Australia is widely recognised as a global leader in the effort to eliminate cervical cancer as a public health issue. The science is robust, the HPV vaccine is highly effective, and national policy settings are among the strongest in the world. On paper, success appears inevitable.

Yet progress is slowing. Not because the science has failed, but because delivery, equity and communication have not kept pace with clinical advancement. Cervical cancer elimination in Australia is no longer primarily a biomedical challenge. It is an equity and communications challenge.

Human papillomavirus (HPV) is a common virus that most people will be exposed to at some stage in their lives. In many cases it causes no symptoms and is cleared naturally by the immune system. However, persistent infection with high-risk strains, particularly HPV 16 and 18, can lead to cancer. HPV is responsible for almost all cases of cervical cancer and is a major cause of several other cancers in women and men.

Australia’s response to HPV has been highly effective. Since the introduction of the national HPV vaccination program in 2007, combined with advances in cervical screening, rates of infection and pre-cancerous cell changes have fallen substantially. In 2021, no cervical cancer cases were diagnosed in women under 25, and national incidence rates continue to decline, positioning Australia among the world’s leaders in cervical cancer prevention.

The paradox is this: despite one of the most successful HPV programs globally, vaccination coverage and cervical screening participation have declined in recent years, and the benefits of prevention remain unevenly distributed. If the science is working, why is the population-level impact so variable?

The answer lies in who is being left behind.

Adolescents living in socio-economically disadvantaged, regional, and remote areas are less likely to be vaccinated against HPV than those in major cities. Aboriginal and Torres Strait Islander women experience cervical cancer at rates comparable to some developing regions of the world and are around four times more likely to die from the disease than non-Indigenous women.

These disparities are not driven by uncertainty about vaccine effectiveness. They are driven by barriers such as limited access to culturally safe healthcare, structural disadvantage, mistrust in institutions, and prevention messaging that is often generic, episodic and system-led, rather than community-designed.

In recent years, medical leaders have raised concerns about declining vaccination rates and growing vaccine hesitancy, calling for stronger, evidence-based communication approaches to counter misinformation and rebuild public trust. At the heart of these warnings is a simple reality: providing information is not the same as building confidence, relevance or trust.

Australia’s introduction of self-collection for cervical screening offers a powerful example of what works. Uptake has been strongest among groups historically under-screened, including First Nations communities, multicultural populations, LGBTQIA+ people, those with disability, and people in regional and remote areas. The success of self-collection was not only a clinical innovation; it was a design and communications achievement. Prevention was re-engineered around dignity, autonomy and lived experience. When access, design and communication align, behaviour changes.

To meet Australia’s cervical cancer elimination target, HPV vaccination coverage must reach at least 90 per cent of adolescents by 2030. Achieving this will require more than maintaining supply and surveillance. It demands sustained, sophisticated communication strategies that are equity-led, community-designed and grounded in behavioural science. It requires co-design with priority populations, long-term trust-building, and a clear positioning of vaccination equity as a national health priority, rather than a secondary outcome.

The next phase of cervical cancer prevention will not be defined by scientific breakthroughs alone. It will be defined by how effectively we communicate, who we reach, and whether the benefits of vaccination are shared equitably across the population. For Australia to truly eliminate cervical cancer, scientific excellence must be matched by communication strategies capable of reaching the communities still being left behind.