Human papillomavirus (HPV) vaccination coverage in adolescents in England: 2022 to 2023
Published 23 January 2024
Applies to England
© Crown copyright 2024
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Main points
This report presents vaccine coverage data for the routine school-aged human papillomavirus (HPV) immunisation programme in England for the 2022 to 2023 academic year. Results include HPV vaccine coverage estimates of dose 1 and dose 2 for children in school years 8, 9 and 10 (or the equivalent ages) measured up to 31 August 2023.
The main findings of this report are summarised in tables 1a and 1b, table 2 and the figures, which show:
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compared to the previous academic year (2021 to 2022) dose 1 coverage increased by 1.7% in year 8 females to 71.3%, but remained 16.7% lower than pre-pandemic coverage in 2018 to 2019
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dose 1 coverage in year 9 females was 75.7%, which is a 6.1% increase from the reported coverage of 69.6% for the same cohort when they were in year 8 in the previous academic year, but 12.3% lower than pre-pandemic coverage of 88.9% in 2018 to 2019
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dose 1 coverage in year 10 females was 83.2%, a 1.0% increase from the reported coverage of 82.2% for the same cohort when they were in year 9 in the previous academic year
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dose 2 coverage decreased in year 9 and year 10 cohorts in 2022 to 2023 compared to the previous academic year
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dose 2 coverage in year 9 females was 62.9% a decrease of 4.4% compared with 67.3% in 2021 to 2022, and 21% lower than pre-pandemic coverage of 83.9% in 2018 to 2019
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dose 2 coverage in year 10 females was 73.5%, a 6.2% increase from the reported coverage of 67.3% for the same cohort when they were in year 9 in the previous academic year
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coverage in males was lower than females in all cohorts for both doses of HPV
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dose 1 coverage in year 8 males was 65.2%, an increase of 2.8% compared to 62.4% in 2021 to 2022
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dose 1 coverage in year 9 males was 69.7%, which is a 7.3% increase from the reported coverage of 62.4% for the same cohort when they were in year 8 in the previous academic year
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dose 2 coverage in year 9 males was 56.1% compared with 62.4% in 2021 to 2022
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dose 1 coverage in year 10 males was 78.6%, a 1.0% increase from the reported coverage of 77.6% for the same cohort when they were in year 9 in the previous academic year
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dose 2 coverage in year 10 males was 68.5%, a 6.1% increase from the reported coverage of 62.4% for the same cohort when they were in year 9 in the previous academic year
Table 1a. Comparison of HPV vaccine coverage (%) between the 2021 to 2022 academic year and the 2022 to 2023 academic year by dose number and school year: females
| Academic year | Year 8: dose 1 | Year 9: dose 1 | Year 10: dose 1 | Year 8: dose 2 | Year 9: dose 2 | Year 10: dose 2 |
|---|---|---|---|---|---|---|
| 2021 to 2022 | 69.6 | 82.2 | 86.5 | 10.7 | 67.3 | 76.9 |
| 2022 to 2023 | 71.3 | 75.7 | 83.2 | 18 | 62.9 | 73.5 |
| Percentage increase in coverage between school years | n/a | 6.1 | 1 | n/a | 52.2 | 6.2 |
Table 1b. Comparison of HPV vaccine coverage (%) between the 2021 to 2022 academic year and the 2022 to 2023 academic year by dose number and school year: males
| Academic year | Year 8: dose 1 | Year 9: dose 1 | Year 10: dose 1 | Year 8: dose 2 | Year 9: dose 2 | Year 10: dose 2 |
|---|---|---|---|---|---|---|
| 2021 to 2022 | 62.4 | 77.6 | 81.5 | 9.8 | 62.4 | 70.9 |
| 2022 to 2023 | 65.2 | 69.7 | 78.6 | 16.2 | 56.1 | 68.5 |
| Percentage increase in coverage between school years | n/a | 7.3 | 1 | n/a | 46.3 | 6.1 |
Note: tables 1a and 1b include the percentage increase between school years by year group, sex and dose. This comparator is the percentage change in coverage in year group cohorts in 2022 to 2023 compared to when students were in the previous school year in 2021 to 2022. For example, 2022 to 2023 year 9 coverage figures are compared to 2021 to 2022 year 8 figures.
Background to the HPV vaccination programme
On the advice of the Joint Committee on Vaccination and Immunisation (JCVI), an HPV national vaccination programme was introduced in 2008, to protect adolescent females against cervical cancer. At that time, a 3-dose schedule was offered routinely to secondary school year 8 females (aged 12 to 13 years) alongside a catch-up programme targeting females aged 13 to 18 years (1).
