Protecting Healthcare Workers Through Vaccination in Low- and Lower-Middle-Income Countries: Barriers and Next Steps

Healthcare workers play a vital role in providing medical care to individuals and communities. However, their work puts them at a higher risk of exposure to infectious diseases, including vaccine-preventable ones, than the general public. Vaccination is therefore an important part of protecting healthcare workers, supporting patient safety, and maintaining resilient health systems.

The World Health Organization (WHO) recommends vaccinations for healthcare workers, including BCG (tuberculosis), hepatitis B, polio, diphtheria, measles, rubella, meningococcal disease, influenza, varicella, pertussis, and COVID-19. Recommendations may vary by vaccine, occupational exposure, and national immunization guidance. Yet, despite established recommendations, health worker vaccination programs are not consistently implemented, particularly in low- and lower-middle-income countries.

The challenge extends beyond vaccine availability. Healthcare workers also need access to affordable vaccination, clear occupational immunization policies, reliable information, and programs that make vaccination part of routine workplace health and safety.

Why Routine Vaccination of Healthcare Workers Matters

Routine vaccination of healthcare workers helps protect them from vaccine-preventable infectious diseases and reduces the risk of transmission to patients and colleagues. It can also help prevent outbreaks that put additional pressure on healthcare systems and increase the costs of treating infected individuals.

Moreover, healthcare workers who are protected against vaccine-preventable diseases are less likely to miss work due to illness or infection, which can support workforce confidence and productivity. This is essential for maintaining quality healthcare and improving overall healthcare system efficiency. Similarly, vaccinated healthcare workers may feel more confident performing their duties, as they are less likely to experience stress and anxiety related to occupational exposure.

Protecting healthcare workers through vaccination is therefore an important component of occupational health and safety. It also demonstrates governments’ and healthcare organizations’ commitment to the people who deliver essential health services.

The WHO’s Implementation Guide for Vaccination of Health Workers provides guidance for countries seeking to establish or strengthen vaccination programs. It is intended for policy-makers, immunization program managers, healthcare facility managers, professional associations, and organizations representing health workers.

Despite the importance of routine vaccination, implementing policies for healthcare workers in low- and lower-middle-income countries still faces several challenges. In a recent article, researchers from the World Federation of Public Health Associations (WFPHA) and its International Immunization Policy Taskforce analyzed these barriers, proposed policy implementation recommendations, and examined the role of partnerships.

Main Barriers to Healthcare Worker Vaccination in Low- and Lower-Middle-Income Countries

According to the WFPHA policy and the research underpinning it, the main barriers to implementing routine vaccination policies for healthcare workers in low- and lower-middle-income countries include insufficient funding, limited vaccine availability, the absence of specific vaccination schedules for healthcare workers, a lack of evidence-based data, vaccine hesitancy, beliefs, and low health literacy.

These barriers are interconnected and can prevent healthcare workers from accessing vaccines even when recommendations and vaccination infrastructure exist.

1. Lack of Funding and Vaccine Availability

Funding shortages are often a major obstacle to introducing and maintaining effective vaccination programs. In low- and lower-middle-income countries, healthcare workers may be expected to pay for their own vaccinations rather than receiving them free of charge through their employer or national health system.

Although Gavi, the Vaccine Alliance, has made significant contributions to global immunization, funding and vaccine availability remain challenges for programs seeking to protect healthcare workers against a range of diseases. A lack of appropriate vaccines can further complicate implementation.

2. Lack of Evidence-Based Data

More research is needed on vaccination among healthcare workers in low- and lower-middle-income countries. Without reliable national data on vaccination coverage, occupational exposure, and the burden of vaccine-preventable diseases among healthcare workers, policy-makers may struggle to identify gaps and allocate resources effectively.

Evidence-based research, including studies examining disability-adjusted life years and quality-adjusted life years, could help inform policy decisions. Meta-analyses could also support developing and implementing appropriate strategies.

3. Vaccine Hesitancy, Beliefs, and Low Health Literacy

Vaccine hesitancy among healthcare workers, including concerns shaped by religious beliefs, misinformation, and limited awareness, is another important barrier to vaccine uptake.

In some settings, medical training does not provide sufficient education or opportunities to develop knowledge about vaccination. Even among trained health professionals, religious views and other personal beliefs can influence attitudes towards vaccines. Understanding these factors is important when designing appropriate awareness, education, and sensitization initiatives.

4. Lack of Dedicated Vaccination Schedules for Healthcare Workers

Another challenge is the lack of specific vaccination schedules and policies for healthcare workers. When immunization programs focus mainly on children and pregnant women, healthcare workers may not be recognized as a priority group requiring dedicated vaccination services.

Without clear schedules, designated funding, and institutional responsibility, vaccination can remain inconsistent across healthcare facilities and professional groups.

Recommendations for Improving Healthcare Worker Vaccination Policies

The WFPHA policy highlights several recommendations to address these barriers and strengthen routine vaccination programs for healthcare workers in low- and lower-middle-income countries.

These include:

• Expanding existing vaccination initiatives: Explore opportunities to extend the COVAX initiative to cover healthcare workers and build on vaccination infrastructure established during the COVID-19 pandemic.
   
• Building strategic partnerships: Strengthen collaboration with the WHO, Gavi, governments, universities, and communities to support policy development, funding, and implementation.
   
• Improving access and affordability: Consider mandatory insurance for healthcare workers that includes vaccination, and work towards providing recommended immunizations free of charge to recipients.

   

• Collecting national data: Develop systems to collect and monitor data on healthcare worker vaccination to help policymakers identify gaps and evaluate progress.
   
• Increasing awareness and health literacy: Strengthen vaccination education at university level and partner with health-related student organizations to improve awareness among future healthcare professionals.
  
  
• Strengthening advocacy: Promote action at different levels, from hospitals and healthcare institutions to national governments, through public health associations, academic institutions, and professional networks.
  
  
• Establishing dedicated vaccination schedules and funding: Introduce specific vaccination schedules and allocate resources for healthcare workers, as is done for other priority groups, including children and pregnant women.
  
  
• Integrating vaccination into occupational health and safety: Include healthcare worker vaccination in occupational safety plans and workplace health policies.

The Role of Partnerships in Implementing Vaccination Policies

Partnerships are essential to overcoming the challenges associated with healthcare worker vaccination. The WHO, Gavi, the World Bank, UNICEF, national governments, universities, public health associations, and healthcare organizations all have a role.

Ministries responsible for implementing vaccination policies should be involved from the beginning. Early engagement can help ensure recommendations align with national priorities, clarify implementation responsibilities, and consider necessary resources.

National public health associations can also support advocacy efforts by working with governments, ministries of health, healthcare professionals, and academic institutions. Collaboration with universities and schools of public health can strengthen education and awareness, while partnerships with health-related student organizations can help introduce vaccination literacy early in professional training.

