Introduction

Human Papillomavirus (HPV) is the most common sexually transmitted infection worldwide, with an estimated 80% of sexually active individuals acquiring the virus at some point in their lifetime.1,2 While the majority of HPV infections are transient, high-risk genotypes, particularly HPV 16 and 18, were responsible for more than 690,000 new cancer diagnoses globally in 2018. 3 Existing evidence suggests that HPV is known to cause more than 90% of anal and cervical cancers, 70% of oropharyngeal and vaginal cancers, and 60% of vulvar and penile cancers, 4 highlighting the importance of optimizing the prevention of this pervasive public health issue.

Vaccination remains one of public health’s greatest achievements, effectively reducing morbidity and mortality from infectious diseases worldwide. 5 Coupled with surveillance and screening, vaccination stands as the cornerstone to HPV prevention. 6 In May 2018, the World Health Organization’s Director-General issued a global call to eliminate cervical cancer, emphasizing the need to vaccinate 90% of 15-year-old girls, screen 70% of women by ages 35 and 45 (respectively), and treat 90% of women with pre-cancerous and cancerous HPV by 2030. 7 Despite this recommendation, rates of cervical cancer in Canada are increasing by approximately 3.7% per year, marking its first significant increase since 1984. 8 Furthermore, HPV-related oropharyngeal cancers are also increasing, with rates being 4.5 times more prevalent in males than females, emphasizing the importance of gender-neutral vaccination.9,10

Historically, societal narratives have framed HPV as predominantly a women’s health issue, resulting in a gendered approach to vaccination. 11 While widespread vaccine uptake in females has been proposed as a way of achieving herd immunity, this approach is inherently limited; it renders males vulnerable to HPV infections and fails to protect populations with low vaccine uptake, including young adults who were not eligible for school-based vaccination, transgender individuals and men who have sex with men (MSM). 9 According to a systematic review and meta-analysis exploring HPV vaccine uptake in Canada, only 56% of individuals reported being vaccinated against HPV in 2017, 1 which underscores the importance of mitigating the multi-level barriers that exacerbates the persistence of this public health issue.

This paper will discuss the need to normalize inclusive HPV vaccination in Canada by: (1) briefly outlining the evolution of HPV vaccination, (2) identifying disparities in HPV vaccine uptake, and (3) discussing recommendations to enhance HPV vaccine delivery by optimizing healthcare provider (HCP) recommendation, improving community-based vaccination services, and refining HPV vaccine communication/messaging.