BACKGROUND:
Human Papillomavirus (HPV) remains a premier global public health concern due to its established role in developing multiple malignancies, including cervical, anal, and oropharyngeal cancers1. Historically, HPV vaccination strategies focused on female adolescents, despite HPV and related cancers also being prevalent in men and adults 2,3. From a public health perspective, this issue has been reframed as a life-course immunisation intervention. This review, therefore, addresses the scarcity of evidence on the practical implementation of HPV vaccination in adult immunisation programmes.

METHODS:
A systematic search of PubMed, Scopus, and Google Scholar was conducted in October 2025 for English-language studies published between 2020 and 2025. Studies were included if they tested the effectiveness of HPV vaccines among adult participants or populations ages 18-45 years. Eligible measures of effectiveness included prevalence of HPV, HPV-related cancers, HSILs/CINs, and anogenital warts, as well as their rates of reduction.

RESULTS:
62 high-quality studies were identified. Odds ratios for HPV positivity following vaccination ranged from 0.20 to 0.60. The incidence of genital warts declined substantially, with rate ratios ranging from 0.30 to 0.55. For high-grade cervical lesions (CIN2+), adjusted odds ratios ranged from 0.40 to 0.65, while reductions in precancerous and cancer outcomes showed relative risks between 0.45 and 0.80 in long-term analyses.

CONCLUSIONS:
This review provides consistent evidence that HPV vaccination is associated with substantial reductions in HPV infection, genital warts, high-grade cervical lesions, and precancerous outcomes at the population level. The magnitude and consistency of effects across study designs support HPV vaccination as an effective public health intervention. Furthermore, it provides evidence of the importance of adopting a life-course approach and the considerations outlined by the WFPHA in their Call to Action on HPV in adults 4.