Assessing the influence of male vaccination on cervical cancer elimination in China under different vaccination coverage scenarios: A modeling study
Cervical cancer caused by human papillomavirus (HPV) infection remains a significant public health challenge in China, where screening and HPV vaccination uptake fall well below World Health Organization's (WHO) targets. This study aimed to assess the impact of gender-neutral vaccination (GNV) on cervical cancer elimination in China at a range of vaccination coverage rates (VCRs) and screening uptake rates. Using a model to project cervical cancer incidence and cases in China over 100 years, we evaluated different vaccination strategies using either a bivalent (2vHPV) or nonavalent (9vHPV) vaccine and estimated the time taken to reach the WHO's elimination threshold of 4 cases per 100,000 women. Results showed that all GNV strategies were more effective than the corresponding girls-only strategy at preventing cervical cancer, and all 9vHPV-based strategies were more effective than the corresponding 2vHPV-based strategies, especially at lower female VCRs. At a 70% screening uptake and a female VCR of 60%, the fastest predicted disease elimination time (65 years) was achieved using GNV-9vHPV; this timeline was accelerated to 56 years at a female VCR of 90%. The time to elimination using GNV-9vHPV could be accelerated by up to 6 years by adding a catch-up vaccination program or 7 years by increasing the screening rate. These results suggest that updating the current Chinese HPV vaccination program by including males and using a nonavalent vaccine, in conjunction with efforts to increase cervical cancer screening uptake, offers the fastest route to cervical cancer elimination in China, especially while VCRs remain low.