This comparative policy analysis examined how national policies for HPV vaccination shape program performance and coverage across eight countries: Australia, Brazil, Japan, Nigeria, Rwanda, Sweden, the United Kingdom, and the United States. The primary aim was to compare policies and assess how the domains of actors, context, content, and process influence vaccination outcomes.
The study used a qualitative cross-case document analysis. The Health Policy Triangle framework—covering Actors, Context, Content, and Process—guided the analytic approach. A standardized data extraction template was applied to each country case. Data synthesis used comparative matrices and iterative cross-case analysis. Coding of extracted data was verified by a second reviewer.
Sources comprised official national HPV vaccination guidelines and technical advisory documents, WHO and UNICEF monitoring reports, and peer-reviewed literature published from January 2006 through December 2024. Documents were identified through structured searches of PubMed, CINAHL, Scopus, and Web of Science. The eight countries were selected for cross-national comparison and include high-, middle-, and low-income settings.
The Health Policy Triangle provided a structured lens to examine:
Using this framework, the authors populated comparative matrices to identify patterns and archetypes across the country cases.
Five distinct policy archetypes emerged from cross-case analysis:
These archetypes describe common configurations of policy content and implementation across diverse contexts rather than rigid categories.
Across the cases, school-based delivery supported by nursing and school health workforces produced the most consistent association with high and equitable coverage. A notable finding was Rwanda, which achieved 98% coverage through a girls-only, donor-supported model; this suggests that strong governance, implementation capacity, and community trust can overcome resource constraints and influence outcomes beyond policy design alone.
Key determinants of vaccination performance reported in the analysis included governance structures, implementation capacity, the presence and strength of the nursing workforce and school health infrastructure, and public trust in the immunization program.
The article highlights the global transition toward single-dose HPV vaccination schedules as an important policy trend that requires careful, country-specific adaptation. The authors note evidence gaps that must be considered when adopting single-dose policies, including the absence of clinical trial data assessing single-dose protection in males and against non-cervical HPV-associated diseases. Policy adoption therefore needs to account for population eligibility exceptions and remaining evidence limitations.
Nurses and the school health workforce are emphasized as central to HPV vaccination delivery worldwide. School-based programs with nursing support were repeatedly linked to higher and more equitable coverage across the countries analyzed. The authors argue that investments in nursing-led outreach and workforce infrastructure are critical to implementation success and to meeting WHO cervical cancer elimination targets.
The analysis concludes that HPV vaccination outcomes are shaped not only by policy content but also by governance, implementation capacity, workforce infrastructure, and public trust. Strengthening school-based delivery, expanding single-dose schedules where supported by evidence, and investing in nursing-led outreach are identified as priority strategies for accelerating progress toward WHO cervical cancer elimination targets.
The authors position nurses as key leaders and advocates for school-based models, workforce investment, and equitable immunization strategies across diverse health system contexts.
This study provides comparative evidence to support nursing leadership and program design choices. Recommended strategic priorities emerging from the analysis are:
The article is based on document analysis of guidelines and reports from 2006 to 2024 and used structured literature searches. Specific operational details, numeric breakdowns beyond the examples cited (for instance Rwanda’s 98% coverage), and exhaustive country-level program metrics were not reported in the abstract. For complete methods, datasets, and full country-level findings, consult the full published article in Journal of Nursing Scholarship (2026;58(5):e70131, DOI: 10.1111/jnu.70131).