HPV vaccination worldwide and in Poland: successes, gaps, and the critical role of nursing practice

Introduction

Human papillomaviruses (HPVs) are small, non-enveloped viruses with a circular double-stranded DNA genome of approximately 8 kb, belonging to the Papillomaviridae family [1, 2]. The viral capsid is composed of the structural proteins L1 and L2, with L1 being the major capsid protein responsible for viral assembly and immunogenicity [2, 3]. To date, more than 200 HPV genotypes have been identified, of which approximately 40 infect the anogenital and oropharyngeal mucosa [1, 4]. These genotypes are classified into low-risk types (e.g. HPV 6 and 11), which cause benign lesions such as anogenital warts, and high-risk oncogenic types, most notably HPV16 and HPV18, which are causally associated with cervical cancer and other anogenital and head-and-neck malignancies [5, 6].
HPV infection is initiated through micro-abrasions in the epithelium, allowing the virus to access basal keratinocytes [2]. The viral life cycle is tightly linked to epithelial cell differentiation, with early viral proteins (E1 and E2) supporting viral genome replication and maintenance in basal cells, while late gene expression and virion assembly occur only in terminally differentiated epithelial cells [2, 6]. Importantly, viral particles are released without cell lysis, resulting in minimal inflammation and enabling effective immune evasion and viral persistence [1, 7].
The oncogenic potential of high-risk HPV types is mediated primarily by the viral oncoproteins E6 and E7, which disrupt key tumour-suppressor pathways [5, 6]. E6 promotes the degradation of the p53 protein, thereby inhibiting apoptosis and DNA damage responses, whereas E7 inactivates the retinoblastoma protein (pRb), leading to dysregulated cell-cycle progression [5, 6]. Persistent expression of these oncoproteins causes genomic instability and, in some cases, integration of viral DNA into the host genome – events that are critical for malignant transformation and typically occur over many years following initial infection [5, 6].
Natural HPV infection induces a weak and often transient immune response, and many infected individuals fail to develop durable protective antibodies [7]. In contrast, prophylactic HPV vaccines are based on virus-like particles (VLPs) composed of the L1 protein, which closely mimic the native virion while lacking viral DNA [3]. These VLPs induce robust neutralising antibody responses that are significantly stronger than those generated by natural infection, explaining the high efficacy of HPV vaccination in preventing infection and HPV-associated disease [3, 7].
Prospective epidemiologic studies conducted in the late 1990s and 2000s established the temporal association between exposure to high-risk (HR) HPV and the subsequent development of cervical intraepithelial neoplasia (CIN) and cervical cancer [8]. The first vaccine for prevention of morbidity and mortality attributable to HPV-associated disease was licensed in 2006. HPV is one of the most common sexually transmitted infections and a well-established cause of cervical cancer, other anogenital cancers (anus, vulva, vagina, and penis), and oropharyngeal cancer [9]. Among HPV-related cancers, cervical cancer has the strongest association with HPV, as the development of virtually all cases is dependent on persistent infection with oncogenic HPV types [10].
All currently available HPV vaccines target HPV16 and HPV18, which cause approximately 70% of all cervical cancers [11]. With the inclusion of 5 additional oncogenic HPV types (HPV31, HPV33, HPV45, HPV52, and HPV58) in the nonavalent HPV vaccine, the preventable proportion of cervical cancers has been estimated to increase to approximately 90% [12].
Data from cancer registry analyses indicate that the median age at diagnosis for HPV-associated cervical cancer is approximately 50 years. This implies that half of women diagnosed with cervical cancer are younger than 50 and half are older, reflecting a disease that typically manifests in middle adulthood rather than adolescence or early adulthood. This age distribution underscores the importance of preventive strategies, such as HPV vaccination in early adolescence, to reduce cancer incidence later in life [13].
The aim of this narrative review was to summarise current evidence on HPV biology, vaccination strategies, and epidemiology, with particular emphasis on international vaccination programmes and the situation in Poland.