At the healthcare facility level, public health specialists can work with hospital directors and occupational health teams to drive local progress. Once governments develop the necessary plans and policies, public health professionals should be trained to support implementation.

The WHO’s Implementation Guide for Vaccination of Health Workers provides further guidance on establishing and strengthening these programs. In addition, a review of health worker vaccination programs in low-, middle-, and upper-middle-income countries identified the use of existing immunization infrastructure, including the WHO Expanded Program on Immunization, and effective program management as important facilitators.

These findings reinforce the value of building on existing systems and partnerships rather than developing vaccination programs in isolation.

Turning Recommendations into Action: The Importance of Government Commitment

Implementing these recommendations requires governments’ genuine commitment to protecting healthcare workers. Regrettably, many governments have yet to prioritize protecting healthcare workers as essential to their nations’ well-being and prosperity. Consequently, this lack of prioritization hinders the successful implementation of the proposed recommendations, despite their potential for positive outcomes.

The WFPHA policy aims to support national public health associations and professionals worldwide in their advocacy efforts with governments and other organizations. Routine vaccination of healthcare workers aligns with international recommendations and standards set by organizations such as the WHO and the Centers for Disease Control and Prevention.

A dedicated policy for routine vaccination would send a clear message that governments and healthcare organizations are committed to the health and safety of their workers and the communities they serve. By implementing such policies, governments and organizations can encourage vaccine uptake, reduce outbreak risk, and strengthen protection across healthcare settings.

The WFPHA calls on governments to prioritize immunizing healthcare workers within national vaccination programs. This includes ensuring access to recommended vaccines free of charge, establishing dedicated vaccination schedules, collecting reliable data, and integrating immunization into occupational health and safety plans.

Protecting healthcare workers is an essential investment in health system resilience. Those who care for others must have access to the protection they need to work safely. Governments, public health associations, healthcare organizations, and international partners all have a role in turning this commitment into action.

Find the original article here.

Preventing death and disease from Respiratory Syncytial Virus (RSV) and Pneumococcal Disease in all our children

RSV and pneumococcal disease are longstanding threats to child health, but we are at a turning point: after decades of research, we now have safe and effective tools that can greatly reduce severe disease and hospitalization in young children.

With this Call to Action, the World Federation of Public Health Associations (WFPHA) and supporting leaders and organizations aim to catalyze urgent, equitable, and sustained investment in protecting every child against preventable respiratory disease.

By doing so, we take a decisive first step in a broader, lifelong commitment: a life-course approach to immunization that safeguards health not just in the first months of life, but at every stage.

Preventing RSV and Pneumococcal Disease in Every Child

Pneumonia is preventable

Pneumonia is the leading infectious killer of children under five. It is not inevitable; it is preventable.

RSV is the single most important cause of severe pneumonia in infants globally. Pneumococcal disease is the second. Together they account for the majority of childhood pneumonia deaths. Both are preventable.

RSV also causes bronchiolitis and other RSV-attributable respiratory illnesses.

Yet the children who bear the greatest burden have the least access to prevention.

We have the tools to prevent severe respiratory disease

We have the tools. We need the political will. We need to act urgently.

Two WHO SAGE-endorsed approaches can prevent severe RSV disease in infants:

• RSV prevention: RSV long-acting monoclonal antibody interventions or RSV maternal vaccination must be introduced and expanded.
• Pneumococcal disease prevention: The pneumococcal conjugate vaccine (PCV), already widely available, must be maintained and expanded.

Particular emphasis is needed on RSV because PCV is already included in many national immunization programs, while an advocacy gap remains for RSV.

The burden of RSV in children

More than 3.6 million children under five are hospitalized each year because of RSV, creating recurring strain on pediatric wards and ICU capacity, especially during seasonal peaks.

Approximately 100,000 children under five die from RSV-attributable respiratory illness annually, and 97% of RSV deaths occur in low- and middle-income countries.

Pneumonia also claims the lives of approximately 700,000 children under five each year.

Countries should make evidence-based immunization policy decisions based on local epidemiology, disease burden, health system readiness, and national public health goals.

Immunization is an investment

Prevention is one of the most cost-effective government investments.

Immunization programs overall are estimated to return $20–$52 for every $1 invested.

Evidence from different settings demonstrates the potential economic value of RSV prevention. In Chile, nirsevimab was cost-saving. In Spain, a universal long-acting monoclonal antibody program averted 215,878 RSV events and saved approximately €48 million in direct costs. In Canada, approximately 47,609 RSV health-related events were averted, with around CAD$45 million in healthcare savings.

The key takeaway is clear: prevention is an investment, not a cost. A major barrier is budget silos, where vaccine and drug budgets may sit in separate ministries or funding streams.

Results can be visible within one year

Act today.

In one year:

• Pediatric RSV hospitalizations can fall by up to 88%.
• ICU admissions can drop by up to 90%.

Results are visible, measurable, and politically rewarding.

Every country needs an approach suited to its context

There is no one-size-fits-all approach. Every country must select the approach best suited to its context, products, and system.

WHO recommends long-acting monoclonal antibody or maternal vaccination for universal implementation. The choice depends on infrastructure and delivery capacity, and some countries may use both.

RSV seasonality varies by region and climate. Local epidemiology and timing should guide strategy.

Alongside PCV, RSV immunization provides a synergistic shield against two leading infectious causes of severe childhood pneumonia.

A Call to Action for RSV Immunization and PCV

Governments and policymakers

WFPHA calls on all stakeholders, including government ministers, politicians and policymakers, health professionals, funders, industry, community leaders and civil society, to act urgently and decisively to make RSV immunization a national priority in every country, for every child, while maintaining, simplifying and strengthening PCV immunization.

Politicians and policymakers should:

• Prioritize RSV prevention alongside PCV.
• Allocate funding and bridge vaccine and drug budget silos.
• Set a national target for RSV coverage for every infant by next season.
• Enhance surveillance.
• Enhance real-world evidence.

Health professionals

Health professionals have a critical role in integrating RSV and PCV prevention into care pathways and advocating for national action.

They should:

• Integrate RSV and PCV into antenatal, neonatal and pediatric pathways as appropriate.
• Advocate for NITAG and HTA consideration.
• Engage professional societies and trusted voices.
• Monitor hesitancy toward long-acting monoclonal antibodies.
• Strengthen training.
• Combine RSV and PCV advocacy in every vaccination engagement.

Experience from Murcia, Stanford and Zurich demonstrates how health-system integration, continuous training, parent education, eligibility checks and opportunities for discussion can support high uptake and reduce equity gaps.

