Potential health impact of therapeutic HPV vaccines in China: a modeling study.

Abstract

Therapeutic HPV vaccines (TxVs) may complement existing cervical cancer prevention strategies, particularly for women already infected with HPV who derive limited benefit from prophylactic vaccination. As China advances toward the WHO 90-70-90 cervical cancer elimination targets, understanding the potential health impact of therapeutic vaccines under varying implementation scenarios is critical. We developed a two-stage hybrid model combining a dynamic HPV transmission model with a natural history model of HPV-related disease progression to project the long-term health impact of therapeutic HPV vaccines in China from 2025 to 2125. Two vaccine types aligned with WHO Preferred Product Characteristics were evaluated: one targeting HPV infection clearance (TxV1) and one targeting treatment of cervical intraepithelial neoplasia (CIN) grade 2 or 3 (TxV2). Vaccination was modelled under two use cases: population-based delivery and integration into existing national screening programmes. Outcomes included cervical cancer cases and deaths averted, relative reductions compared with no therapeutic vaccination, age-standardised incidence, and the projected year of elimination. One-way and probabilistic sensitivity analyses evaluate model uncertainty. In the base case, screening-integrated TxV1 (Use Case 2) could avert up to 834.0 thousand cervical cancer cases (12.7% reduction) and accelerate elimination by 11 years, while population-based TxV1 could avert 169.6-474.0 thousand cases (2.6-7.2% reduction). TxV2 showed more modest effects (2.4-7.4% reduction) and was highly sensitive to conventional CIN treatment coverage. Therapeutic vaccine impact was greater in scenarios with limited scale-up of prophylactic vaccination. Vaccine efficacy, coverage, genotype spectrum, and rollout timing were key drivers of impact. Therapeutic HPV vaccines with substantial efficacy could reduce the cervical cancer burden in China, particularly during the transition toward full-scale prophylactic vaccination and screening. These findings support continued investment in therapeutic HPV vaccine development and provide evidence to inform national strategy planning aligned with elimination goals.