{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T01:28:25Z","timestamp":1792200505284,"version":"4.4.0"},"reference-count":64,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T00:00:00Z","timestamp":1767571200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>Human papillomavirus (HPV) drives a substantial cancer burden across all genders. This perspective argues that gender-neutral HPV vaccination is an equitable and cost-effective public health investment when designed for scale. Rather than presenting methods in detail, we synthesize recent epidemiology, policy positions, and economic evaluations to propose a simplicity-first pathway\u2014a pragmatic model that, where permitted, prioritizes single-dose schedules, school-based delivery for adolescents aged 9\u201314, small, computable set of key performance indicators (KPIs) set (coverage, timeliness, series completion, and equity gaps), routine adverse events following immunization (AEFI) monitoring, and phased expansion as system capacity grows. The simplicity-first pathway advances global equity by protecting boys and girls alike, reducing stigma, and delivering both direct and indirect benefits to underserved groups, including sexual minority populations. In resource-constrained settings, single-dose policies (where adopted), integration with existing school-based platforms, and pooled multi-year procurement can reduce delivery complexity and improve value for money. Cost-effectiveness remains context-specific and is sensitive to vaccine price, achievable coverage, and which outcomes are included in the analysis. Policy implications: Countries should strongly consider gender-neutral vaccination as the default program design to accelerate population-level protection and close avoidable equity gaps, while adapting schedules and financing to national regulations, fiscal space, and information-system readiness. This simplicity-first framing offers a practical bridge between policy intent and sustainable routine implementation.<\/jats:p>","DOI":"10.3389\/fpubh.2025.1725127","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T06:36:44Z","timestamp":1767595004000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Gender-neutral human papillomavirus vaccination: an equitable and cost-effective public health investment"],"prefix":"10.3389","volume":"13","author":[{"given":"Qingjing","family":"Luo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"21048","DOI":"10.1038\/s41598-025-06700-8","article-title":"HPV cancer burden by anatomical site, country, and region in 2022","volume":"15","author":"Zhang","year":"2025","journal-title":"Sci Rep"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e34874","DOI":"10.2196\/34874","article-title":"Global pattern and trends in penile cancer incidence: population-based study","volume":"8","author":"Fu","year":"2022","journal-title":"JMIR Public Health Surveill"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"100549","DOI":"10.1016\/j.jvacx.2024.100549","article-title":"Human papilloma virus vaccination in the resource-limited settings of sub-Saharan Africa: challenges and recommendations","volume":"20","author":"Murewanhema","year":"2024","journal-title":"Vaccine X"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"h2016","DOI":"10.1136\/bmj.h2016","article-title":"Direct benefit of vaccinating boys along with girls against oncogenic human papillomavirus: bayesian evidence synthesis","volume":"350","author":"Bogaards","year":"2015","journal-title":"BMJ"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"f2032","DOI":"10.1136\/bmj.f2032","article-title":"Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data","volume":"346","author":"Ali","year":"2013","journal-title":"BMJ"},{"key":"ref6","volume-title":"From evidence to impact: A synthesis of gender analyses in immunization","year":"2024"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"EVIDoa2100056","DOI":"10.1056\/EVIDoa2100056","article-title":"Efficacy of single-dose HPV vaccination among young African women","volume":"1","author":"Barnabas","year":"2022","journal-title":"NEJM Evid"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2506765","article-title":"Noninferiority of one HPV vaccine dose to two doses","author":"Kreimer","year":"2025","journal-title":"N Engl J Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3224","DOI":"10.1038\/s41591-023-02658-0","article-title":"Durability of single-dose HPV vaccination in young Kenyan women: randomized controlled trial 3-year results","volume":"29","author":"Barnabas","year":"2023","journal-title":"Nat Med"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1010","DOI":"10.3390\/vaccines13101010","article-title":"Human papillomavirus vaccination coverage estimates among the primary target cohort (9-14-year-old girls) in the world (2010-2024)","volume":"13","author":"Ilic","year":"2025","journal-title":"Vaccine"},{"key":"ref11","volume-title":"New HPV vaccines \u2013 Current landscape and future directions","year":"2024"},{"key":"ref12","volume-title":"PAHO revolving fund: Vaccine prices for the calendar year 2024","year":"2024"},{"key":"ref13","volume-title":"Human papillomavirus vaccines: WHO position paper","year":"2022"},{"key":"ref14","volume-title":"Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated \u2014 WHO, UNICEF","year":"2025"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"4001","DOI":"10.1016\/j.vaccine.2020.04.021","article-title":"Human papillomavirus vaccine coverage in Rwanda: A population-level analysis by birth