Eliminating cervical cancer in Canada
Progress on HPV vaccination in Canada
Under current circumstances, Canada is not on track to meet the first target of the Action Plan for the Elimination of Cervical Cancer in Canada, 2020–2030 (Action Plan): 90% of 17-year-olds fully vaccinated with the HPV vaccine by 2025. Provinces and territories are recovering from the impact of the COVID-19 pandemic, which disrupted vaccination programs in schools and resulted in many children missing doses of the HPV vaccine.1,2 Urgent action is needed to increase HPV vaccination rates and get Canada back on track to reach its HPV vaccination target.
Key takeaways
- HPV vaccination rates across Canada are suboptimal, with only three provinces reporting rates higher than 80% for boys or girls. By contrast, vaccination rates for other adolescent vaccines such as hepatitis B range from 85% to 95%.3
- HPV vaccination rates vary significantly between and within jurisdictions, ranging from 16% to 93%.
- From 2013 to 2018, the number of cervical pre-cancers detected among women aged 18 to 24 decreased, due in large part to increasing HPV vaccination coverage. However, in recent years, cervical cancer incidence has increased and was cited as the fastest increasing cancer among females. This shift might be explained by suboptimal HPV vaccination rates, suboptimal cervical screening uptake and a lack of follow-up after screening.4
- HPV vaccination rates are lower among children from equity-denied communities including those from lower-income neighbourhoods.5 Very little data has been collected to describe how race, ethnicity, education and other social determinants of health impact HPV vaccination rates.
- HPV vaccination rates differ between geographies.5 In some regions, those in rural and remote communities experience lower vaccination rates than their urban counterparts, while in other regions it is the other way around.
HPV vaccination rates by province/territory (years vary)
Hover over each province and territory for HPV vaccination rates and additional context.
*Each province and territory has provided its own content and measures this indicator differently. Because of these differences, data cannot be compared across provinces/territories. Quebec data was gathered from the February 2024 Flash Vigie report.
**All provinces and territories (except Quebec) administer GARDASIL®9 on a two- or three-dose schedule according to the National Advisory Committee on Immunization recommended immunization schedule for HPV vaccines. People under the age of 15 are given two doses.
Data table and footnotes
Percentage of women (aged 18+) with cervical precancer as their most severe Pap test result in a 12-month timeframe, by age group, 2012 to 2018
Legend
● 18-24 ● 25-44 ● 45-69 ● 70+
Data table and footnotes
Percentage of 14-year old children vaccinated for HPV, by neighbourhood income quintile (before tax), Canada, 2021
Legend
● Vaccination target
Data table and footnotes
Percentage of 14-year old children vaccinated for HPV, by location, Canada, 2021
Legend
● Vaccination target
Data table and footnotes
Story of progress
HPV vaccine uptake can vary from neighbourhood to neighbourhood
Vancouver Coastal Health (VCH) is one of five regional health authorities in British Columbia, serving more than 1.25 million people in its local region. VCH also delivers specialized, complex care and services for people throughout British Columbia and serves as the province’s hub for healthcare education and research. The health authority conducted a study using vaccination, demographic and school enrollment data to understand trends in vaccine uptake among students in Grades 6 and 9. The study revealed significant differences in HPV vaccine uptake among students by sex, grade and school type.
VCH also found that HPV vaccine coverage was influenced by socio-demographic differences in neighbourhoods, including level of social deprivation, material deprivation, geographical community of care and proportion of visible minority residents. Neighbourhood- and community-specific research can help highlight pockets of under-vaccinated people within a population. This information can be used to design interventions tailored to neighbourhood contexts to improve HPV vaccination rates.
First Nations-, Inuit- and Métis-governed research and data systems
To further support closing gaps in care, health system partners are prioritizing First Nations-, Inuit- and Métis-governed research and data systems and collaborating with First Nations, Inuit and Métis communities to co-design tailored solutions.
Efforts are also needed to enhance linkages across cancer data and fill data gaps, including collecting data on equity identifiers, to better understand who experiences disparities. This reporting will provide actionable insights to support program improvement.
Gaps in HPV vaccination uptake must be closed
HPV vaccination rates vary significantly between and within provinces and territories, with some populations experiencing rates as low as 50%. HPV vaccination efforts should focus on identifying and addressing barriers experienced by communities with lower uptake of HPV vaccines to ensure all people in Canada are protected from HPV and cervical cancer.
The graph below projects future cervical cancer incidence for populations with varying levels of HPV vaccine uptake in school-aged children (50%, 70% and 90%). Populations with 50% uptake will experience significantly worse outcomes than populations with 70–90% uptake.
Projected age-standardized incidence rate (per 100,000) for cervical cancer by level of HPV vaccination uptake, 2018 to 2051
Legend
● 50% of people in universal school-based vaccination programs vaccinated from 2024 onwards + implementation of HPV primary screening from 2025 onwards*
● 70% of people in universal school-based vaccination programs vaccinated from 2024 onwards + implementation of HPV primary screening from 2025 onwards*
● 90% of people in universal school-based vaccination programs vaccinated from 2024 onwards + implementation of HPV primary screening from 2025 onwards*
● Elimination threshold
*Increasing HPV vaccination must be combined with the implementation of HPV primary screening and improved follow-up of screening results to eliminate cervical cancer.
Data table and footnotes
- Diamond LM, Clarfield LE, Forte M. Vaccinations against human papillomavirus missed because of COVID-19 may lead to a rise in preventable cervical cancer. CMAJ 2021; 193(37).
- Public Health Ontario. Immunization coverage report for school-based programs in Ontario: 2019-20, 2020-21 and 2021-22 school years with impact of catch-up programs [Internet]. Toronto, ON: Public Health Ontario; 2023 [cited 2024 Mar 10]. Available from: https://www.publichealthontario.ca/-/media/Documents/I/2023/immunization-coverage-2019-2022.pdf.
- Public Health Agency of Canada. Vaccination coverage goals and vaccine preventable disease reduction targets by 2025. 2022 [Internet]. Ottawa, ON: Public Health Agency of Canada; 2022 [cited 2024 Mar 11]. Available from: https://www.canada.ca/en/public-health/services/immunization-vaccine-priorities/national-immunization-strategy/vaccination-coverage-goals-vaccine-preventable-diseases-reduction-targets-2025.html.
- Canadian Cancer Statistics Advisory Committee, Canadian Cancer Society, Statistics Canada, Public Health Agency of Canada. Canadian cancer statistics 2023 [Internet]. Canadian Cancer Society: 2023 [cited 2024 Feb 6]. Available from: https://cancer.ca/Canadian-Cancer-Statistics-2023-EN.
- Public Health Agency of Canada. Childhood national immunization coverage survey. 2023 [Internet]. Ottawa, ON: Public Health Agency of Canada; 2023 [cited 2024 Mar 10]. Available from: https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/2019-highlights-childhood-national-immunization-coverage-survey.html.