Abstract
Twelve years after the first HPV vaccine registration, less than half of WHO Member States have introduced HPV vaccine into the routine national immunisation schedule. Introductions are lowest in Gavi countries and non-Gavi, non-PAHO middle- income countries (MICs). Supply is currently insufficient to meet demand and some countries have or will have to postpone introductions. WHO issued a call for action towards global cervical cancer elimination in May 2018 which, through national introductions in all countries and increased coverage, is estimated to increase total demand for HPV vaccines by at least 100M doses over the next 10 years. To meet the expected increase in demand due to the cervical cancer elimination initiative, siseable increases in supply will be required. Constraints are expected until at least 2024, assuming the base case supply scenario. This timing may change depending on selected vaccination strategies and investment decisions of current manufacturers, as well as on the timing of the three products in advanced stage of clinical development. Meeting the projected demand volumes required for multi-age cohort (MAC) introductions (9–14 years of age), as per WHO recommendation, will remain especially problematic in large countries, as well as meeting additional demand generated by implementing gender-neutral HPV vaccination. Affordability of HPV vaccines in non-Gavi MICs is a barrier which needs to be addressed to encourage introduction.