Authors: Andi Reza Ferdiansyah, Ruth Tabita
Reviewers : Farid al Firdaus, Priska Maya Putri, Dwi Martutiningrum
Background – Global & Indonesia Cervical Cancer Challenges
Cervical cancer remains a major global health concern, with more than 661,000 new cases and 348,000 deaths reported in 2022, making it the fourth most common cancer among women worldwide (Bray et al., 2024; Zhou et al., 2025). The disease is primarily caused by persistent infection with high-risk human papillomavirus (HPV), especially types 16 and 18, which can progress from precancerous lesions to invasive cancer if left untreated (Marshal, 2025).
Source: https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21834
Cervical cancer incidence in Indonesia remains among the highest in Southeast Asia, with an estimated 36,964 new cases and 20,000 deaths annually (WHO, 2020). According to the latest data from the Indonesian Ministry of Health, cervical cancer continues to exhibit a significant prevalence. The following section presents prevalence and mortality figures across several regions in Indonesia (Fadhliana, 2024).
Source: https://ejurnalunsam.id/index.php/jempa/article/view/11681
In response, Indonesia has integrated HPV vaccination into its national immunization program since 2022, in line with the World Health Organization’s “90-70-90” strategy for cervical cancer elimination.
This article examines the implementation of the HPV vaccination program, highlights progress and disparities, and identifies key challenges and strategic recommendations for sustainable success.
The National Action Plan (Rencana Aksi Nasional/RAN) as A Strategic Government Program Aimed at Mitigating The Cervical Cancer Burden
Indonesia’s commitment to cervical cancer prevention is reflected in its adoption of WHO’s 90-70-90 targets and the integration of HPV vaccination into the national immunization schedule. The program is primarily delivered through the Bulan Imunisasi Anak Sekolah (BIAS) initiative, which administers the first dose to fifth-grade girls and the second dose to sixth-grade girls, with a minimum six-month interval.
To strengthen the HPV immunization program, the Government of Indonesia, through the Ministry of Health, has issued several legal instruments, including Ministerial Decree No. HK.01.07/MENKES/35/2025, which officially incorporates HPV vaccination into the national routine immunization schedule. Furthermore, Ministerial Decree No. HK.01.07/MENKES/6779/2021 on the Introduction of the HPV Vaccine Immunization Program (2022–2024) stipulates phased implementation: initially in selected provinces during 2022–2023, followed by nationwide coverage across all districts and cities in 2024.
To ensure inclusivity, community-based outreach is conducted by public health centers (puskesmas) to reach out-of-school children. Although cervical cancer typically affects women aged 30–50, early vaccination is recommended due to stronger immune responses and long-term protection when administered before sexual debut.
Progress and Disparities in HPV Immunization Coverage
The government has launched “catch-up” programs for 15-year-old girls who may have missed earlier doses, including those outside the formal school system for all over Indonesia (Antara News, 2023).
Although notable progress has been made, the reported national coverage rates, which are approximately 95 percent for the first dose and 90 percent for the second dose, may conceal disparities in vaccine distribution. These figures represent aggregate outcomes and may obscure inequalities across geographic regions, urban and rural populations, and school versus non-school children (Wulandari et al., 2023).
Moreover, not all districts introduced the HPV vaccine simultaneously. Several cities only adopted the free vaccination program after 2022, resulting in delayed protection for eligible cohorts (Sekretariat Kabinet Republik Indonesia, 2022). These variations indicate that, despite the near-universal reach of policy coverage across the country, actual vaccine uptake remains inconsistent, particularly in remote and underserved communities.
Table of Cervical Cancer Urgency
| Indicator | Value | Source |
| Cervical cancer incidence | 36,964 cases | IARC, 2024 |
| Annual mortality | ±20,000 | WHO, 2023 |
| HPV vaccine coverage (1st dose) | 95% (national) | Ministry of Health, 2024 |
| HPV vaccine coverage (2nd dose) | 90% (national) | Ministry of Health, 2024 |
The Challenges and What Should be Improved
Governance Gap
Despite Indonesia’s strong policy commitment to cervical cancer elimination through the National Action Plan (RAN), a significant governance gap persists between central and local authorities. While the Ministry of Health formulates national targets and policies, local health offices often struggle to implement them effectively due to limited resources, unclear authority, inconsistent budget transfers, and weak data systems. These challenges result in uneven HPV vaccination coverage across regions, with stronger outcomes in well-supported provinces and weaker progress in resource-limited areas. Strengthening decentralization, accountability, and local capacity is therefore crucial to ensure consistent and effective program implementation nationwide.