Funders, industry and interest groups

Funders, industry and interest groups should:

• Fund country-level economic analyses and budget impact models.
• Invest in production capacity when appropriate.
• Finance surveillance and real-world data.
• Close access gaps through tiered pricing, expanded LMIC regulatory filings, and manufacturing and supply commitments.
• Ensure RSV and PCV financing fit coherent investment strategies.

Access depends on functioning markets and predictable supply. Clear demand forecasting, healthy markets, multiple products, appropriate manufacturing capacity, and market-shaping mechanisms are important to ensuring that children can benefit from available prevention tools.

Civil society and community leaders

Civil society, community leaders, and community health workers can translate evidence into accessible language, build awareness and acceptability, and elevate the prioritization of infant pneumonia prevention.

They should:

• Amplify demand for infant pneumonia prevention.
• Counter misinformation with accessible and culturally appropriate narratives.
• Advocate to elected representatives through patient associations.
• Engage faith and community leaders.
• Champion equity so no child is unprotected by geography, income, or ethnicity.

Measure the burden. Measure the impact. Make success visible.

Surveillance is not universal, making robust RSV and PCV surveillance an immediate priority.

Countries should:

• Build baseline burden estimates.
• Establish standardized reporting, case detection, and laboratory confirmation.
• Monitor serotypes where appropriate.
• Conduct post-introduction monitoring.
• Collect first-season impact data.
• Maintain pharmacovigilance.
• Share national data globally.
• Communicate results publicly.
• Advocate for RSV to be included on notifiable disease lists where appropriate.
• Maintain virological surveillance, including monitoring of mutations.

A practical eight-step framework can support implementation:

1. Know your burden.
2. Assess your system.
3. Check product access.
4. Run the numbers.
5. Gauge community readiness.
6. Engage your NITAG.
7. Integrate and launch.
8. Measure and adapt.

Equity must remain at the center

Science alone does not drive policy. Advocacy requires clear, emotionally resonant narratives.

Every child, wherever born, deserves a first birthday free from vaccine-preventable disease.

RSV and PCV prevention together are a statement of equity. The burden falls hardest on families vulnerable to structural disadvantage, including differences related to ancestry, economic status, and other social factors.

Long-acting monoclonal antibodies are a new therapeutic class that parents and caregivers may not understand. For some hesitant families, this can also become a communication asset when the approach is explained clearly.

The data are strong. The tools exist.

Every day without action means preventable deaths.

This is a rare, urgent, and timely opportunity to protect countless children from severe respiratory disease.

The WFPHA and those who recognize the importance of this opportunity call on all organizations, professionals and citizens who seek fairer, healthier and more equitable societies to join us by signing this document and committing to drive the changes outlined in the Call to Action.

Learn more: WHO: Respiratory syncytial virus (RSV) | UNICEF: Pneumonia in children

Read the original call to action

Watch the call to action video with Michael Moore, Chair of the Global Taskforce on Immunization Policy

Maternal Health Policy: Recommendations for Equitable Pregnancy Care

Pregnancy is a critical period that shapes the health and well-being of women, infants, families, and communities. It underpins optimal fetal growth and development. Despite a 40% reduction in the global maternal mortality ratio (the number of mothers dying from pregnancy or childbirth per 100,000 live births) between 2000 and 2023, progress has slowed over the last decade.

Achieving the Sustainable Development Goal (SDG) target of 70 maternal deaths per 100,000 live births by 2030 will require an annual reduction of nearly 15% over the next seven years, compared with the average annual reduction of 2.2% achieved over the past 15 years.

Progress is hampered by the complex biological, social, cultural, economic, and environmental determinants of maternal health. These exposures and risk factors directly influence fetal growth, placental function, and developmental trajectories.

Maternal Health Policy Context

Governments at all levels have a responsibility to protect women’s health, rights, and well-being during pregnancy. This includes ensuring comprehensive and equitable access to quality care that supports maternal health and optimal fetal growth and development.

Evidence-based antenatal, intrapartum (labor and delivery), and postnatal care improves maternal and newborn outcomes and forms the core of WHO recommendations. However, translating global guidance into practice remains challenging, particularly in countries bearing the greatest burden of maternal morbidity and mortality. A broader, multipronged approach is needed to address the determinants of maternal health beyond the healthcare system.

Preventable maternal mortality is not solely attributable to biological factors related to pregnancy, childbirth, and the postnatal period. It also reflects persistent inequities in global health and socioeconomic development. These inequities contribute to poor fetal growth, adverse birth outcomes, and compromised early development, perpetuating intergenerational cycles of disadvantage. In 2023, countries classified as being in conflict accounted for 61% of global maternal deaths despite representing only 25% of global live births. Emerging evidence also links climate change drivers with adverse maternal and neonatal health outcomes.

Indigenous women, women from refugee and migrant backgrounds, adolescents, women living in poverty or remote areas, and women with disabilities or complex social circumstances face disproportionately higher rates of stillbirth, obstetric complications, fetal growth restriction and adverse neonatal outcomes.

These disparities are rooted in structural discrimination, limited access to high-quality care, social exclusion and systemic barriers to support. Maternal and neonatal health must therefore be prioritized in the planning and monitoring of pregnancy-related programs.

International commitments and implementation

Progress requires investment and capacity building to achieve universal health coverage and strengthen prevention, early identification of complications, health literacy and continuity of care throughout pregnancy. Woman-centered care, grounded in autonomy, dignity, respect and cultural safety, is essential to building trust and achieving equitable health outcomes.

Pregnant people face heightened vulnerabilities during public health crises, including pandemics, climate-related disasters, forced displacement and humanitarian emergencies. Health systems must ensure continuity of pregnancy care, safeguard human rights and maintain access to essential services that support healthy fetal development. These measures are central to emergency preparedness and response. Promoting pregnancy health therefore requires a holistic approach that integrates clinical care, health promotion, social support and rights-based policy action.

Purpose and Scope of the Policy

This policy statement provides a framework to guide governments, health systems, civil society and global partners in promoting the health, rights and wellbeing of all pregnant people. It emphasizes a rights-based, equity-focused and woman- and person-centered approach that integrates health promotion, quality clinical care and social support throughout pregnancy and the postnatal period.

Recommendations for Equitable Pregnancy Care

The World Federation of Public Health Associations recommends that Public Health Associations and health professionals advocate for the following actions:

1. Promoting a Healthy Lifestyle During Pregnancy

Promoting healthy behaviors during pregnancy is central to preventing adverse maternal and neonatal outcomes. The WHO recommends education and counseling to support a healthy diet by increasing the diversity and amount of food consumed, promoting adequate but not excessive weight gain through sufficient, balanced protein and energy intake, and encouraging consistent use of micronutrient supplements, food supplements, or fortified foods. Nutrition guidance must be culturally appropriate and tailored to individual needs.