cohort","volume":"38","author":"Sayinzoga","year":"2020","journal-title":"Vaccine"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1177\/10105395241273296","article-title":"Lessons learned from Bhutan on extending girls-only HPV vaccination program to boys: A qualitative study","volume":"36","author":"Yangchen","year":"2024","journal-title":"Asia Pac J Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"e0278477","DOI":"10.1371\/journal.pone.0278477","article-title":"Changes in genital human papillomavirus (HPV) prevalence among urban females a decade after the Malaysian HPV vaccination program","volume":"17","author":"Khoo","year":"2022","journal-title":"PLoS One"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"6734","DOI":"10.1016\/j.vaccine.2023.10.002","article-title":"The impact of over ten years of HPV vaccination in England: surveillance of type-specific HPV in young sexually active females","volume":"41","author":"Checchi","year":"2023","journal-title":"Vaccine"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"e54","DOI":"10.1093\/infdis\/jiaf052","article-title":"Population-level impact of human papillomavirus vaccination on the incidence of genital warts in Sweden","volume":"232","author":"Astorga Alsina","year":"2025","journal-title":"J Infect Dis"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.4103\/singaporemedj.SMJ-2020-446","article-title":"Clinical and economic impact of school-based nonavalent human papillomavirus vaccination in females in Malaysia","author":"Hsu","year":"2023","journal-title":"Singapore Med J"},{"key":"ref21","volume-title":"Human papillomavirus and related diseases in Argentina","author":"Bruni","year":"2023"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2514949","DOI":"10.1080\/21645515.2025.2514949","article-title":"Impact of HPV vaccination on the hospitalizations for anogenital warts and high-grade cervical intraepithelial neoplasia in Brazil: A national analysis","volume":"21","author":"Bierrenbach","year":"2025","journal-title":"Hum Vaccin Immunother"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"590","DOI":"10.3390\/vaccines13060590","article-title":"Overcoming HPV vaccine hesitancy in Japan: a narrative review of safety evidence, risk communication, and policy approaches","volume":"13","author":"Takahashi","year":"2025","journal-title":"Vaccine"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2410","DOI":"10.1111\/cas.16167","article-title":"Even though active recommendation for HPV vaccination has restarted, Japan's rates have not recovered","volume":"115","author":"Yagi","year":"2024","journal-title":"Cancer Sci"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e1421","DOI":"10.1002\/hsr2.1421","article-title":"A call for bridging gender gap in HPV vaccination policies in Japan","volume":"6","author":"Kaneda","year":"2023","journal-title":"Health Sci Rep"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1186\/s12889-023-15842-1","article-title":"Barriers and facilitators of HPV vaccination in sub-saharan Africa: a systematic review","volume":"23","author":"Kutz","year":"2023","journal-title":"BMC Public Health"},{"key":"ref27","volume-title":"Penis cancer fact sheet (GLOBOCAN)","year":"2022"},{"key":"ref28","volume-title":"Sub-Saharan Africa fact sheet (GLOBOCAN)","year":"2022"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1016\/S0140-6736(19)30298-3","article-title":"Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis","volume":"394","author":"Drolet","year":"2019","journal-title":"Lancet"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1448","DOI":"10.1016\/S1473-3099(20)30687-3","article-title":"Prevalence of human papillomavirus in young men who have sex with men after the implementation of gender-neutral HPV vaccination: a repeated cross-sectional study","volume":"21","author":"Chow","year":"2021","journal-title":"Lancet Infect Dis"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"e2539258","DOI":"10.1001\/jamanetworkopen.2025.39258","article-title":"Updated estimates of patients with oropharyngeal cancer in the US","volume":"8","author":"Cao","year":"2025","journal-title":"JAMA Netw Open"},{"key":"ref32","volume-title":"Interim position statement on HPV vaccination of men who have sex with men (MSM)","year":"2013"},{"key":"ref33","volume-title":"Immunization agenda 2030: A global strategy to leave no one behind","year":"2020"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"974","DOI":"10.1080\/13696998.2025.2520703","article-title":"Public health impact and cost-effectiveness of implementing gender-neutral vaccination with a 9-valent HPV vaccine in Japan: a modeling study","volume":"28","author":"Palmer","year":"2025","journal-title":"J Med Econ"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"e0310591","DOI":"10.1371\/journal.pone.0310591","article-title":"Modeling the health and economic implications of adopting a 1-dose 9-valent human papillomavirus vaccination program in adolescents in low\/middle-income countries: an analysis of Indonesia","volume":"19","author":"Daniels","year":"2024","journal-title":"PLoS One"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"2127983","DOI":"10.1080\/21645515.2022.2127983","article-title":"Cost-effectiveness and epidemiological impact of gender-neutral HPV vaccination in Spain","volume":"18","author":"Linertov\u00e1","year":"2022","journal-title":"Hum Vaccin Immunother"},{"key":"ref37","volume-title":"Statement on HPV vaccination","year":"2018"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"1934","DOI":"10.1016\/j.vaccine.2023.02.025","article-title":"Impact