoria (81.3%) and the ACT (87.1%), above 80% in boys only in Victoria (80.1%) and the ACT (87.0%), but above 80% in girls in all but three jurisdictions (Qld 78.2%, NT 76.4%, SA 79.6%)

Socioeconomic and regional disparities were wider amongst Indigenous adolescents than in the whole cohort. There was substantial variation in coverage amongst Indigenous adolescents by jurisdiction, with coverage in females ranging from 66.7% in SA to 83.8% in the ACT and coverage in males ranging from 55.7% in SA to 81.0% in the ACT, which was the only jurisdictions with coverage in Indigenous boys above 80% (Figure 5.2). Coverage amongst Indigenous girls continued to decline since 2020 when they had the highest national coverage. By sex and Indigenous status, only non-Indigenous girls now have national coverage above 80% (Figure 5.3).

Source: Australian Immunisation Register (AIR) data, as at 2nd February 2025 for 2024 data, sourced from the National Centre for Immunisation Research and Surveillance (NCIRS).

Updated data are for the 15-year-old cohort in 2024 (i.e. those born 1 Jan 2009 - 31 Dec 2009) and only includes HPV vaccinations administered prior to their 15th birthday. 

Aboriginal or Torres Strait Islander identification was based on whether a person had ever self-reported their status, as recorded in the Australian Immunisation Register.

In 2024, HPV vaccine coverage continued to decline from its peak in 2020, falling to 79.5%. Inequity in coverage continues to increase by available demographic variables notably for Indigenous adolescents, very remote and remote areas, and by jurisdiction of residence, and needs to be urgently addressed to prevent further falls. Modelling has suggested, for countries like Australia with vaccination of males as well as female adolescents, elimination of vaccine-preventable HPV types is likely achievable in the long term with a sustained coverage of 80% (or more) (5). Concerningly coverage data comparing HPV coverage in those turning 13 years old (i.e. closer to age of vaccination, which occurs routinely through the school based immunisation program at age 12-13 years in Year 7) between 2023 and 2024, shows continuing coverage declines between the two cohorts (from 74.2 to 71.8%  in girls and from 70.1% to 67.8% in boys ) (7,8), suggesting an ongoing issue rather than just a decline in cohorts directly impacted by pandemic disruptions to school programs. Vaccine coverage in Australia has declined in the post-pandemic period across the adolescent vaccine schedule, with factors like fewer school visits, higher absenteeism, competing priorities and resource limitations in the education sector, digitisation of routine school communications and some consent processes and potentially vaccine ‘fatigue’ post COVID hypothesised to be behind gradual, incremental declines seen in adolescent vaccination (9,10). Globally and nationally childhood immunisation coverage has not yet returned to 2019 levels, with 60 large measles outbreaks reported globally in 2024 (11). 

Other high-income countries are also struggling to regain HPV vaccine coverage post COVID-19 pandemic disruptions. A post pandemic decline in HPV vaccine uptake continues in the United States, on a background of continuous year on year increases in coverage pre-pandemic (12, 13). HPV vaccine coverage in England has not yet recovered to pre-pandemic levels, with the same ongoing incremental declines as noted here and increasing inequity in coverage, potentially threatening cervical cancer elimination efforts (14, 15). In Canada, an important decline has occurred post pandemic in school-based HPV vaccination rates, with coverage ranging from 47 to 81% for the 2 or 3 dose course (16). While single dose vaccination creates the opportunity for easy catch up in multiple settings, including in school, community and primary care settings such as pharmacies, further promotion of its availability and desirability appears to be urgently needed. Data are not yet available reporting coverage for other priority populations such as people who are part of culturally and linguistically diverse communities, those living with disability, or those who are medically at higher risk from HPV (e.g. immunosuppressed), although work is underway to develop methods for monitoring coverage in these groups through data linkage (the INCLUDE study) (17).  

It should be noted that this indicator is designed to monitor achievement of coverage by a certain age over time rather than highest coverage ever achieved in a birth cohort (for example by including doses delivered at age 15 or afterwards). Data suggests that coverage by birth cohort currently peaks at age 19 years in Australia (7). There is now an additional opportunity to improve coverage further, catch up the pandemic and post-pandemic cohorts, and mitigate the dilution of coverage by immigration in the young adult age group, through the extended funded single dose catch up introduced in 2023 through to age 25 years inclusive. 

It is now urgent that large scale national action is taken, supported by sufficient investment, to address these ongoing vaccine coverage declines. A cross sectoral whole of government approach is likely required to commit to turning around and restoring vaccine rates across the schedule as part of the implementation of the new National Immunisation Strategy (18).

