Research Offers Answers to Improving HPV Vaccine Uptake Among Young Adults
September 1, 2025 6 minutes read
By Melinda Young
The vaccine that helps prevent infection from nine types of human papillomavirus (HPV) that cause numerous cancers and diseases, including cervical, vaginal, vulvar, anal, head and neck, and genital warts, has been proven safe and effective for decades. But vaccine hesitancy has led to low global vaccine coverage.1,2 New research offers answers about why vaccine-eligible young adults are not as enthusiastic about a vaccine that can prevent cancer and infertility, particularly for pregnancy-capable young adults.
The HPV vaccine merges the fields of cancer and sexual and reproductive health, says Namoonga Mantina, PhD, MSPH, MBA, a community outreach manager in the office of community outreach and engagement at the University of Arizona Cancer Center in Tucson. “I wanted to see what was done by other researchers and see what they have heard from young adults and look at areas where there may be challenges and opportunities for clinicians in practice,” Mantina explains. “We began this review in 2023, and it took 18 months to complete.” Mantina and co-investigators looked at 42 studies and a population of young adults, ages 18 to 24 years, to identify barriers to HPV vaccine use.1
One of their findings is that young adults sometimes think they are too old to receive the HPV vaccine; they think it is a childhood vaccine, Mantina notes. “We want people vaccinated as young as possible,” she says. But it is not exclusively for children and adolescents. Some parents decline the vaccine for their children, so those who missed out still can receive it as young adults.
The vaccine is available for people through age 26 years. Even if they have been sexually active and exposed to some types of HPV, the Gardasil 9 vaccine’s coverage protects against nine types of HPV, so it likely would be helpful for most young adults.1,2 Early uptake of the HPV vaccine can result in a lower incidence of cervical cancer over a person’s lifetime. Despite this, it is estimated that HPV vaccination among females is only 15% worldwide. In the United States, the Centers for Disease Control and Prevention (CDC) estimates that 53% of adolescents aged 13-15 years had received the HPV vaccine.1,3
Later uptake also has significant benefits in cancer prevention. It is estimated that more than half of HPV infections that develop into cancer are acquired by the age of 21 years, which means low rates of uptake of the HPV vaccine among children can leave older teens and young adults at risk and in need of the vaccine to prevent new HPV infections.1,4
“How can we continue this conversation with young adults who are making decisions for themselves?” Mantina says. “If their parent had not made that decision to vaccinate them, then there’s still an opportunity for them to get vaccinated and receive the benefit of cancer prevention.”
Another sentiment young adults express about their HPV vaccine hesitancy is that they practice safe sex by using condoms or through abstinence, Mantina says. The challenge for clinicians is to encourage them to keep themselves safe during sexual activity but also to get vaccinated against the common sexually transmitted infection.
In some of the research Mantina reviewed, women thought they were protected from cervical cancer by having an annual Pap smear, and so they did not believe there was a reason to get the vaccine. Clinicians could offer their perspective on why it is important to maximize all opportunities to prevent cancer, including the vaccine and Pap smear.
“Providers can provide information around the importance of the vaccine and how it’s safe and effective in cancer prevention,” Mantina suggests. “We have screening guidelines in the context of the emergence of cancer.” For example, clinicians could talk about how each of us does several things to keep our bodies healthy, including eating well, exercising, and getting enough sleep, she says. “Translate the same approach to something of this nature, where — yes — you go for your regular screenings but also get vaccinated,” Mantina adds.
Another barrier to HPV vaccine uptake among young adults is their belief they are not at risk of infection if they are in a committed and monogamous relationship, she says. “There’s a sense that only people who need the vaccine are those who have multiple partners,” Mantina says. Clinicians can encourage young people to take this simple and safe preventive measure as an additional precaution, just as some people may use contraception even if they have plans to not engage in sexual intercourse.
