HPV vaccination coverage trends in women across 11 EU countries: a joinpoint analysis

Background

Disparities in female HPV vaccination coverage across Europe highlight the critical role of contextual and structural determinants beyond mere vaccine access. This study examines temporal coverage trends across 11 EU countries from 2010 to 2024 using joinpoint regression, evaluating their descriptive associations with delivery model architecture, programmatic stability, and crisis management.

Methods

Annual female HPV coverage data were retrieved from WHO/ECDC databases for 11 countries (Denmark, France, Germany, Ireland, Italy, Latvia, Luxembourg, Netherlands, Portugal, Slovenia, Spain). Joinpoint regression estimated the Annual Percent Change (APC) per trend segment (p < 0.05). Correlations with policy variables were explored descriptively, without direct causal inference.

Results

Coverage ranged from ∼15% (Denmark, 2015) to 93% (Portugal, 2024). Portugal and Spain achieved the highest levels (>90%, ∼88%), whereas Italy and France remained persistently below 50%; Italy recorded a significant decline (2016–2021, APC −4.81%) and recent partial recovery (APC +7.01%). Denmark and Ireland displayed V-shaped trajectories, while Germany and Luxembourg showed volatile but increasing trajectories, whereas Slovenia remained broadly stable. Latvia declined early (APC −6.57%) then partially recovered (APC +1.63%), and Netherlands displayed a uniform linear trend over the entire period (APC +0.58%).

Conclusions

The stark contrast between the high coverage in Portugal and Spain (≥90%) and the persistently low uptake in France (<45%) suggests that national policy architecture is a primary driver of vaccination success. Such disparities emphasize the need for comparative policy analysis to identify transferable practices across European health systems. Additionally, marked temporal trends in countries like Denmark highlight the necessity of investigating the contextual factors that shape coverage trajectories over time.

Key messages

• Between 2010 and 2024, HPV vaccination coverage across 11 EU countries followed markedly different trajectories, ranging from ∼15% (Denmark, 2015) to 93% (Portugal, 2024).

• The contrast between high-performing and low-coverage EU countries highlights the value of identifying transferable policy practices to improve HPV vaccination across European health systems