1 World Health Organization. Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020. Available at: https://www.who.int/publications/i/item/9789240014107 

2 Simms KT, Steinberg J, Caruana M, et al. Impact of scaled up human papillomavirus vaccination and cervical screening and the potential for global elimination of cervical cancer in 181 countries, 2020-99: a modelling study. Lancet Oncology 2019; 20(3): 394-407. 

3 Bruni L, Saura-Lazaro A, Montoliu A, et al. HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019. Preventive Medicine 2020: 106399. 

4 Australian Centre for the Prevention of Cervical Cancer. National Strategy for the Elimination of Cervical Cancer in Australia. November 2023. Available at: https://www.health.gov.au/resources/publications/national-strategy-for-the-elimination-of-cervical-cancer-in-australia?language=en 

5 Brisson M, Benard E, Drolet M, et al. Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models. Lancet Public Health 2016; 1(1): e8-e17.

6 Australian Curriculum Assessment and Reporting Authority. Student attendance. 16 Oct 2025, Accessed 16 Oct 2025, 2025. Available at: https://www.acara.edu.au/reporting/national-report-on-schooling-in-australia/student-attendance 

7 Hull B, Hendry A, Macartney K, Beard F. Annual immunisation coverage report 2024. National Centre for Immunisation Research and Surveillance 2025.   Accessed 3 Nov 2025. Available at: https://ncirs.org.au/sites/default/files/2025-10/Annual%20Immunisation%20Coverage%20Report%202024.pdf 

8 Hull B, Hendry A, Macartney K, Beard F. Annual immunisation coverage report 2023. National Centre for Immunisation Research and Surveillance 2024. Accessed 3 Nov 2025.  Available at: https://ncirs.org.au/sites/default/files/2024-10/NCIRS%20Annual%20Immunisation%20Coverage%20Report%202023.pdf 

9 Steffens M, Bolsewicz K, Prokopovich K, Beard F, Brotherton J. Transition to a single dose HPV vaccine schedule in Australia: lessons learned. Submitted manuscript.

10 McIndoe L, Young A, Davies C, et al. Provider Preference, Logistical Challenges, or Vaccine Hesitancy? Analyzing Parental Decision-Making in School Vaccination Programs: A Qualitative Study in Sydney, Australia. Vaccines (Basel). Jan 17 2025;13(1)doi:10.3390/vaccines13010083

11 Burki T. Global immunisation coverage not where it should be. The Lancet Infectious Diseases 2025;25(9): e501 - e502  

12 Pingali C, Yankey D, Elam-Evans LD, et al. Vaccination Coverage Among Adolescents Aged 13–17 Years - National Immunization Survey-Teen, United States, 2024. MMWR Morb Mortal Wkly Rep 2025;74:466–472. DOI: http://dx.doi.org/10.15585/mmwr.mm7430a1.  

13 Vu M, Li J, Hong K, Kaminski JW, Cho BH, Kang Y. An Ecological Analysis of HPV Vaccination in the United States Before and During the COVID-19 Pandemic by Age, Sex, and Urbanicity Using Private Insurance Claims Data. Cancer Med. 2025 Mar;14(6):e70761. doi: 10.1002/cam4.70761. PMID: 40116295; PMCID: PMC11926641.

14 National Health Executive. HPV vaccine coverage threatens elimination of cervical cancer. Published 24^th June 2025. Available at: https://www.nationalhealthexecutive.com/articles/hpv-vaccine-coverage-threatens-elimination-cervical-cancer. Last accessed 16 Oct 2025.

15 UK Health Security Agency. Official Statistics. Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2023 to 2024. Updated 24 June 2025. Available at:  https://www.gov.uk/government/statistics/human-papillomavirus-hpv-vaccine-coverage-estimates-in-england-2023-to-2024/human-papillomavirus-hpv-vaccination-coverage-in-adolescents-in-england-2023-to-2024 

16 Perez S. Progress and Challenges in Canada's Path Toward the Elimination of Cervical Cancer. Curr Oncol. 2024 Sep 29;31(10):5850-5861. doi: 10.3390/curroncol31100435. PMID: 39451739; PMCID: PMC11506197.  

17 The INCLUDE Study: Cervical cancer prevention for all. Webpage; Kirby Institute UNSW. Last accessed 23/08/2024. Available at: https://www.kirby.unsw.edu.au/research/projects/include-study 

18 Australian Government Department of Health, Disability and Ageing. National Immunisation Strategy For Australia 2025–2030. Published 12 June 2025. Last accessed 16 Oct 2025.  Available at: https://www.health.gov.au/resources/publications/national-immunisation-strategy-for-australia-2025-2030?language=en