Human Papillomavirus (HPV) is the most common STI worldwide, with 85% of people contracting it at least once in their life. While most infections don’t lead to symptoms and often resolve on their own, persistent infection can come with great risk. Persistent HPV infection is responsible for virtually all cervical cancer cases, a leading cause of death for women globally. HPV infection can also cause vaginal, anal, vulvar, throat and penile cancers. Although HPV affects individuals of all genders, and is more common in men, much of the conversation and prevention efforts have disproportionately focused on women due to its direct link to cervical cancer. The risk of HPV-related cancers extends to everyone and addressing this requires comprehensive, inclusive prevention efforts.

One of the most effective preventive measures is the HPV vaccine, which has been shown to prevent 90% of HPV-related cancer cases. Vaccination efforts are particularly focused on adolescents, with a target age range of 9 to 14 years old, as this is when the vaccine is most effective. While the vaccine has been available for girls since 2006, eligibility for the vaccine has been expanded to include boys in the same age group in the last five years.

With many adolescent sexual and reproductive health (SRH) topics, there is often hesitancy to discuss them openly, discouraging young people from making their own decisions. This can manifest in the belief that doing so will deter adolescents from engaging in sexual behavior. Research has shown the contrary—that comprehensive SRH education equips youth with the knowledge to navigate decisions around their sexual health confidently, resulting in improved health outcomes and in some, delayed sexual initiation.

Associate Professor Tracey Chantler, Co-director of the Vaccine Centre at the London School of Hygiene & Tropical Medicine and a co-theme lead for vaccine delivery in the Health Protection Research Unit with the UK HSA, has spent nearly a decade researching the implementation and reception of HPV vaccination efforts, especially the UK's school-based HPV vaccination programme. MARCH Student Liaison Officer, Olga Laskin spoke with Tracey about her work, exploring the barriers to vaccine uptake and the broader tension surrounding its place within adolescent sexual health.  

Your research explores the experiences of individuals and communities in relation to vaccine provision. What are some common misconceptions or beliefs surrounding HPV vaccination that are distinct from other vaccines? 

There is a different level of risk perception associated with the HPV vaccine. Unlike vaccines such as those for meningitis, where the vaccine protects young people against what are perceived to be more immediate risks, HPV can be contracted at any point in life and may lead to cancer later on. With HPV, it’s more about longer-term prevention rather than gaining protection against diseases young people could acquire in the short-term. 

How do gender norms and societal attitudes toward adolescent SRH shape HPV perceptions and vaccination decisions? 

A major reason for hesitancy toward the vaccine among parents is often rooted in sociocultural norms and religious beliefs surrounding SRH. Many parents worry that sharing information about HPV vaccination and prevention might encourage early sexual debut. Since the vaccine was introduced in the UK in 2008, the messaging has been heavily focused on cancer prevention as an outcome.  

It’s important to emphasise that HPV can be transmitted not just through intercourse, but also through skin-to-skin contact, and it carries significant health risks. While adolescents can decline the vaccine and receive it later in life, getting vaccinated earlier provides much stronger protection. Breaking through the stigma around sexual health is essential to fostering open conversations about HPV prevention. We need to create environments where young people feel comfortable discussing these topics among each other and with their parents to reduce hesitation and misinformation surrounding the vaccine. 

What are some successful interventions you’ve seen that helped increase HPV vaccination uptake? 

HPV vaccination uptake faces multiple barriers: cultural resistance in certain communities, educational gaps around the vaccine’s benefits, and systemic challenges in accessing vaccines. 

The school-based vaccination programme in the UK, in partnership with community health trusts, has worked really well to overcome these barriers and reach a broad population. In early interviews, I found that parents who were initially hesitant felt more comfortable when the vaccine was offered through the school, as it helped normalise it. But this means that at 12 or 13, it’s the first time a child is receiving a vaccination without a parent present. As a result, it’s even more important that the information provided to both parents and young people is clear, accessible, and comprehensive. 

To support this, our team co-produced an educational intervention called EDUCATE with young people and researchers at the University of Bristol. The programme  educates UK youth about HPV prevention, transmission, and its associated cancer risks. We found that an educational approach, where hesitant parents can discuss concerns with healthcare professionals, is particularly effective. Ultimately, we need to move towards more multi-pronged approaches that integrate opportunities for vaccine information provision within the health system. 

What are current gaps in policy or research surrounding HPV vaccine uptake that you believe deserve public health professional’s focus? 

There is a lot still to be understood about how boys and men engage with the vaccine. The rates of HPV-related cancers are high in men, but it only recently became cost effective enough to extend vaccine eligibility to them. This happened during the pandemic when uptake was understandably low, so we don’t yet have a clear sense of how uptake is performing, especially now that vaccination teams can again enter schools. The boys we spoke to before the vaccine was offered were quite positive about wanting it, but they also wanted more information about the cancers it could prevent in men. This remains a major area for growth, and we’re likely to see more research on it in the coming years as more data is collected. 

In the decade you have been working on this, how have you seen the field change? 

There’s increasing interest in qualitative research to not just measure vaccine confidence and hesitancy, but to understand the sociocultural issues and barriers that make health services inaccessible for some people. For example, colleagues in the MRC/UVRI & LSHTM Uganda Research Unit are focusing on HPV vaccination for girls who don’t attend school and exploring how they can access the vaccine. 

This HPV awareness day we highlight the importance of continuing to address barriers to HPV vaccination. It is crucial that we foster open, inclusive conversations around sexual health and provide accessible, clear information to both young people and their parents. By breaking down cultural stigmas surrounding adolescent SRH, improving education, and expanding access to the vaccine, we can ensure that more individuals are protected from HPV-related cancers.