Review methods

This narrative review was conducted using a combination of scientific literature and official governmental data sources. Peer-reviewed articles were identified through PubMed and Scopus databases, using keywords such as “human papillomavirus”, “HPV vaccination”, “cervical cancer prevention”, “population-based vaccination”, and “Poland”. Only articles published in English between 1999 and 2025 were considered. In addition, official data were obtained from national and international public health authorities, including the Polish Ministry of Health, the National Cancer Registry, the European Centre for Disease Prevention and Control (ECDC), and the UK Health Security Agency, to provide up-to-date statistics on HPV epidemiology and vaccination coverage. Reference lists of relevant publications were also screened to identify additional sources. This approach allowed for an integrated analysis of HPV biology, vaccine development, epidemiology, and vaccination programme implementation both globally and specifically in Poland. Limitations include potential publication bias and variability in data reporting between countries, especially regarding privately funded vaccinations.

HPV situation worldwide

The 2025 Cervical Cancer Elimination Progress Report, compiled by the NHMRC Centre of Research Excellence in Cervical Cancer Control, provides robust evidence on Australia’s achievements and remaining challenges in cervical cancer prevention. The report highlights that for the first time since data collection began in 1982, no cases of cervical cancer were diagnosed in women under 25 in 2021, a milestone largely attributed to the long-standing national HPV vaccination programme and the transition to HPV-based cervical screening. HPV prevalence of high-risk types 16 and 18 was very low nationally (approximately 1.4% in 2024), reflecting the ongoing impact of vaccination across cohorts now entering the screening age. However, HPV vaccine coverage by age 15 declined from a peak of 85.7% in 2020 to 79.5% in 2024, with notable disparities by Indigenous status, geographic remoteness, and jurisdiction of residence. Coverage among females turning 15 in 2024 stood at 81.1% (non-Indigenous) and 76.7% (Indigenous), while male coverage was 77.9% nationally, with even lower uptake among Indigenous males (69.2%), underscoring persistent inequities. The authors warn that reversing these declines will require strengthened school-based immunisation delivery and comprehensive, cross-sectoral action to sustain progress toward the WHO elimination target of 90% vaccination coverage by 2030 [14].
A systematic review by Yakely et al. evaluated the impact and effectiveness of HPV vaccination on anogenital warts in the United States, synthesising evidence from population-level impact and individual-level effectiveness studies published up to 2018. The analysis demonstrated clear declines in anogenital wart diagnoses among females and males aged ≤ 25 years after the introduction of routine HPV vaccination, with reductions emerging first in females following the 2006 vaccination recommendation and later in males after the 2011 recommendation for male immunisation. In contrast, little to no change was observed in individuals older than 25, reflecting both lower vaccination coverage and the longer time needed for herd effects to manifest in older age groups. Studies that incorporated vaccination history consistently showed a lower risk of anogenital warts among those who received at least one vaccine dose compared with unvaccinated individuals, underscoring the real-world effectiveness of HPV vaccines in preventing clinically relevant HPV-related disease. These findings highlight the age- and sex-specific benefits of vaccination, while also suggesting that achieving the full preventive potential of HPV immunisation in the U.S. will require increased coverage across all eligible populations [15].

