Human papillomavirus (HPV) is one of the most common viruses in the world, with most people acquiring it during adolescence or early adulthood, often without ever knowing it [1]. HPV lives in the skin and the mucosal linings of the body and spreads easily through intimate skin-to-skin contact, including sexual activity. In most cases (90%), HPV infection clears naturally within a few years.
There are more than 200 types of HPV. Most cause no harm. Some cause genital warts, which are not dangerous but can be upsetting and uncomfortable. A small number of ‘high-risk’ HPV types can cause a range of cancers if the infection persists. Cervical cancer is the most widely recognised but HPV can also cause anal, vulval, vaginal, penile and oropharyngeal (head and neck) cancers.
Over recent decades, HPV-related oropharyngeal squamous cell carcinoma (OPSCC) has risen sharply in many countries. Notably, more than half of cancers of the tonsils and base of the tongue are now attributable to HPV, particularly HPV 16. These cancers disproportionately affect younger, non-smoking males. Although treatment advances have improved survival, the long-term impacts – swallowing difficulties, altered speech, taste changes, reduced saliva and lasting effects on quality of life – are considerable. Preventing these cancers before they occur is therefore vital.
Why vaccination as primary prevention is key
Although often associated with cervical cancer prevention, the HPV vaccine offers broader protection, particularly current multivalent vaccines [2]. Crucially, it prevents the high-risk HPV types responsible for most related cancers, including those affecting the head and neck, as well as those that cause genital warts.
HPV vaccination programmes exist in a growing number of countries, with varying eligibility criteria, delivery mechanisms and dosing schedules. Despite these differences, the overarching goal is the same: to provide immunity before exposure, with high, equitable coverage so no community carries a disproportionate burden of preventable disease.
Where uptake is high, countries have seen substantial reductions in HPV infection, pre-cancerous lesions and genital warts. In Scotland, long-term data show no cervical cancers caused by vaccine-covered HPV types among girls vaccinated at age 12–13 years [3,4]. Although equivalent long-term surveillance systems for head and neck cancers are still developing and outcomes will take longer to demonstrate, there are expectations of similar long-term benefits.
The UK context: progress and persistent inequalities
In the UK, the HPV vaccine is routinely offered in early adolescence through a school-based programme. Initially offered to girls, since 2019, it expanded to include boys. This followed earlier expansion of eligibility to include gay and bisexual men who have sex with men (GBMSM) up to and including the age of 45, attending specialist sexual health services, given their higher risk, including for head and neck cancers.
Gender-neutral HPV vaccination programmes now exist in many countries and reflect increasingly strong evidence that all genders benefit from vaccination, and is particularly valuable for preventing HPV-related head and neck cancers, which affect men disproportionately.
Despite having a national school-based programme, free at the point of delivery, recent Scottish data illustrate not everyone is benefitting equally:
- Vaccine uptake varies by gender, with boys’ uptake lower than girls’. This gap matters. HPV does not discriminate. It affects everyone, and vaccinating boys not only protects them directly, but also strengthens wider population protection and supports their future partners’ health.
- Socioeconomic inequality affects uptake. Adolescents in more deprived communities are consistently less likely to be vaccinated, despite facing higher burdens of HPV-related disease. These disparities have been increasing over time, creating future pockets of preventable disease, deaths and disadvantage. Inequalities in HPV vaccine uptake by deprivation in Scotland, as for other UK countries, have been increasing over time, and are now marked (Figure 1).
- Ethnic disparities are emerging. Differences in uptake across ethnic groups are becoming increasingly visible (Figure 2). These patterns are complex but concerning, reinforcing the importance of culturally informed engagement strategies.
Figure 1: HPV immunisation coverage rates in S4 pupils, school year 2019/20 to 2024/25, by deprivation (Scottish Index of Multiple Deprivation [SIMD] 2020v2 Scotland level population weighted quintile). Image source: Public Health Scotland.
Figure 2: HPV immunisation coverage rates in S1 pupils, school year 2024/25, by ethnic group and sex. (Coverage in some ethnic groups are prone to fluctuation due to the small number of children in these cohorts). Image source: Public Health Scotland.
The drivers behind lower uptake – including access issues, mistrust, cultural factors, school absence during vaccination sessions and low awareness of catch-up eligibility – are complex and overlapping but familiar to many health systems worldwide.
Screening and early recognition remain essential
Vaccination alone cannot eliminate HPV-related disease. Cervical screening remains essential for women and anyone with a cervix, even if vaccinated, because the vaccine does not protect against every cancer-causing HPV type.
"HPV does not discriminate. It affects everyone"
No population-level screening programme currently exists for HPV-related oropharyngeal cancer. As a result, ENT clinicians play a crucial role in early detection. Persistent sore throat, unilateral ear pain, dysphagia, voice change, neck nodules or unexplained weight loss should prompt assessment. As younger vaccinated cohorts age, clinical vigilance for older, unvaccinated adults remains important.
Fair and equal access to HPV vaccine: a shared global challenge
HPV affects all of us, and HPV vaccination is one of the most effective tools to prevent multiple cancers, including oropharyngeal cancers. The inequalities observed in Scotland mirror findings in diverse international settings. Opportunities for improvement include:
- Strengthening gender-neutral messaging to emphasise relevance for boys and the importance of preventing male cancers.
- Targeted outreach to communities with lower access or engagement.
- Culturally adapted communication, co designed with ethnic minority communities.
- Clearer communication of catchup pathways for those who missed vaccination and remain eligible. In the UK for anyone who missed vaccination in school, eligibility may remain up to 25th birthday, and for eligible GBMSM, age 45 years.
- Improved cross-specialty collaboration, with ENT clinicians reinforcing the importance of HPV vaccination in preventing head and neck cancers.
By increasing vaccination uptake, and screening where available, across every community, together with sufficient awareness of concerning symptoms, health systems can reduce the burden of HPV-related cancers, creating a fairer, healthier future for all.
References
1. Serrano B, Brotons M, Bosch FX, Bruni L. Epidemiology and burden of HPV-related disease. Best Pract Res Clin Obstet Gynaecol 2018;47:14–26.
2. UK Health Security Agency. Human papillomavirus (HPV): the green book, chapter 18a. 2013.
www.gov.uk/government/publications/
human-papillomavirus-hpv-the
-green-book-chapter-18a
[Link last accessed June 2026].
3. Palmer TJ, Kavanagh K, Cuschieri K, et al. Sustained impact of bivalent HPV immunisation on CIN incidence over two rounds of cervical screening. Int J Cancer 2026;158(5):1348–60.
4. Cameron RL, Palmer T, Cuschieri K, et al. Assessing real world vaccine effectiveness: A review of Scotland’s approach to monitoring human papillomavirus (HPV) vaccine impact on HPV infection and cervical disease. Vaccine 2024;42(21):126177.
Declaration of competing interests: None declared.
