Twenty years after the first dose of the Gardasil vaccine was administered in Australia, the country is approaching a major public health milestone: becoming the first country in the world to eliminate cervical cancer as a public health problem.
The vaccine, developed from pioneering research by Australian scientists Professor Ian Frazer and the late Dr Jian Zhou, was first administered in Brisbane in 2006. Since then, HPV vaccination has become a central part of Australia’s strategy to prevent cervical cancer, alongside regular screening and early treatment.
Australia is now aiming to achieve cervical cancer elimination by 2035, with experts describing the country’s progress as one of the strongest examples of how vaccination and screening can work together to prevent cancer.
Cervical cancer is primarily caused by persistent infection with high-risk types of human papillomavirus, commonly known as HPV. HPV is extremely common, but most infections clear naturally. In some people, however, persistent infection can cause abnormal changes in cervical cells that may eventually develop into cancer.
The introduction of HPV vaccination has changed that trajectory dramatically.
Australia became the first country to introduce a publicly funded national HPV vaccination program in 2007, initially targeting adolescent girls through school-based vaccination. The program was later expanded to include boys, recognising that HPV affects people of all sexes and that broader vaccination can help reduce transmission as well as prevent several HPV-related cancers.
Over the years, the vaccine program has evolved. Australia has moved from a three-dose vaccination schedule to fewer doses, making vaccination easier to deliver and improving accessibility for young people.
The impact has been particularly visible among younger Australians. Cervical cancer rates have fallen sharply in age groups that have benefited from the HPV vaccination program. Among women aged 25 to 29, cervical cancer incidence fell from 9.3 cases per 100,000 in 2013 to 3.4 cases per 100,000 in 2021.
In 2021, no new cases of cervical cancer were recorded among women under 25, although health researchers caution that the number of people in this age group with the disease is relatively small.
The success cannot be attributed to vaccination alone.
Australia has spent decades building one of the world’s most comprehensive cervical cancer prevention systems. The National Cervical Screening Program was introduced in 1991, significantly reducing cervical cancer incidence and deaths. The country later moved from traditional Pap tests to HPV-based screening, allowing doctors to identify people carrying high-risk HPV infections before cancer develops.
The combination of vaccination and screening has been crucial. Vaccination protects future generations from HPV, while screening helps detect infections and abnormal cervical changes among people who may already have been exposed to the virus.
Under the international definition of elimination, cervical cancer must fall below four new cases per 100,000 women per year. Australia is projected to reach that threshold by 2035.
The achievement would make Australia the first country to reach cervical cancer elimination through deliberate public health interventions.
However, health experts warn that reaching the final stage will not be automatic.
HPV vaccination rates have declined in recent years, raising concerns that progress could slow or even be reversed. Screening participation has also fallen, particularly among some groups that already face barriers to accessing healthcare.
This has made maintaining high vaccination and screening coverage one of Australia’s biggest challenges.
Health inequalities are another major concern. Aboriginal and Torres Strait Islander communities continue to experience higher rates of cervical cancer than the broader population. People living in rural and remote areas, disadvantaged communities and some culturally and linguistically diverse groups can also face difficulties accessing vaccination, screening and follow-up treatment.
For Australia to eliminate the disease nationally, experts say the benefits of prevention must reach every community rather than being concentrated among populations with easier access to healthcare.
Australia’s national elimination strategy therefore focuses not only on achieving high vaccination rates but also on improving screening participation and ensuring people with abnormal results receive timely treatment.
The 20th anniversary of Gardasil also highlights the extraordinary journey of the science behind the vaccine.
Frazer and Zhou’s work transformed understanding of how HPV could be used to develop a vaccine against cancer. Their research eventually contributed to the development of Gardasil, which protects against HPV types responsible for a large proportion of cervical cancers as well as several other HPV-related cancers.
What began as laboratory research has consequently become one of the world’s most significant cancer-prevention programs.
Australia’s experience is also being closely watched internationally. Cervical cancer remains a major health problem globally, particularly in countries where access to vaccination, screening and treatment is limited. Australia’s progress demonstrates how sustained investment in prevention can dramatically change the burden of a cancer that is largely preventable.
Twenty years after Gardasil’s arrival, Australia is therefore not simply celebrating a medical breakthrough. It is approaching the possibility of making cervical cancer an exceptionally rare disease.
But experts emphasise that elimination is not the end of the fight. Vaccination, screening and treatment will need to remain accessible and widely used even after incidence falls below the elimination threshold.
If Australia can reverse recent declines in vaccination and screening and close persistent healthcare gaps, the 2035 target could become a reality.
The story of Gardasil, meanwhile, offers a powerful lesson in public health: when scientific discovery is combined with long-term government policy, widespread vaccination and effective screening, a cancer once responsible for thousands of illnesses and deaths can potentially be pushed to the brink of disappearance.