In September 2014 (2) the programme changed to a 2-dose schedule based on evidence that showed antibody response to 2 doses of HPV vaccine in adolescent females was as good as 3 doses. Public Health England (PHE) recommended the following:
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the first dose can be given at any time during school year 8
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the minimum time between the first and second dose should be 6 months
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for operational purposes a 12-month gap between the 2 doses is recommended, that is, the first HPV vaccine dose should be offered in year 8 (aged 12 to 13 years) and the second dose should be offered in year 9 (aged 13 to 14 years), as this reduces the number of HPV vaccination sessions required in school
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however, local needs should be considered when planning the programme
In England, the decision about when to offer the 2 HPV vaccine doses is made by NHS England (NHSE) commissioned providers, and so some areas offer both doses in year 8 while others offer HPV dose 1 in year 8 and HPV dose 2 in year 9.
From September 2019 (3), males aged 12 to 13 years became eligible for HPV immunisation alongside females, based on JCVI advice (3). This is the third year that males in year 9 have been offered the HPV vaccine.
In order to evaluate the roll-out of the HPV vaccine to males the vaccine coverage collection was changed to monitor coverage in males and females separately.
From September 2023, the programme changed to a one dose only schedule. This is because the JCVI advised that a one dose HPV vaccine schedule was shown to be just as effective as 2 doses at providing protection from HPV infection.
Methods
Full details of the methodology can be found in the HPV vaccine coverage user guide for data providers.
Data providers must use updated data sources (that is, school rolls for all types of schools or units, plus children schooled at home, or Child Health Information Systems (CHIS)) to identify all eligible females and males in the locality for the academic year. The 2022 to 2023 HPV vaccine coverage was calculated based on the total number of eligible females or males in the target population who had received dose 1 and/or dose 2 of the HPV vaccine for the academic year. Historical annual HPV vaccine coverage reports from academic year 2008 to 2009 to academic year 2021 to 2022 and associated data tables can be found on the UK Health Security Agency (UKHSA) website.
2022 to 2023 was the second year that the data collection tool had the capability to capture dose 1 and dose 2 vaccine coverage for both males and females in all of the year 8, year 9 and year 10 birth cohorts.
In 2022 to 2023, the birth cohorts which coverage data was collected for are as follows:
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school year 8: males (cohort 4) and females (cohort 20) born between 1 September 2009 to 31 August 2010
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school year 9: males (cohort 3) and females (cohort 19) born between 1 September 2008 to 31 August 2009
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school year 10: males (cohort 2) and females (cohort 18) born between 1 September 2007 to 31 August 2008
The aim of including the year 10 data collection was to update the coverage reported for children in school year 9 in the 2021 to 2022 academic year and to assess any impact that catch-up activities have had on improving the low vaccine coverage reported in some areas in the preceding 2019 to 2020 to 2021 to 2022 academic years as a result of the COVID-19 pandemic.
Local authority level HPV vaccine coverage data up to 31 August 2023 was manually uploaded by data providers to the ImmForm (4) website retrospectively, from 1 September 2023 to 1 October 2023. For the purpose of this report, City of London and Hackney local authorities are counted as one local authority because their data is submitted together on ImmForm.
For 49 of 151 local authorities, provisional denominators (the number of children eligible for HPV vaccination) were used to calculate vaccine coverage of one and/or 2 doses of HPV vaccine in year 8, year 9 or year 10. This was due to a fault in the submission form for data which retained these provisional denominator figures rather than the updated actual denominators. Each year, provisional denominators are estimated based on cohort numbers recorded in the previous school year. Therefore, for year 10 students, provisional numbers are based on year 9 student numbers from 2021 to 2022 and for year 9 students, numbers are based on year 8 student numbers from 2021 to 2022.
During the data submission process, the data is usually updated to an actual denominator to reflect changes in the school rolls, including movers into and out of areas. These provisional figures do not therefore account for changes in the size of school cohorts from one year to the next. Based on submitted data, the margin of expected change from provisional to actual denominators is on average 5.4%. Numerators (the number of children vaccinated) are not affected by this issue but, as a result, there may be small under or overestimates in coverage in the 49 affected local authorities. The local authorities affected are marked in the accompanying supplementary data tables.
Results
This report presents annual HPV vaccine coverage data for the ninth year (2022 to 2023) of the 2-dose schedule. The adolescent HPV immunisation programme is a school-based programme, with alternative provision in place for children who are not in mainstream schools. Full data tables of coverage in each school year are available by NHS England commissioning region, UKHSA region, Integrated Care Board (ICB) and local authority in England. UK data is also included.
