Vaccine Coverage Indicators (2022)

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 (25,26). 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 the use of the indicator ‘HPV vaccination coverage by age 15 years (27).

This indicator measures the proportion of the population turning 15 in the reporting year who have completed their HPV vaccine course coverage by age 15, noting that the number of (correctly spaced) doses required to complete the course has changed over time from 3 doses to 2 doses. 

The WHO target relates to female-only programs, which are the most cost-effective option. Australia has a both-sex program, and modelling suggests the same effect could be achieved with less than 90% coverage (as elimination of vaccine-preventable HPV types is likely achievable with a sustained coverage of 80% in both-sex programs) (28).

Nationally, in the cohort who turned 15 in 2020 (hereafter referred to as the 2020 cohort), HPV vaccination coverage with completed courses was 79.1% (80.5% in females and 77.6% in males). Coverage increased by 0.9% compared to the 2019 cohort (0.9% in females and 0.8% in males).

Indigenous status: In the 2020 cohort, completed course coverage was substantially lower amongst Indigenous adolescents at 71.5% (females 75.0%, 68.0% males) than non-Indigenous adolescents (79.5% overall; female 80.9%, male 78.2%) (Figure 5.1).

In the 2020 cohort, Indigenous males residing in the lowest SES quintile had the lowest completed course coverage by SES of residence (64.3%), as did Indigenous males living in remote areas (61.3%) by areas of residence (Figure 5.2).

For Indigenous females and males there was substantial variation in completed course coverage between jurisdictions: ranging from 58.8% in SA to 83.5% in NSW amongst females and from 47.5% in SA to 77.3% in NSW amongst males (Figure 5.2).  In comparison, completed course coverage ranged from 77.2% (Queensland) to 83.9% (ACT) for non-Indigenous females, and from 73.7% Tasmania to 80.9% (ACT) for non-Indigenous males.

Completed HPV vaccine course coverage has increased between 2016 and 2020 in both sexes amongst both Indigenous and non-Indigenous adolescents (Figure 5.3). Completed HPV vaccine course coverage amongst Indigenous adolescents increased between the 2019 and 2020 cohorts by 3.4% in females and 2.6% in males, and increased between 2016 and 2020 by 10.8% in females and 12.3% in males.

Jurisdiction: In 2020, completed course coverage was over 80% in females in NSW, Vic and ACT and over 80% in males in NSW and ACT (Figure 5.1).

Remoteness and socioeconomic status: In 2020, completed course coverage was similar in major cities (80.7% females, 77.9% males) and regional areas (80.8% females, 77.6% males) but lower in remote areas for both females (74.9%) and males (70.2%) (Figure 5.1). There was a gradient seen in both sexes for completed course coverage by area level socioeconomic status, with a coverage difference of 6.5% in males and 4.2% in females between the most (lowest coverage) and least (highest coverage) disadvantaged quintile.

Source: Australian Immunisation Register (AIR) data, as at 31 March 2021, sourced from NCIRS.

Updated data are for the 15-year-old cohort in 2020 (i.e. those born 1 Jan 2005 - 31 Dec 2005) and only includes HPV vaccinations administered prior to 15th birthday. Either two validly spaced doses (five months or more between doses) or three doses were considered to indicate course completion.

Herd effects from Australia’s both-sex vaccination program provide substantial protection to non-vaccinated women. Modelling has suggested, for countries that have introduced both-sex vaccination, that elimination of vaccine-preventable HPV types is likely achievable with a sustained coverage of 80% (28). In 2020, overall national completed course coverage was close to this threshold at 79.1%. The data presented here, however, flags substantial variation by available demographic variables and by jurisdiction of residence, which will need to be addressed in order to achieve elimination equitably. Despite gradually improving coverage over time, a large disparity remains between Indigenous adolescents and non-Indigenous adolescents in receipt of the final dose.

Indigenous status was not specified for 1.3% of people in AIR. 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 (eg immunosuppressed).

HPV vaccine coverage by 15 years of age for 2020 predominantly represents vaccinations delivered in school-based programs prior to the COVID-19 pandemic, as adolescents turning 15 in 2020 would predominantly have been offered their first dose in 2017/2018.

A high level of vaccine coverage sustained over many years, which will achieve population level control of vaccine targeted HPV types, is required in the long term for cervical cancer elimination (25,26). 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 the use of the indicator ‘HPV vaccination coverage by age 15 years (27).

This indicator measures the uptake of a first dose of HPV vaccine, rather than the completed course, to indicate acceptability of HPV vaccination. There is a growing body of evidence that one dose of HPV vaccine has substantial effectiveness (29-31)

Nationally, in the cohort who turned 15 in 2020, HPV course initiation was 85.7%, at 86.6% in females and 84.9% in males (an increase from the 2019 cohort of 1.1% (0.9% in females and 1.4% in males)). Both-sex one dose coverage was 85.4% amongst Indigenous adolescents (1.4% increase from 2019) and 85.8% amongst non-Indigenous adolescents (a 1.2% increase from 2019). There was minimal variation by socioeconomic group or area of residence nationally (Figure 6.1). Two jurisdictions achieved over 90% HPV vaccine initiation amongst Indigenous females (NSW 92.4%, Tas 91.5%) (Figure 6.2). All groups except for Indigenous males in WA, SA and ACT exceeded 80% HPV vaccine initiation (Figure 6.2). Between 2016 and 2020, HPV vaccine initiation has improved in both sexes in both Indigenous and non-Indigenous adolescents with reducing disparity between groups over time (Figure 6.3).

Source: Australian Immunisation Register (AIR) data, as at 31 March 2021, sourced from NCIRS.

Updated data are for the 15-year-old cohort in 2020 (i.e. those born 1 Jan 2005 - 31 Dec 2005) and only includes HPV vaccinations administered prior to 15th birthday.

These data suggest gradually increasing HPV vaccine initiation over time, with reducing inequities over time, and the difference between female and male initiation almost resolved. First dose coverage is notably more equitable than completed course coverage. There is no explicit WHO 2030 or Australian target for HPV vaccine initiation although coverage over 90% for females is implied by the WHO 2030 90% completion target for girls-only programs. Modelling has suggested, for countries that have introduced both-sex vaccination, that elimination of vaccine preventable HPV types is likely achievable with a sustained coverage of 80% (28). In 2022 WHO’s Strategic Advisory Group of Experts on Immunisation (SAGE) reviewed the evidence and suggested that it now supports an equivalent efficacy of either one or two doses in those aged up to 20 years (26). Should one dose of HPV vaccine be recommended as the routine schedule, then the initiation rate achieved would become the completed coverage rate.

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).

HPV vaccine initiation by age 15 years for 2020 predominantly represents vaccinations delivered in school-based programs prior to the COVID-19 pandemic, as adolescents turning 15 in 2020 would predominantly have been offered their first dose in 2017/2018.