Population-based analysis of cervical cancer mortality trends following HPV vaccination in England, 2001-2024

HPV vaccination is a key component of cervical cancer elimination strategies. While substantial declines in cervical cancer incidence following HPV vaccination have been observed in several countries, evidence of its effect on mortality is scarce. England introduced a national HPV vaccination program in 2008 for girls aged 12-13 years, achieving 80-90% coverage before the COVID-19 pandemic, with a catch-ip campaign in 2008-2010 for girls aged 14-18 years. A population-based analysis investigated trends in cervical cancer mortality in England from 2001 to 2024. In women aged 20-24 years between 2020 and 2024, in whom vaccination coverage was around 88-90% at age 12-13 years, no deaths occurred, compared with 23.1 expected deaths based on historical rates, corresponding to a mortality reduction of 100% (95% CI 84-100). In earlier births cohorts, who were offered vaccination up to age 18 years with coverage of around 63-87%, mortality reductions of 80% (95% CI 51-94) in women aged 20-24 years in 2015-2019, and 69% (55-79) in women aged 25-29 years in 2020-2024 were observed. The relative risk reduction in vaccinated women was estimated to be 100% (95% CI 81 to 100) in women aged 20-24 years, 100% (89 to 100) in those aged 25-29 years, and 63% (-13 to 100) in those aged 30-34 years. Up until the end of 2024, HPV vaccination in England was associated with a reduction of around 199.6 cervical cancer deaths (95% CI 125.0-274.2). The authors conclude that these findings provide the first robust national-level evidence, albeit observational, that high HPV vaccination coverage is associated with a substantial reduction in cervical cancer deaths.