The routine school-aged HPV immunisation programme was delivered in year 8 and year 9 throughout England in the 2022 to 2023 academic year, with most areas offering opportunistic vaccination for children in year 10 who had missed out on preceding academic years.
The first dose of HPV vaccine was offered to children in year 8 in all but one (who offered dose 1 in year 9) of 151 local authorities. The second dose was offered to all pupils in year 8 in 53 local authorities, but the majority offered it in year 9.
HPV vaccine coverage of dose 1 for year 8 females in 2022 to 2023 (born 1 September 2009 to 31 August 2010) was 71.3% in England, 1.7 percentage points higher than 2021 to 2022 and 16.7% lower than uptake pre-pandemic (2018 to 2019). Coverage by NHS commissioning region ranged from 59.0% (London) to 77.4% (East of England). Coverage in each region was between 10.8% (East of England) and 24.8% (London) lower than coverage prior to the COVID-19 pandemic reported in the 2018 to 2019 academic year (figure 1).
HPV vaccine coverage of dose 1 for year 8 males in 2022 to 2023 (born 1 September 2009 to 31 August 2010) was 65.2% in England, 2.8 percentage points higher than coverage reported in 2021 to 2022, but 5.8% lower than in 2020 to 2021 (figure 2). Coverage by NHS commissioning region ranged from 55.0% in London to 71.3% in the East of England.
National coverage for dose 1 in year 8 males was 6.1 percentage points lower than that in year 8 females this academic year. All NHS regions had vaccinated a greater number of females, with the greatest difference of 7.3 percentage points in the Midlands region (figure 3).
HPV vaccine coverage in England for dose 1 in year 9 females in 2022 to 2023 was 75.7%. This is a 6.1% increase from the reported coverage of 69.6% for the same cohort when they were in year 8 in the previous academic year (table 2), but is 6.5 percentage points lower than coverage achieved in year 9 females in the previous year (82.2%).
HPV vaccine coverage in England for females completing a 2-dose HPV schedule by year 9 (born 1 September 2008 to 31 August 2009) was 62.9%. This is 4.4 percentage points lower than the 67.3% achieved in 2021 to 2022 and 21% lower than pre-pandemic (2018 to 2019). Two-dose coverage in year 9 females ranged from 52.9% (London) to 71.9% (South East) by region in 2022 to 2023. Coverage in all regions was lower than coverage prior to the COVID-19 pandemic reported in the 2018 to 2019 academic year 9 (figure 4).
HPV vaccine coverage in England for dose 1 in year 9 males in 2022 to 2023 was 69.7%. This is a 7.3 percentage point increase from the reported coverage of 62.4% for the same cohort when they were in year 8 in the previous academic year (table 2), but is 7.9 percentage points lower than coverage achieved in year 9 males in the previous year (77.6%). National coverage for year 9 males was 6.0 percentage points lower than in year 9 females this academic year.
HPV vaccine coverage in England for males completing a 2-dose HPV schedule by year 9 (born 1 September 2008 to 31 August 2009) was 56.1%, a decrease of 6.3 percentage points compared to the 2021 to 2022 academic year. Coverage by NHS commissioning regions ranged from 45.7% (London) to 64.7% (South East). National coverage of 2 doses for year 9 males was 6.8 percentage points lower than in year 9 females this academic year.
Data providers were asked to report an updated cumulative coverage for dose 1 and 2 in year 10 students, who first became eligible when they were in year 8 in 2020 to 2021, to assess the impact of any catch-up activities in 2022 to 2023. Data providers covering 148 out of 150 local authorities provided a return and are included in this analysis. No catch-up activity in year 10 was reported for dose 1 in 28 local authorities, including 24 which reported no dose 2 catch-up either.
Coverage for HPV dose 1 in year 10 girls was 83.2%, representing an increase of 1.0 percentage point compared to the same cohort when coverage was measured at the end of year 9 in the 2021 to 2022 academic year (table 2).
Coverage for HPV dose 1 in year 10 girls ranged by NHS commissioning region from 75.4% (London) to 87.6% (East of England). Compared to the same cohort when coverage was measured at the end of year 9 in the 2021 to 2022 academic year, in one region (South East), coverage decreased marginally (1.3%) due to population movements in and out of the area. In the other regions coverage increased between 0.3% (North West) and 3.8% (East of England).