Safe, regular physical activity throughout pregnancy, aligned with guidelines, helps reduce complications such as gestational diabetes and hypertensive disorders. Women should receive clear guidance tailored to their health status and stage of pregnancy.

Preventing harmful exposures

WHO guidelines recommend routine screening for tobacco use, vaping, alcohol consumption, substance use, and prescription medications during pregnancy. Women should be offered stigma-free, supportive interventions, including motivational interviewing and referral to specialized harm-reduction or cessation services when needed. A zero-alcohol recommendation should be consistently communicated before and during pregnancy to prevent Fetal Alcohol Spectrum Disorder and other harms resulting from prenatal alcohol exposure.

Oral health is an essential component of antenatal care. Preventive dental care and timely treatment reduce the risk of periodontal disease, which is associated with adverse pregnancy outcomes. Guidance on safe sexual activity during pregnancy should address common myths and concerns.

2. Advancing Quality, Woman-Centred Pregnancy Care

Improving pregnancy outcomes requires high-quality, woman-centered maternity care that respects the rights, dignity and autonomy of all pregnant people. Health systems must provide respectful, culturally safe care grounded in shared decision-making, enabling women to make informed choices about pregnancy, birth and postnatal care.

Continuity-of-care models, particularly those led by midwives, can improve outcomes and strengthen trust, safety and satisfaction. Quality pregnancy care must also include diverse populations.

3. Providing Essential Antenatal, Birth and Postnatal Care

The most common direct causes of maternal injury and death include excessive blood loss, infection, high blood pressure, unsafe abortion and obstructed labor. Timely management can prevent many of these outcomes. Universal access to antenatal care is fundamental to maternal health, and antenatal visits must align with best-practice evidence in both content and frequency.

Early and continuous antenatal care

Early engagement, ideally within the first 10 weeks of pregnancy, supports accurate assessment, timely screening and early identification of potential complications. Integrated referral pathways connecting primary care, specialist providers and community services help ensure that women with emerging risk factors receive appropriate, coordinated support.

Antenatal care should also prepare women and their families for labor, birth, and early parenting. Education should cover consent, labor choices, pain management, postpartum expectations, contraception and pregnancy spacing, mental health, and blood pressure monitoring to prevent and manage maternal hypertensive disorders. It should also address follow-up screening, including oral glucose tolerance testing after gestational diabetes.

Preventing and managing postpartum hemorrhage

The WHO, the International Federation of Gynecology and Obstetrics (FIGO) and the International Confederation of Midwives launched consolidated guidelines for the prevention, detection and treatment of postpartum hemorrhage, the leading cause of maternal morbidity and mortality globally.

These guidelines highlight postpartum hemorrhage prevention and management as an equity intervention and identify quality antenatal and postnatal care as core components. They also provide an evidence-based rationale for revisiting clinical practice and policy definitions of postpartum hemorrhage. Adapt and implement the recommendations at scale to improve early diagnosis and timely intervention.

Supporting breastfeeding

Breastfeeding is a key determinant of infant and maternal health, yet less than 50% of children globally are breastfed as recommended in WHO guidelines.

Counseling on the benefits of breastfeeding, latch and positioning, and addressing early challenges should begin during pregnancy and continue throughout the postpartum period. Midwives, lactation consultants, peer supporters, and community health workers all play essential roles in supporting breastfeeding success.

4. Identifying and Managing High-Risk Pregnancies

Early identification and management of high-risk pregnancies are core functions of antenatal care. Screening should assess risks related to maternal weight, nutrition, smoking, alcohol and other drugs, social determinants, congenital infections, and sexual or mental health to enable timely intervention and referral.

Women with pre-existing chronic conditions, including diabetes, hypertension, cardiovascular disease, autoimmune conditions and cancer, or states of immunosuppression, including those related to medical treatment or HIV, require early risk stratification, multidisciplinary care and individualized management plans throughout pregnancy and the postpartum period.

Screening and managing pregnancy complications

Pregnancy complications must be managed through routine screening, evidence-based clinical pathways, and timely escalation of care. These include:

• Hypertensive disorders
• Gestational diabetes
• Intrauterine growth restriction and small-for-gestational-age infants
• Infection and sepsis
• Preterm birth

Women with a history of miscarriage, stillbirth, preterm birth or gestational diabetes, or a family history of diabetes, require enhanced screening, monitoring and tailored care plans. These should aim to minimize recurrence risks and support positive outcomes through postpartum risk counseling, dietary and lifestyle education, and preventive strategies to reduce progression to type 2 diabetes following gestational diabetes.

5. Supporting Perinatal Mental Health and Emotional Wellbeing

Pregnancy is a period of heightened vulnerability. Health systems must prioritize perinatal mental health, psychosocial wellbeing and safety.

Routine psychosocial screening helps identify depression, anxiety, trauma, stress, domestic or family violence, and reproductive coercion, including pressure to continue or terminate a pregnancy. Pregnant women must be offered confidential, respectful and stigma-free care that prioritizes safety, autonomy and empowerment.

Screening for postpartum depression should be integrated into postnatal care using validated tools and clear referral pathways for assessment and appropriate support. Early identification and management of maternal depression are essential to protect maternal wellbeing and infant care and development.

6. Preventing and Managing Communicable Diseases

Screening, prevention and management of communicable diseases are critical components of antenatal care. Universal testing for HIV, syphilis and other sexually transmitted infections supports early identification and treatment, reducing the risk of transmission to the fetus and adverse outcomes in offspring.

Hepatitis B and C screening and management, including vaccination, antiviral treatment where appropriate, and neonatal prophylaxis, are essential to protecting maternal and newborn health.
Assessment of vaccination status is an integral part of antenatal care. Maternal immunization provides direct protection during pregnancy and passive immunity to the newborn. Vaccines recommended during pregnancy include influenza and diphtheria–tetanus–pertussis (DTPa). HPV vaccination may also be relevant in pre-pregnancy care.

7. Strengthening Health Systems and Public Health

High-quality pregnancy care depends on strong, equitable and resilient health systems. Investment in workforce training, including cultural competence, cultural safety, trauma-informed care and woman-centered practice, is essential to improving care quality and reducing disparities.

The WHO recommends improving antenatal care by using women-held case notes, shifting tasks such as health promotion and malaria prevention to other health workers and, where needed, community health workers, and scheduling antenatal contacts to improve utilization and quality of care.

Improving access and continuity of care

Access to healthcare must be prioritized for rural and remote communities, women experiencing financial hardship, and groups facing systemic discrimination. The WHO provides criteria for training skilled birth attendants and guidance for countries with low coverage. It also supports task shifting among health professionals to improve maternal and newborn outcomes.