HPV situation in Europe

According to the European Centre for Disease Prevention and Control (ECDC) [16], across Europe, HPV vaccination schedules follow broadly similar principles, yet important national differences remain in terms of age of initiation, target groups, and dosing schemes. Most European countries recommend routine HPV vaccination for both girls and boys, typically beginning between 9 and 14 years of age, aligning with the period of strongest immunogenic response and before the onset of sexual activity. In many settings, a two-dose schedule is standard for younger adolescents, while individuals starting vaccination at an older age – usually 15 years or above – are advised to receive a three-dose regimen. Numerous countries have also implemented catch-up programmes extending into late adolescence or early adulthood to increase population immunity and reduce disparities in vaccine uptake. Despite these common frameworks, the specific implementation varies based on national public health strategies, financial resources, and historical patterns of HPV-related disease, resulting in a diverse landscape of vaccination policies across Europe. The overall trend, however, demonstrates a clear movement toward earlier vaccination, gender-neutral coverage, and broader accessibility as key tools in reducing the burden of HPV-associated cancers.
The Swedish study “Population-level impact of human papillomavirus vaccination on the incidence of genital warts” assesses the real-world effects of Sweden’s HPV immunisation programmes on genital wart incidence, an early clinical outcome of HPV infection. Using national registry data from 2006 to 2018 for individuals aged 15-44 years, the authors found substantial declines in genital wart incidence following the introduction and expansion of HPV vaccination programmes. By 2016-2018, incidence decreased by approximately 89% in women aged 15-19, 73% in women aged 20-24, 50% in women aged 25-29, and 20% in women aged 30-34 compared with the pre-vaccination period, reflecting the largest reductions among cohorts eligible for school-based vaccination and the cumulative population-level vaccine effect. A similar downward trend – albeit of lower magnitude – was also observable in men, indicating indirect herd protection despite their lower early vaccination coverage. The study estimated that tens of thousands of genital wart cases were averted among vaccinated cohorts, demonstrating the remarkable effectiveness of organised HPV vaccination programmes in reducing not only infection but also clinically relevant HPV-related disease outcomes at a national level [17].
The United Kingdom operates a long-standing, school-based HPV vaccination programme that was introduced for girls in 2008 and extended to boys in 2019. According to the most recent national surveillance data from the UK Health Security Agency, HPV vaccination coverage among adolescents aged 12-13 years in England remains below pre-pandemic levels, with uptake in the 2023-2024 academic year reaching approximately 72.9% in girls and 67.7% in boys, with substantial regional variation and the lowest coverage observed in London [18]. A UK-focused systematic review demonstrated that, despite generally high acceptance of HPV vaccination among parents and adolescents, persistent barriers such as difficulties in obtaining parental consent, socio-economic inequalities, and concerns regarding vaccine safety continue to negatively affect vaccination uptake [19]. In response to declining coverage following the COVID-19 pandemic, UK public health authorities have implemented intensified catch-up vaccination strategies and transitioned to a single-dose HPV vaccination schedule, aiming to improve accessibility and restore population-level protection against HPV-related diseases [18].

