School-based HPV programmes are among the most effective and equitable way to achieve high vaccination coverage. High coverage can also be achieved through well-organised healthcare-based or other delivery platforms.
Organised delivery platforms that reliably reach adolescents are a key determinant of high HPV vaccination coverage, regardless of the specific setting used [2].
Across multiple countries in Europe, school-based HPV vaccination programmes are consistently associated with high overall coverage and more equitable reach as this is the setting where children and adolescents spend a significant portion of their time [3, 4]. European guidance further indicates that, where feasible, school-based immunisation is often among the lowest-cost delivery options for HPV vaccination, as it reaches whole cohorts efficiently and keeps organisational and delivery costs relatively low, although local factors such as school health infrastructure, consent arrangements, and funding mechanisms influence feasibility [5, 6].
European experience also demonstrates that high coverage can be achieved through well-organised healthcare-based or other delivery platforms, reinforcing that delivery success is not dependent on a single model [2, 4]. In some settings, primary care services and pharmacist-led delivery may help expand access by providing additional vaccination opportunities, supporting vaccine confidence through trusted patient-doctor relationships, and increasing the number of accessible vaccination sites. Evidence from high-income countries with established school-based HPV vaccination programmes indicates that inequalities in uptake may persist, with girls from lower socioeconomic status (SES) and minority ethnic groups tending to be less likely to be vaccinated [7]. These findings could inform targeted approaches to catch-up vaccination. HPV vaccination delivery should also be considered within a life-course immunisation approach, with opportunities to vaccinate through adolescent programmes, catch-up activities, and primary care services. Further detail on catch-up and extended-age vaccination is provided in section 6.
Adequate delivery systems, supported by sufficient trained personal and logistics, are a prerequisite for consistent and scalable HPV vaccination programmes
HPV vaccination programmes that achieve sustained coverage are characterised by planned and recurrent delivery arrangements for adolescents, with clearly designated vaccinators who are trained and authorised to deliver HPV vaccination within those settings, reflecting the additional coordination required compared with infant immunisation [8].
HPV specific implementation guidance indicates that HPV vaccine introduction requires careful planning of delivery strategies and logistics because the target group is outside of routine immunisation, and that building health worker capacity and skills is an essential part of implementation support [3, 8].
European countries show substantial variation in HPV vaccination coverage, alongside marked differences in delivery organisation, workforce arrangements, and system readiness [1].
Policy design choices relating to age eligibility, dosing schedules, and consent requirements directly shape how easily HPV vaccination can be delivered in routine practice, with more complex or restrictive policies increasing the risk of missed or delayed vaccination.
WHO implementation guidance emphasises that delivery feasibility should be considered at the policy design stage, including alignment of eligibility criteria and vaccination schedules with existing delivery opportunities, such as school-based or other adolescent health platforms, to support consistent implementation and reduce missed vaccinations [8]. Additionally, complex eligibility criteria such as multiple age cut-offs, sex-specific rules, or narrowly defined target cohorts, as well as restrictive scheduling or delivery arrangements that are poorly aligned with service organisation can increase operational burden and hinder programme performance [8,9].
ECDC guidance on HPV vaccine introduction in EU countries, and information from the Vaccine Scheduler describes how age eligibility, consent models, and scheduling choices affect the feasibility of delivery across different settings, including schools and healthcare services [2,10].