Effective collaboration and continuity of care between primary and tertiary services, including general practice, midwifery, obstetric and pediatric care, are essential for timely referral, coordinated management of complications, and seamless transitions across antenatal, intrapartum, and postnatal care. Strong data and surveillance systems are also needed to monitor outcomes, identify inequities, and continuously improve services.

Addressing social determinants and protecting pregnancy during crises

Cross-sector collaboration across health, social care, housing, child protection and community organizations is crucial to addressing the complex social determinants of maternal health.
Health systems must ensure safe, continuous and respectful maternity care in humanitarian and fragile settings, where conflict, displacement and resource constraints substantially increase maternal and neonatal risks.

Embedding the right to health in legislation, policy and implementation frameworks is fundamental to achieving equitable pregnancy outcomes. All pregnant people must be able to access the individualized care they need, regardless of background or circumstance.

Read the original Pregnancy Policy here, which includes all detailed references.

Editors’ note: This policy primarily uses the term “pregnant people” to reflect all individuals who may experience pregnancy. However, “pregnant women” is retained where it reflects the original language of cited policies, guidelines, or source documents. Both terms refer to pregnant individuals and are used interchangeably to stay consistent with source material and align with existing policy language. 

18th World Congress on Public Health: What Cape Town Asked Us to Change

The 18th World Congress on Public Health brought the global public health community to Cape Town, South Africa, from September 6–9, 2026.

Its theme, Health Without Borders: Equity, Inclusion, and Sustainability, reflected a world in which the major threats to health increasingly cross the boundaries between countries, sectors, and disciplines.

Climate change does not stop at a border. Neither do infectious diseases, misinformation, forced migration, conflict, or economic shocks.

But the Congress raised a harder question: If the problems are interconnected, why are our responses still so fragmented?

Across plenaries, World Leadership Dialogues (WLD), workshops, oral presentations, posters and special sessions, participants returned to questions of power, access, trust, leadership and implementation.

The most interesting discussions rarely focused on whether a problem exists. We already know that.

They were about who has the power to change it, who gets left out, and what it takes to turn public health knowledge into action.

Health inequity starts long before someone enters a clinic

The Congress’s opening discussions on inequity and health challenged a familiar tendency in public health: focusing on the moment when someone encounters the healthcare system rather than the conditions that shaped their health long before that encounter.

Housing. Income. Education. Gender. Geography. Employment. Social exclusion. Caregiving. Political power.

These are not peripheral issues to health. They are part of the environment in which health is produced.

One speaker used the image of a woman living in an informal settlement to make the point. From the housing, infrastructure, and socioeconomic conditions surrounding a child from birth, it may already be possible to anticipate many of the challenges that child will face.

That is the power and the uncomfortable implication of the social determinants of health.

The Congress also examined how public health institutions themselves can reproduce inequity. Discussions of gender and leadership highlighted that public health leadership remains shaped by hierarchical, medically dominated structures, while caregiving responsibilities can interrupt traditional leadership pathways.

One reflection captured the nuance:

“Gender always matters, but it never acts alone.”

The implication is important. An intersectional approach cannot treat gender, race, class, geography, or other forms of disadvantage as separate variables.

They interact through systems of power.

That is why health equity requires looking both outward at the populations public health serves and inward at the institutions responsible for serving them.

Economic policy is public health policy

This question of structural inequality carried directly into Economics of Democracy and Public Health.

Asma Khan, whose all-female restaurant kitchen is staffed by mothers and grandmothers, challenged the audience to think about the economic value attached to care.

Women provide enormous amounts of paid and unpaid care worldwide. Yet the work of providing, nurturing, and healing has historically been undervalued, particularly when it is performed by women from economically marginalized communities.

Her message was deceptively simple: if equality means valuing women’s contribution, that value has to be economic as well as symbolic.

Dr. Mohamed Janabi, Director of the World Health Organization African Region, connected the argument to government decision-making:

“Economic decisions are health decisions.”

Taxation, public spending, employment and social protection determine the conditions in which people live.

That means a health budget cannot be neatly separated from an education budget, an employment policy, or a social protection program.

And democracy cannot mean participation only on election day. It must also mean having a meaningful voice in the decisions that determine whether communities have access to food, housing, employment, education and health care.

The Brazilian experience of the Sistema Único de Saúde (SUS) offered another lesson. A universal health system can expand rights on an enormous scale while still leaving significant inequalities in quality, access, and regional coordination.

Universal coverage is a destination. Equity requires constant attention to how the system actually works.

Can global health rules change who holds power?

The Congress then took the question of power from the national level to the international stage.

In International Law and Global Treaties in Public Health, Dr. Moeketsi Modiseyane asked:

“We share the world, but we don’t share the power.”

That question cuts to the heart of global health governance.

Countries may formally sit around the same negotiating table, but they do not necessarily arrive with the same financial resources, technological capacity, manufacturing capabilities, or political influence.

So what does “solidarity” mean when solidarity becomes expensive? What does “equity” mean if it has no mechanism for accountability?

And can international law actually redistribute power? Or does it simply formalize the distribution of power that already exists?

Prof. Flavia Senkubuge, Dean and Professor in the Faculty of Health Sciences at the University of Pretoria, brought the discussion back to the health system itself.

A treaty does not vaccinate a child. A treaty does not manufacture medicine. A treaty does not put a nurse in a rural clinic.

Those outcomes depend on institutions and people with the resources and capacity to implement international commitments.

COVID-19 exposed the gap dramatically. The world witnessed extraordinary scientific collaboration and rapid vaccine development, while access to those breakthroughs remained profoundly unequal.

Having a seat at the table is not necessarily the same as having the power to negotiate.

Innovation only matters if people can use it

That same tension between promise and implementation appeared in the WLD Digital Health in BRICS: Towards an Equity-Oriented Technological Development Model.

Artificial intelligence, telemedicine, digital surveillance and other technologies could transform access to health care.

But technology can also introduce new barriers.

As Dr. Lwando Maki, President of the Public Health Association of South Africa, emphasized, connectivity is not the same as equitable access.

A rural patient cannot benefit from telemedicine simply because a telemedicine platform exists. Reliable connectivity, appropriate infrastructure, affordable data, and a health system that can respond to the consultation are needed.

This is where the phrase “digital divide” can be too simplistic. The issue is not just whether someone is connected. It is whether they can meaningfully use the connection to improve their health.

Dr. Minghui Ren argued that digital health should be understood as an instrument of health-system transformation rather than a collection of new technologies. That means using it to strengthen primary health care, integrate services, support health workers and improve access across the life course.

Meanwhile, Dr. Rômulo Paes-Sousa emphasized that digital health sits inside a much larger ecosystem involving politics, markets, culture, regulation and clinical practice.

This raises a question worth carrying beyond Cape Town: When does technology become a public good, and when does it simply become another layer of inequality?