of including boys in the national school-based human papillomavirus vaccination programme in Singapore: A modelling-based cost-effectiveness analysis","volume":"41","author":"Wahab","year":"2023","journal-title":"Vaccine"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"S41","DOI":"10.1016\/j.vhri.2019.08.240","article-title":"PIN9 public health and economic impact of a gender-neutral quadrivalent human papillomavirus vaccination program in Colombia","volume":"19","author":"Carrasquilla","year":"2019","journal-title":"Value Health Reg Issues"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1186\/1471-2334-14-351","article-title":"Is expanding HPV vaccination programs to include school-aged boys likely to be value-for-money: a cost-utility analysis in a country with an existing school-girl program","volume":"14","author":"Pearson","year":"2014","journal-title":"BMC Infect Dis"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"127770","DOI":"10.1016\/j.vaccine.2025.127770","article-title":"Cost-effectiveness of different HPV vaccination strategies for cervical cancer prevention in South Africa","volume":"64","author":"van Schalkwyk","year":"2025","journal-title":"Vaccine"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"S170","DOI":"10.1016\/j.jval.2020.04.489","article-title":"Estimating the impact of a gender-neutral quadrivalent human papillomavirus vaccination program in all HPV 6\/11\/16\/18-related diseases in Colombia","volume":"23","author":"Carrasquilla","year":"2020","journal-title":"Value Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"1200","DOI":"10.1016\/j.vaccine.2024.01.094","article-title":"Costs of human papillomavirus vaccine delivery in low- and middle-income countries: A systematic review","volume":"42","author":"Slavkovsky","year":"2024","journal-title":"Vaccine"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"7435","DOI":"10.1016\/j.vaccine.2023.11.008","article-title":"Cost and operational context for national human papillomavirus (HPV) vaccine delivery in six low- and middle-income countries","volume":"41","author":"Mvundura","year":"2023","journal-title":"Vaccine"},{"key":"ref45","volume-title":"WHO position papers on Human papillomavirus (HPV)","year":"2022"},{"key":"ref46","volume-title":"WHO adds an HPV vaccine for single-dose use","year":"2024"},{"key":"ref47","volume-title":"Human Papilloma Virus (HPV) vaccine price data","year":"2025"},{"key":"ref48","volume-title":"PAHO revolving fund: Prices for the calendar year 2025","year":"2025"},{"key":"ref49","volume-title":"Co-financing policy","year":"2025"},{"key":"ref50","volume-title":"Eligibility & co-financing policies","year":"2025"},{"key":"ref51","volume-title":"WHO updates recommendations on HPV vaccination schedule","year":"2022"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"1785","DOI":"10.1002\/cncr.29111","article-title":"A cost-effectiveness analysis of human papillomavirus vaccination of boys for the prevention of oropharyngeal cancer","volume":"121","author":"Graham","year":"2015","journal-title":"Cancer"},{"key":"ref53","volume-title":"Behavioural and social drivers of vaccination: Tools and practical guidance for achieving high uptake","year":"2022"},{"key":"ref54","volume-title":"Vaccine messaging guide: A handbook for delivering key messages on vaccine equity and access","year":"2023"},{"key":"ref55","volume-title":"Implementing the immunization agenda 2030: A framework for action through coordinated planning, monitoring & evaluation, Ownership & Accountability, and Communications & Advocacy","year":"2020"},{"key":"ref56","volume-title":"Immunization information systems (IIS) resources: About IIS","year":"2024"},{"key":"ref57","volume-title":"Rapid community assessment guide: A guide to help you understand your community\u2019s needs around vaccination","year":"2023"},{"key":"ref58","volume-title":"Canadian adverse events following immunization surveillance system (CAEFISS)","year":"2025"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"623","DOI":"10.2471\/BLT.11.097253","article-title":"Achieving high coverage in Rwanda's national human papillomavirus vaccination programme","volume":"90","author":"Binagwaho","year":"2012","journal-title":"Bull World Health Organ"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"3726","DOI":"10.1016\/j.vaccine.2015.05.078","article-title":"Introduction of a national HPV vaccination program into Bhutan","volume":"33","author":"Dorji","year":"2015","journal-title":"Vaccine"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3201\/eid2701.191364","article-title":"Impact of human papillomavirus vaccination, Rwanda and Bhutan","volume":"27","author":"Baussano","year":"2021","journal-title":"Emerg Infect Dis"},{"key":"ref62","volume-title":"Data quality assurance: Module 3 \u2013 Site assessment of data quality: Data verification and system assessment","year":"2020"},{"key":"ref63","volume-title":"IIS functional standards introduction","year":"2025"},{"key":"ref64","volume-title":"Immunization information system functional standards version 4.1 resource guide","year":"2022"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1725127\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T06:36:49Z","timestamp":1767595009000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2025.1725127\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":64,"alternative-id":["10.3389\/fpubh.2025.1725127"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2025.1725127","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]},"article-number":"1725127"}}