Sexual identity also can be a barrier: “There’s definitely an opportunity to do more and advocate for HPV vaccination for everyone, regardless of gender and sexual orientation,” Mantina says. “Some men and members of the LGBTQ+ community who desired to be vaccinated did not receive the vaccine,” she adds. “The HPV vaccine is for everyone.” Conditions caused by HPV infection are among the leading causes of death among women globally, she says.
Clinicians who see children ages 9 years and older could discuss HPV vaccination as a cancer prevention tool and emphasize that aspect more than its use in preventing sexually transmitted infections. This could help dispel the concern some parents may have about vaccinating their child for a sexually acquired disease.
“The association of HPV with sexual behavior [leads to the attitude of] ‘I’m not going to vaccinate my child because it’s for sex,’” Mantina explains. “The HPV vaccine really is cancer prevention. Yes, the mode of transmission is sexual in nature, but the heart of this is cancer prevention, and that’s a conversation we can amplify and use to help any adults understand it.”
Institutions can play an important role in increasing uptake of the HPV vaccine. They can create intake forms that ask about patients’ vaccine status. Patients’ answers can open a conversation between the clinician and patient about the HPV vaccine and whether an unvaccinated young adult would like to receive the shot during the clinic visit, she says.
Clinics can make it more convenient for patients to get vaccinated through better scheduling strategies. The current recommendations are for young adults to receive three doses of the HPV vaccine, while for children the recommendation is for two doses, she notes.
“That’s three different appointments the person has to make, so are there reminders in place for the patient to come back for subsequent appointments?” Mantina says. “Is there an electronic medical record alert that notifies the physician that this person is due for their next dose or a first dose? These are just practical steps and processes.”
Another way to improve the HPV vaccination rate would be for U.S. public health organizations to adopt the same recommendation that is being used by many other nations and was approved by the World Health Organization (WHO): a one- or two-dose schedule for girls aged 9 to 14 years and a one- or two-dose schedule for girls and women aged 15-20 years, and two doses within a six-month interval for women older than 21 years.5
A policy change in the United States would be a way to ease the burden of HPV vaccination among people who may have difficulty finding time to visit a clinic three times and/or have insurance coverage issues. WHO says that “a single-dose schedule, referred to as an alternative, off-label single-dose schedule can provide a comparable efficacy and durability of protection to a two-dose regimen.”5
From a clinician’s perspective, it is important to at least get patients in for that first dose of HPV, Mantina says. “Get people in for that first dose; let’s at least get people vaccinated,” she says. “Once they initiate the first dose, it’s a different series of considerations to get them to complete the series: how do we get them to come back?”
Young adults want more active and informed conversations with their doctors. Discussing HPV vaccination gives clinicians an opportunity to have those conversations, Mantina adds. “Just give space for young adults to ask questions and to make sure they are feeling heard,” she says. “Create a space for that human interaction between patients and physicians.”
Melinda Young has been a healthcare and medical writer for 30 years. She currently writes about contraceptive technology.
References
1. Mantina NM, Smith J, Miiro FN, et al. Perspectives of HPV vaccine decision-making among young adults: A qualitative systematic review and evidence synthesis. PLoS One. 2025;20(5):e0321448.
2. Merck. Gardasil 9, human papillomavirus 9-valent vaccine, recombinant. https://www.gardasil9.com/
3. National Cancer Institute. HPV Vaccination. Cancer Trends Progress Report. Last reviewed April 2025. https://progressreport.cancer.gov/prevention/hpv_immunization
4. Burger EA, Kim JJ, Sy S, Castle PE. Age of acquiring causal human papillomavirus (HPV) infections: Leveraging simulation models to explore the natural history of HPV-induced cervical cancer. Clin Infect Dis. 2017;65(6):893-899.
5. World Health Organization. WHO updates recommendations on HPV vaccination schedule. Dec. 20, 2022. https://www.who.int/news/item/20-12-2022-WHO-updates-recommendations-on-HPV-vaccination-schedule
New research offers answers about why vaccine-eligible young adults are not as enthusiastic about a vaccine that can prevent cancer and infertility, particularly for pregnancy-capable young adults.
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