The vaccine conversation needs to move beyond “hesitancy”

The WLD Strengthening Vaccine Confidence: A Global Public Health Imperative pushed the vaccine debate into more complicated territory.

Prof. Heidi Larson, Founder and Director of The Vaccine Confidence Project, highlighted declining confidence among younger adults and a changing political and information environment.

But one useful insight was that trust in science does not exist in isolation.

People may trust science while also placing enormous confidence in family members, friends, religious leaders and community figures.

That means public health communication cannot assume information moves directly from expert to individual. It moves through relationships.

Prof. Katie Atwell, Professor of Political Science and Public Policy at the University of Western Australia, also challenged the language used to describe vaccine uptake.

Instead of automatically framing low uptake as individual “hesitancy,” public health needs to examine access barriers, structural conditions and the responsibilities of governments.

This changes the question.

Rather than asking only: Why aren’t people accepting vaccines?

We should also ask: What makes vaccination difficult, inaccessible, or untrusted in the first place?

That distinction becomes even more important as misinformation and disinformation become more sophisticated.

Prevention needs to follow people across the life course

The WLD Closing the Prevention Gap through Adult HPV Vaccination: From a Women-Only Narrative to Universal Cancer Prevention applied a similar principle to HPV vaccination.

For years, HPV vaccination has often been framed predominantly around girls and cervical cancer prevention.

The discussion in Cape Town challenged that narrow framing.

A universal cancer prevention approach recognizes the wider population affected by HPV and asks how adult vaccination strategies can close gaps in protection across genders and across the life course.

That is a broader public health proposition:

Prevention works better when the strategy reflects how disease actually moves through populations rather than how health programs have traditionally been organized.

The same life-course thinking appeared elsewhere at WCPH, from pediatric immunization to chronic disease prevention and healthy aging.

The science may be advancing faster than the systems delivering it

The WLD Healthy Beginnings, Protected Futures: Scaling Impact in Pediatric RSV and Pneumococcal Immunization examined the challenge of translating immunization advances into population-level protection.

The scientific development of vaccines and preventive tools is only one part of the equation.

A product still needs to reach a child.

That requires financing, procurement, supply chains, trained health workers, community confidence, primary care infrastructure, and systems that can identify who is being missed.

The same challenge surfaced in the WLD, The Convergence Imperative: From Innovation to Implementation Equity in Ending TB and HIV.

New diagnostics, vaccines, therapeutics, artificial intelligence, and digital health could accelerate progress against TB and HIV. But tools alone cannot end epidemics.

The implementation gap is where equity is won or lost.

Prof. Yogan Pillay emphasized the need for stronger population surveys and surveillance, while speakers highlighted local capacity, leadership, financing, and primary health care.

The underlying lesson was consistent: The question is no longer only whether we can develop better tools. It is whether we can build systems that can deliver them fairly.

Primary health care needs leadership, data and resources

This is why primary health care remained one of the strongest threads running through the Congress.

In discussions on Primary Health Care, Public Health Systems for Equity and Universal Access, speakers emphasized task shifting, supply-chain innovation, workforce development and the need to remove practical barriers to care.

But they also made a less technical point: Primary health care needs political leadership.

Former Namibian Minister of Health Dr. Bernard Haufiku emphasized the importance of leadership, local capacity building and adequate resourcing.

Primary health care cannot be something governments endorse rhetorically while leaving communities to deal with under-resourced services.

And leadership cannot remain concentrated at the top. Distributive leadership comes with accountability.

The Congress also returned to the need to develop younger public health leaders, not simply as people who inform today’s decision-makers, but as people who will eventually make the decisions themselves.

That raises another uncomfortable question: Are public health institutions doing enough to prepare the next generation to lead?

Mental health: stop asking individuals to adapt to unhealthy institutions

The WLD Promoting Mental Well-Being in Academia: Evidence, Tools and Action Plans brought the question of institutional responsibility into universities and research environments.

Prof. Anna Odone, Principal Investigator of Health Mode On at the University of Pavia, introduced evidence examining student and researcher mental health and well-being.

The findings presented during the session were difficult to ignore. Among the 11,676 students included in the analysis, 63.1% reported at least one mental disorder in the previous 12 months. Nearly four in ten reported loneliness, and almost one in five reported hopelessness about the future.

But perhaps the most revealing finding concerned access to help. Nearly half of students did not know that support services existed.

Dr. Laura Magaña, President and CEO of the Association of Schools and Programs of Public Health and Founding President of the Global Network for Academic Public Health, framed the institutional question:

“How do we create institutions in which people grow?”

That is different from asking how we can teach individuals to cope with stressful environments.

Academic competition, workloads, financial insecurity, supervision, career uncertainty, and institutional culture all shape wellbeing.

Yoga and mindfulness may have a role. They cannot substitute for institutional change.

You cannot build a resilient public health workforce by normalizing nervous exhaustion as the price of excellence.

Decolonization asks who gets to define public health

The question of institutional power extended into Restoring Balance: Indigenous Knowledge Systems & Decolonizing Global Health.

Decolonization is sometimes reduced to a question of representation: who is on the panel, whose name appears on the paper, or which perspectives are included in a curriculum.

The deeper issue is authority.

Who decides what counts as knowledge? Who determines the research questions?

Who controls funding? Who owns the data?

Who decides which interventions are appropriate for a community?

And who gets to say whether an intervention actually worked?

These questions also connect to the Congress’s discussions on global health partnerships and migration, including the movement from brain drain to brain gain.

A more equitable global health system cannot simply depend on expertise flowing from wealthier institutions toward lower-resource settings.

It must create conditions in which local institutions, communities, and professionals have genuine authority over the work being done in their own contexts.

Health without borders also means health beyond humans

The One Health in a Changing World plenary pushed the Congress beyond conventional definitions of public health.

Human health cannot be separated from animal health or ecosystem health.

Climate change, emerging infectious diseases, food systems, biodiversity loss and environmental degradation increasingly interact.

The implication is practical: public health cannot solve these problems by working within the health sector’s traditional boundaries.

The Congress also explored how cities, buildings, transportation and the design of healthcare environments shape health.

A hospital can treat disease.

But a city’s design can influence whether people become sick in the first place. That distinction is central to prevention.

The environments we build are part of the health systems we create.

Conflict makes every health system vulnerability visible

Few issues make the gap between health as a right and health as a reality more visible than war.

The Congress addressed Public Health in Conflict, War and Peace Building, the protection of public health in armed conflict, and the role of nurses working in conflict zones.

These discussions brought health workers and health infrastructure into the center of the conversation.

During conflict, the need for health services increases at precisely the moment when hospitals, supply chains, staff and communities are under extraordinary pressure.

The Congress therefore treated peace, human rights and health as interconnected rather than separate policy areas.

This also connects to the broader question of global governance:

What is the value of international commitments if the institutions expected to uphold them cannot protect people when they are most vulnerable?