Coverage for HPV dose 1 in year 10 males was 78.6%, representing an increase of 1.0 percentage point compared to the same cohort when coverage was measured at the end of year 9 in the 2021 to 2022 academic year. Coverage ranged by NHS commissioning region from 70.3% (London) to 83.8% (East of England). Compared to the same cohort when coverage was measured at the end of year 9 in the 2021 to 2022 academic year, in one region (South East), coverage decreased marginally (1.9%) due to population movements in and out of the area. Coverage in London remained the same, while in the other 5 regions coverage increased between 0.7% (North West) and 4.8% (East of England). National coverage for year 10 males was 4.6 percentage points lower than in year 10 females this academic year.
Coverage for year 10 girls completing the 2 dose course was 73.5%, representing an increase of 6.2 percentage points compared to the same cohort when coverage was measured at the end of year 9 in the 2021 to 2022 academic year. Coverage ranged by region from 64.8% (London) to 80.0% (South East). By region, coverage increased between 1.8% (London) and 14.2% (East of England).
Coverage for year 10 males completing the 2 dose course was 68.5%, representing an increase of 6.1 percentage points compared to the same cohort when coverage was measured at the end of year 9 in the 2021 to 2021 academic year. Coverage by region ranged from 60.7% (London) to 75.0% (South East). By region, coverage increased between 1.0% (London) and 13.9% (East of England). National coverage for 2 doses for year 10 males was 5.0 percentage points lower than in year 10 females this academic year.
For both dose 1 and dose 2 in males and females, the gains in coverage when measured in year 10 nationally and by region were much smaller this academic year than in the 2021 to 2022 year, indicative of less catch-up activity taking place for this cohort.
Table 2. HPV vaccine coverage (%) among cohorts assessed in the 2022 to 2023 academic year by dose number, school year and sex
| Date of birth range of children included | Cohort number | Sex | Dose | Year 8 | Year 9 | Year 10 |
|---|---|---|---|---|---|---|
| 1 September 2009 to 31 August 2010 | Cohort 20 | Female | Dose 1 | 71.3 | not collected yet | not collected yet |
| 1 September 2009 to 31 August 2010 | Cohort 20 | Female | Dose 2 | 18.0 | not collected yet | not collected yet |
| 1 September 2008 to 31 August 2009 | Cohort 19 | Female | Dose 1 | 69.6 | 75.7 | not collected yet |
| 1 September 2008 to 31 August 2009 | Cohort 19 | Female | Dose 2 | 10.7 | 62.9 | not collected yet |
| 1 September 2007 to 31 August 2008 | Cohort 18 | Female | Dose 1 | 76.6 | 82.2 | 83.2 |
| 1 September 2007 to 31 August 2008 | Cohort 18 | Female | Dose 2 | 12.7 | 67.3 | 73.5 |
| 1 September 2009 to 31 August 2010 | Cohort 4 | Male | Dose 1 | 65.2 | not collected yet | not collected yet |
| 1 September 2009 to 31 August 2010 | Cohort 4 | Male | Dose 2 | 16.2 | not collected yet | not collected yet |
| 1 September 2008 to 31 August 2009 | Cohort 3 | Male | Dose 1 | 62.4 | 69.7 | not collected yet |
| 1 September 2008 to 31 August 2009 | Cohort 3 | Male | Dose 2 | 9.8 | 56.1 | not collected yet |
| 1 September 2007 to 31 August 2008 | Cohort 2 | Male | Dose 1 | 71.0 | 77.6 | 78.6 |
| 1 September 2007 to 31 August 2008 | Cohort 2 | Male | Dose 2 | 11.9 | 62.4 | 68.5 |
Figure 1. Dose 1 HPV vaccine coverage by NHS commissioning region for the routine female cohort (year 8) academic year 2018 to 2019 up to academic year 2022 to 2023 in England
Dose 1 HPV vaccine coverage for the routine female cohort (year 8) in all but one region (London) in 2022 to 2023 was higher than coverage reported in the 2021 to 2022 academic year, and remains lower than pre-pandemic levels reported for the 2018 to 2019 academic year in all regions. In 2022 to 2023, coverage by NHS commissioning region ranged from 59.0% (London) to 77.4% (East of England).
Figure 2. Dose 1 HPV vaccine coverage by NHS commissioning region for the routine male cohort (year 8) academic year 2019 to 2020 up to academic year 2022 to 2023 in England
Dose 1 HPV vaccine coverage for the routine male cohort (year 8) in all but one region (London) in 2022 to 2023 was higher than coverage reported in the 2021 to 2022 academic year. In 2022 to 2023, coverage by NHS commissioning region ranged from 55.0% (London) to 71.3% (East of England).