HPV situation in Poland

In Poland, cervical cancer remains a significant public health challenge, with incidence and mortality rates that are comparatively high within Europe. According to the Polish National Cancer Registry and official epidemiological data, Poland reports approximately 3,000-3,862 new cases of cervical cancer annually depending on the year and reporting source, making it one of the more commonly diagnosed malignancies among women in the country. Age-standardised incidence rates were estimated at about 12.2-12.3 per 100,000 women, reflecting a substantial burden of disease. Mortality remains high, with roughly 1,500-2,100 deaths per year, corresponding to a mortality rate of approximately 5.4 per 100,000 women [20]. Despite preventive efforts, Poland has one of the higher cervical cancer mortality-to-incidence ratios in Europe, underscoring persistent gaps in early detection and effective primary prevention [21].
In Poland, HPV voluntary vaccination was recommended for the first time in the vaccination schedule in 2008, with girls aged 11-12 years as an HPV-vaccination-eligible population [22].
Since 1 June 2023, a nationwide HPV vaccination programme has been implemented in Poland. The programme is part of the National Oncology Strategy for 2020-2030 and was created in response to the high incidence of HPV-related cancers in Poland. Initially, the programme covered children aged 12-14 years. From 1 September 2024, the programme was expanded to include children from 9 to 14 years of age, meaning that children aged 9, 10, and 11 years are now also eligible for free vaccination. The national HPV vaccination programme offers free access to two types of HPV vaccines: 2-valent and 9-valent vaccines. The vaccination schedule consists of two doses administered at an interval of 6-12 months [23]. Parents wishing to vaccinate their children can register through primary healthcare providers (POZ) or via the Internet Patient Account (IKP/mojeIKP). Although telephone hotlines such as 989 were used in earlier vaccination campaigns, they are no longer the main registration channel for the HPV programme.
Since 1 September 2024, the use of the central e-registration system has no longer been mandatory, and direct registration at primary healthcare facilities is sufficient. The central system remains optional, depending on local availability.
The health communication strategy for the national HPV vaccination programme included media campaigns (TV, radio), billboards, and leaflets as well as web marketing (including social media).
Since 1 January 2026, an expanded reimbursement policy for HPV vaccines has been introduced in Poland, further increasing financial accessibility of vaccination beyond the core age groups covered by the national programme. Under the new regulations, selected HPV vaccines are eligible for reimbursement within the public healthcare system, reducing out-of-pocket costs for individuals vaccinated outside the free childhood programme and supporting broader population-level protection against HPV infection [23].
By 23 November 2025, over 762,000 children had been vaccinated against HPV within the national programme. This represents only 16.10% of all children eligible for vaccination. The highest vaccination coverage was observed in the Pomorskie (19.36%) and Kujawsko-Pomorskie (19.32%) voivodeships, whereas the lowest rates were recorded in the Opolskie (9.89%) and Lubelskie (11.45%) voivodeships [24] (Table 1). There is a lack of scientific data on public awareness of the national HPV vaccination programme as well as exposure to health communication campaigns on HPV vaccination and sources of knowledge on HPV vaccination. In 2023, Jankowski et al. conducted research to identify factors associated with public awareness of the national HPV vaccination programme among adults in Poland and the willingness to vaccinate children against HPV, one month after the introduction of the programme [25]. This study showed that one-third of adults in Poland have never heard of the national HPV vaccination programme. The HPV vaccine is well accepted by the public, but most of the respondents were not aware of the HPV-vaccination-eligible population despite the implementation of the information campaign on the HPV vaccination programme. Only 60.1% of respondents stated that HPV infection can cause cervical cancer, 51.6% were aware that HPV can lead to vaginal cancer and 42.1% of respondents indicated that HPV could cause penile cancer. Less than one-third of respondents believed that HPV infection can cause cancer of the mouth, throat, or larynx.
The POLKA 18 Study investigated HPV vaccination coverage among final-year secondary school students in Poland, revealing alarmingly low uptake in a population group that is critical for disease prevention. Conducted in 2019 across six Polish regions using self-reported paper questionnaires completed by 2,701 adolescents, the study found that only 16.0% of respondents reported having received any HPV vaccine (18.2% of females and 14.5% of males), while 58.2% were unaware of their own vaccination status, indicating substantial gaps in both vaccination and awareness. Significant regional variation was also observed, with the highest coverage in the Śląskie and Wielkopolskie regions, underscoring geographic disparities in access or health communication. The authors highlighted that at least one quarter of adolescents who had already experienced sexual debut remained unvaccinated, further emphasizing missed opportunities for effective primary prevention. Given that Poland historically relied on locally funded or voluntary vaccination programmes rather than comprehensive national coverage, these findings illustrate entrenched challenges in achieving high HPV vaccination rates and suggest that national strategies must address both access and education to improve coverage [26].
One important limitation in evaluating the true HPV immunisation coverage in Poland is the lack of comprehensive data on individuals vaccinated outside the national programme. Official statistics from the National Immunisation Programme capture only vaccinations administered within the public health system, but many adolescents and adults receive HPV vaccines privately – either before the introduction of the universal programme or because they are outside the age groups eligible for free vaccination. There are no centralised reports or registries that systematically record these privately funded vaccinations, meaning that the actual number of vaccinated individuals in the population is likely underestimated in official figures. This gap is compounded by the relatively high out-of-pocket cost of HPV vaccines in private settings: in Poland, prior to full public funding, the cost for the complete vaccine series could exceed several hundred złoty per dose, with prices for commercially purchased vaccines – such as Gardasil or Gardasil 9 – reported to be around PLN 900-1,650 per dose (making the total cost for a full three-dose course a significant financial burden for families) and partially reimbursed Cervarix costing around PLN 415 for the full series in earlier schemes. Because such private vaccinations are not systematically reported, we do not know the true extent of population immunity against HPV in Poland, nor can we accurately assess how many additional individuals have been protected through non-public routes [26].

Conclusion/nursing implications

Nurses play a pivotal role in the successful implementation of HPV vaccination programmes by combining clinical practice with health education and public health advocacy. Their responsibilities extend beyond vaccine administration to include educating adolescents and their caregivers about HPV transmission, vaccine safety, and long-term cancer prevention benefits, thereby addressing vaccine hesitancy and misinformation. In Poland, where the national HPV vaccination programme is relatively recent and data on privately vaccinated individuals remain incomplete, nurses are especially important in identifying eligible children, facilitating access to publicly funded vaccines, supporting catch-up vaccination initiatives, and ensuring accurate documentation of administered doses. Through their close and trusted contact with patients and communities, nurses significantly contribute to improving vaccination uptake, strengthening surveillance data quality, and enhancing the overall effectiveness of national HPV prevention strategies.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References