From innovation to implementation

Perhaps the strongest thread connecting the Congress was the distance between what we know and what we do.

We know social determinants shape health. We know primary health care matters.

We know vaccines prevent disease. We know digital technologies can expand access.

We know climate change threatens health. We know mental health needs institutional attention.

We know conflict destroys the foundations on which health depends. We know that communities need a voice.

The harder question is why implementation remains so uneven.

The WLD Political Leadership for Integrated Financing of Social and Behavior Change in African Health Systems: A Call to Action addressed one part of that problem directly: resources and political commitment.

Public health strategies require more than declarations.

They need budgets, institutions, trained people, coordination, data, and accountability. And they need political leaders willing to sustain action beyond the next news cycle or funding cycle.

That is why the Congress repeatedly returned to leadership. Not leadership as a title.

Leadership as the ability to make difficult choices, distribute power, invest for the long term, and remain accountable for what happens after the policy is announced.

What does “Health Without Borders” mean after Cape Town?

The 18th World Congress on Public Health did not produce one simple answer.

It produced a set of questions that are harder and potentially more useful.

Can international law redistribute power? Can technology become a genuine social good? Can public health rebuild trust? Can health systems innovate without widening inequality?

Can global health partnerships become more equitable? Can academic institutions pursue excellence without sacrificing wellbeing? Can public health associations turn evidence into political influence? Can young professionals be given real opportunities to lead?

Can governments finance the systems needed to deliver on their commitments?  And can the public health community move quickly enough from innovation to implementation?

The Congress Statement makes the direction clear: achieving health equity requires action across governments, international organizations, academia, civil society, public health associations and communities. It calls for stronger primary health care, investment in the public health workforce, meaningful community participation, greater accountability and a fairer distribution of resources and decision-making power.

The challenge now is to carry those commitments beyond Cape Town.

The work continues

The 18th World Congress on Public Health ended on September 9, but the issues it brought together will continue to shape public health for years to come.

The value of a Congress is not ultimately measured by how many sessions took place or how many people attended. It is measured by what changes afterward.

If a new partnership begins, a policy changes, a young professional finds a mentor, a community gains a stronger voice, a health system removes a barrier, or a public health leader asks a different question because of something they heard in Cape Town, then the conversation has moved beyond the conference room.

That may be the most important challenge WCPH 2026 leaves behind: We know the world is changing. Are our public health systems changing with it?

The 19th World Congress on Public Health will take place in Auckland, New Zealand, in 2028.

Until then, Cape Town leaves the global public health community with something more demanding than a conclusion: a responsibility to act.

HPV Vaccination Across the Life Course: Protecting More People from Preventable Cancer

Human papillomavirus (HPV) is one of the world’s most common infections. WHO estimates that up to 80% of sexually active people will acquire HPV during their lifetime. Most infections clear naturally, but persistent infection with high-risk types can cause cancer.

The list is broader than many people realize. HPV can cause cervical, anal, penile, vulvar, vaginal, and oropharyngeal cancers. In 2019, HPV was estimated to cause around 620,000 cancer cases in women and 70,000 in men worldwide.

That is why the conversation around HPV vaccination needs to evolve. HPV prevention has long been associated primarily with adolescent girls and cervical cancer. Those programs remain essential, but they do not represent the full HPV disease burden or the full population that may benefit from prevention.

HPV-related cancer is not a women’s health issue alone

Cervical cancer remains the most significant HPV-related cancer globally and is a major health equity challenge. Yet HPV affects people of all genders.

Among men, HPV can cause anal, penile, and oropharyngeal cancers. Oropharyngeal cancer has become one of the most common HPV-associated cancers in men in several high-income countries, illustrating how an approach focused exclusively on cervical cancer can leave important gaps in public understanding. 

The way HPV is discussed is critical. When the virus is presented only in relation to women’s health, men may not recognize their own risk or understand why vaccination is relevant to them.

HPV prevention should therefore be communicated as what it is: cancer prevention for people of all genders.

Why consider HPV vaccination beyond adolescence?

Routine vaccination before exposure to HPV remains the foundation of prevention. 

However, a large number of adults were never offered HPV vaccination when they were younger.

The reasons differ. Some were already beyond the age groups targeted when national programs were introduced. Others faced eligibility, access, or cost barriers. HPV vaccines were introduced at different times across countries, creating significant differences between generations.

Adults can continue to encounter new HPV exposure risks throughout life. Previous infection does not necessarily mean previous exposure to every HPV type covered by a vaccine. Vaccination does not treat an existing infection, but it can provide protection against HPV types a person has not encountered. 

National recommendations for adult HPV vaccination vary. A life-course approach is therefore not a single global vaccination schedule. It is a public health framework that asks whether current programs are reaching the populations they are designed to protect and what happens to those who were missed.

What is a life-course approach to HPV immunization?

A life-course approach recognizes that prevention does not happen at one point in time.

For HPV, it begins with strong vaccination programs for adolescents and continues by creating opportunities for catch-up and adult vaccination where national policies, evidence, and health systems support them.

A comprehensive approach can include:

• Routine vaccination for adolescents
• Catch-up vaccination for eligible populations
• Consideration of adult vaccination
• Inclusive policies covering people of different genders
• Convenient access through appropriate healthcare and community settings
• Clear communication from trusted health professionals

The principle is simple: a person’s age should not be the only lens through which prevention opportunities are considered.

The vaccination access gap

Having an effective vaccine is only one part of a successful immunization program.

People need to know that vaccination is available, understand why it matters, and be able to access it without unnecessary barriers.

For adults, this may mean offering vaccination through services they already use. Primary care, pharmacies, sexual health services, specialist clinics, workplaces and community programs can all provide potential access points depending on the national context.

Healthcare professionals are equally important. A recommendation from a trusted clinician can help people make informed decisions, particularly where misinformation has created uncertainty about vaccines.

Access strategies must also reflect local realities. A program designed for a large urban health system may not work in a rural community. Cost, distance, language, and trust can all determine whether prevention reaches the people it is intended to serve.

A global conversation that includes LMICs

Low- and middle-income countries carry a disproportionate burden of HPV-related disease. According to WHO, around 94% of the approximately 350,000 cervical cancer deaths recorded in 2022 occurred in low- and middle-income countries.

This imbalance should shape the global conversation about HPV prevention.

Countries facing the greatest burden must be represented in decisions about vaccine access, financing, delivery, and policy. A global life-course approach cannot simply export models developed elsewhere. It needs to account for different health systems, disease burdens and access challenges.

The goal is shared, but implementation will look different from one country to another.

From evidence to action

The World Federation of Public Health Associations (WFPHA), together with more than 60 supporting organizations, is calling for greater attention to adult HPV vaccination through its Advancing Adult HPV Vaccination: From Evidence to Action initiative.