Figure 3. Dose 1 HPV vaccine coverage by NHS commissioning region for the routine female and male cohort (year 8) in academic year 2022 to 2023 in England
Dose 1 HPV vaccine coverage for the routine female cohort (year 8) was higher than the dose 1 HPV vaccine coverage for the routine male cohort (year 8) in all NHS commissioning regions in the 2022 to 2023 academic year.
Figure 4. Dose 2 (completed course) HPV vaccine coverage by NHS Commissioing Region for the routine female cohort (year 9) academic year 2018 to 2019 up to academic year 2022 to 2023 in England
Second dose coverage in year 9 females ranged from 52.9% (London) to 71.9% (South East) by NHS commissioning region in the 2022 to 2023 academic year and remains lower than pre-pandemic levels in all areas.
Factors affecting HPV vaccine coverage estimates in academic year 2022 to 2023
From March 2020, the COVID-19 pandemic led to disruption of the school-based immunisation programme delivery, impacting upon HPV vaccine coverages estimates. The biggest impact was observed in the 2019 to 2020 academic year when all schools where closed in the first national lockdown (5). Throughout the 2020 to 2021 academic year school attendance rates in England were lower than normal and in January 2021 schools were closed to all, except children of key workers and vulnerable children, with a phased reopening of secondary schools from March 2021. Staff absences in both schools and school-aged immunisation services (SAIS) also added to the disruption. In the 2021 to 2022 academic year, school attendance rates in England remained lower than normal until the ‘Living with COVID-19’ guidance was implemented from February 2022 and all restrictions were lifted (6). Vaccine coverage in 2021 to 2022 improved significantly but was still not back up to pre-pandemic levels.
Vaccine coverage for HPV dose 1 in the 2022 to 2023 academic year shows signs of recovery across year 8 and year 9 male and female cohorts but is still considerably lower than pre-pandemic levels. SAIS providers have continuously been focusing on HPV programme recovery since the pandemic and have robust catch-up plans in place for HPV based on population need. In 2022 to 2023, additional pressures on school-age immunisation services included an expanded influenza immunisation programme targeting secondary school pupils. Following a late policy announcement, implementation of the influenza programme in schools continued into the spring term, coinciding with when HPV vaccines are often delivered.
Coverage (of 1 and/or 2 doses) may be over or under-estimated for some local authorities due to movement of students in and out of schools during the academic year not being accurately reflected in the denominators and/or numerators for some data providers. This may be exacerbated in the data presented here as, for a third of local authorities, provisional denominators were used to calculate vaccine coverage of one and/or 2 doses of HPV vaccine in year 8, year 9 or year 10, as explained above.
Coverage of the second dose was much lower than the previous academic year. This may be in part due to some areas anticipating the move to a one-dose schedule which came into effect on 1 September 2023.
References and notes
1. JCVI (2008). ‘Statement on human papillomavirus vaccines to protect against cervical cancer (July)’
2. PHE, DH, NHS England (2014). Tripartite letter
3. JCVI (2018). ‘Statement on HPV vaccination (July)’
4. ImmForm is the system used by UKHSA to record vaccine coverage data for some immunisation programmes and to provide vaccine ordering facilities for NHS England.
5. Department for Education (DfE) (2021). ‘Attendance in education and early years settings during the coronavirus (COVID-19) pandemic (November)’
6. DfE (2022). ‘Attendance in education and early years settings during the coronavirus (COVID-19) pandemic (July)’
About theses statistics
Our statistical practice is regulated by the Office for Statistics Regulation (OSR). OSR sets the standards of trustworthiness, quality and value in the Code of Practice for Statistics that all producers of official statistics should adhere to. You are welcome to contact us directly by emailing adolescent@ukhsa.gov.uk with any comments about how we meet these standards. Alternatively, you can contact OSR by emailing regulation@statistics.gov.uk or via the OSR website.
UKHSA is committed to ensuring that these statistics comply with the Code of Practice for Statistics. This means users can have confidence in the people who produce UKHSA statistics because our statistics are robust, reliable and accurate. Our statistics are regularly reviewed to ensure they support the needs of society for information.
UKHSA will next be conducting a formal review of these statistics in the summer of 2024. Following this review, an implementation plan will be developed to continue to improve the trustworthiness, quality and value of these statistics. Key continuous improvements made will be highlighted within future releases of these statistics for transparency.