The Call to Action focuses on strengthening prevention across the life course and addressing populations that earlier vaccination programs may have missed. It calls for:

• Greater consideration of adult HPV vaccination
• Broader and more inclusive prevention strategies
• Better integration of vaccination into healthcare systems
• Stronger public and professional awareness
• Policies that address gaps in access
• Meaningful participation from low- and middle-income countries in shaping global approaches

It’s not shifting attention or resources away from adolescent vaccination; it examines the gaps that remain once those programs are in place.

The public health opportunity is clear: protect adolescents early, close gaps where they exist, and avoid treating previous missed opportunities as permanent.

Protecting people across the life course

HPV vaccination has already changed what is possible in cancer prevention. The next challenge is ensuring that prevention strategies reflect the full reality of HPV-related disease.

That means recognizing cancers affecting women and men. It means strengthening routine programs while considering those who were never reached. It means designing access around people rather than expecting people to navigate complex systems.

Most importantly, it means changing the question.

Instead of asking only: Who is the vaccine traditionally offered to?

Public health leaders should also ask: Who remains unprotected, and what can be done about it?

The WFPHA’s Advancing Adult HPV Vaccination: From Evidence to Action Call to Action brings this question to the forefront.

HPV-related cancers are preventable. The evidence is there. The tools are available.

The next step is to expand prevention.

Watch the video here

Advancing Adult HPV Vaccination: From Evidence to Action

Human papillomavirus (HPV) is one of the most prevalent infections in the world, affecting up to 80% of individuals at some point in their lives. While the immune system clears most infections naturally, persistent high-risk HPV oncogenic genotypes can lead to serious health outcomes, including cervical, anal, vaginal, vulvar, penile, and oropharyngeal cancers. 

Even with highly effective vaccines authorized for adults and available in sufficient supply, vaccination rates among adults remain far too low. Expanding adult HPV vaccination offers a vital opportunity to reduce disease burden, strengthen long-term health outcomes, and accelerate progress toward broader cancer prevention goals.

Why Universal Vaccination Matters for Long-Term Cancer Prevention

Although early HPV prevention initiatives largely prioritized younger age groups, there is now broad recognition that universal HPV vaccination across adulthood is a crucial component of comprehensive disease prevention. Adults continue to face new exposure risks throughout their lives, and vaccination can protect them against HPV types they have not yet encountered. 

Importantly, natural immunity from previous infections does not offer complete protection against other high-risk genotypes, meaning adults with prior HPV exposure still gain meaningful benefit from vaccination. Emerging evidence also highlights positive outcomes when vaccination is delivered before or after cervical conization, reinforcing its value across different stages of adult care.

Barriers Limiting Adult Vaccine Uptake and Why They Must Be Overcome

Although clinical and economic advantages are well-established, adult vaccine uptake remains low due to:

• Lack of awareness and misconceptions about vaccine efficacy
• Limited access and insufficient provider recommendations
• Policy and funding gaps within national immunization programs

Many adults were not vaccinated during adolescence due to eligibility criteria, vaccine availability, or limitations in the healthcare system. Expanding eligibility can close this gap. 

Policymakers are key to establishing sustainable vaccination programs by embedding HPV vaccination for medically or socially vulnerable adults into routine healthcare and ensuring adequate funding and equitable access. Adult programs should not compromise coverage in younger populations. Cultural and linguistic sensitivity must also be part of these strategies to support trust and acceptance.

Accelerating Progress Toward WHO Elimination Goals

WHO has set ambitious goals for cervical cancer elimination, prioritizing adolescent girls as the primary target group, but extending vaccination to boys and adults whenever feasible. National programs should move forward using emerging evidence and practical implementation models. 

Strengthened vaccination systems can help reduce HPV-related cancers, improve health equity, and support progress toward global elimination.

Strengthening Policy and Practice for Adult HPV Vaccination

This call to action emphasizes the value of adult HPV vaccination from public health and economic perspectives. It highlights the global burden of HPV-related diseases and successful policy models from multiple countries. 

Key recommendations include integrating adult vaccination into routine care, expanding national immunization guidelines, strengthening awareness efforts, and adopting universal and inclusive approaches that span ages, genders, and geographies.

Risk Stratification Isn’t Enough, Adults Still Need Protection

Risk-based approaches are limited due to the widespread nature of HPV and varied exposure patterns. Several key considerations support universal adult vaccination:

Adults Remain at Ongoing Risk

Individuals continue to face new exposure risk throughout adulthood.

Men Are Disproportionately Underserved

Without access to established screening programs and often acquiring infections later, adult males represent a highly vulnerable group.

Ending Transmission Requires Addressing the Viral Reservoir

To eliminate HPV-related cancers, transmission must be stopped at its source, requiring immunization of both women and men.

Vaccination Works Even After Exposure

Adults previously exposed to certain HPV types still benefit from protection against other genotypes.

Public Health Outcomes Are Significant

Adult vaccination provides direct protection while reducing transmission and decreasing overall disease burden.

Current Age-Restricted Funding Leaves People Behind

Many national funding systems exclude adults who are still at risk.

Vaccination Must Be Easy to Access

Success depends on convenience, such as pharmacies, workplaces, and community hubs serving as vaccination sites.

A Consensus on Adult Vaccination Is Needed

Clear and unified policy guidance is essential to strengthen recommendations and drive adoption.

Low- and Middle-Income Countries Must Help Shape Global Policy

These regions carry the highest disease burden and must be active contributors to ensure global equity.

Faster Elimination Is Achievable

Countries like Sweden demonstrate that vaccinating adults can accelerate the elimination of HPV-related cancers.

Clear, Inclusive Communication Matters

Language such as “universal vaccination” promotes gender equity and reduces stigma.

A Global Call to Action for Policymakers and Health Leaders

Governments, global health organizations, and national public health associations are urged to expand HPV vaccination programs, particularly for adults and males, mobilize resources, and embed evidence-based strategies into national immunization plans. 

By committing to these priorities today, countries can accelerate cancer prevention and move closer to eliminating HPV-related disease.

Moving Forward Toward Global Health Equity

Expanding HPV vaccination to adults is a critical, evidence-based strategy to reduce HPV-related disease and advance global cancer prevention. Universal adult vaccination delivers individual and population-level benefits, especially in regions with limited access to screening and care. Progress requires collaboration among policymakers and health leaders to address gaps in access, awareness, and coverage. 

Integration into routine healthcare, stigma-free and inclusive communication, and a focus on vulnerable populations, such as individuals living with conditions like HIV, are essential. Taking timely action will drive progress toward eliminating HPV-related cancers and building a more equitable global health future.

Read our original call to action here.

Watch our video on this HPV call to action here.

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