Supply Chain Barrier
In geographically dispersed regions such as Papua, Maluku, and East Nusa Tenggara, HPV vaccine distribution faces major logistical challenges due to difficult terrain, limited transportation, and unreliable electricity that disrupt cold-chain systems. Although national efforts have been made to ensure vaccine availability, challenges such as delivery delays, quality control issues, and inadequate coordination between central and regional warehouses continue to result in uneven stock distribution. Consequently, some districts experience an oversupply of vaccines, while others face shortages. Strengthening vaccine logistics information systems and investing in last-mile delivery infrastructure are therefore crucial to achieving equitable and timely vaccine access across Indonesia.
Social Acceptance Issue
Sociocultural perceptions significantly influence the success of the HPV vaccination program. In particular, persistent misconceptions linking the vaccine to early sexual activity or promiscuity continue to circulate in certain communities. These beliefs contribute to parental reluctance, especially in conservative and rural areas. Limited public understanding of the vaccine’s role in preventing cervical cancer further reinforces this stigma. To overcome these barriers, community engagement must actively involve local leaders, religious figures, and schools to build trust and promote accurate information. Public communication should highlight the vaccine’s safety, efficacy, and cancer-prevention benefits rather than its association with sexual transmission.
Conclusions and Recommendations for Practice
The HPV immunization program represents a critical step toward reducing cervical cancer mortality in Indonesia. High national coverage rates demonstrate strong political and institutional commitment. If sustained annually and equitably across all regions, Indonesia is well-positioned to meet WHO’s elimination targets.
However, long-term success depends not only on maintaining high coverage but also on addressing disparities in access, strengthening surveillance systems, and integrating vaccination with screening and early treatment programs. Cervical cancer prevention efforts should be implemented through an integrated approach that ensures equitable access for all eligible populations, without discrimination based on geographic location, educational attainment, or socioeconomic status.
Building on these conclusions, the following recommendations outline practical strategies to ensure the sustainability and equity of Indonesia’s HPV immunization program.
- Logistics and Infrastructure
To ensure equitable and timely access to HPV vaccines across Indonesia, it is recommended to strengthen the national vaccine logistics management information system and invest in last-mile delivery infrastructure within the Directorate of Immunization Management. These efforts must be supported by the availability of real-time, reliable data on vaccine administration and stock levels at the district and municipal levels. Such data are essential for evidence-based evaluation and decision-making, enabling regular monitoring of coverage, program quality, and operational challenges.
- Intersectoral Collaboration and Community Engagement
Addressing sociocultural resistance requires coordinated efforts across sectors. Strengthening collaboration among government agencies, civil society, and community leaders is essential to combat misinformation and promote vaccine acceptance. Deploying mobile vaccination units with flexible service schedules can help reach underserved populations, including out-of-school and economically disadvantaged children.
References:
- IARC. (2024). GLOBOCAN 2022 Indonesia fact sheet. International Agency for Research on Cancer. Retrieved from https://gco.iarc.who.int/media/globocan/factsheets/populations/360-indonesia-fact-sheet.pdf
- Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2024;74:229–63. https://doi.org/10.3322/caac.21834.
- Marshall, A., Pareja, R., Ruzindana, K., Bhatla, N., & Wilailak, S. (2025). FIGO position statement on the effectiveness and safety of the HPV vaccine. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.70506
- WHO. Human papillomavirus and cancer. n.d. https://www.who.int/news-room/fact-sheets/detail/human-papilloma-virus-and-cancer. Accessed 23 September 2025
- \WHO. Cervical Cancer Elimination Initiative. https://www.who.int/initiatives/cervical-cancer-elimination-initiative . Accessed 23 September 2025
- Zhou, L., Li, Y., Wang, H., Qin, R., Han, Z., & Li, R. (2025). Global cervical cancer elimination: Quantifying the status, progress, and gaps. BMC Medicine, 23(1), Article 57. https://doi.org/10.1186/s12916-025-03897-3
- Tjokroprawiro, B. A., Novitasari, K., Saraswati, W., Yuliati, I., Ulhaq, R. A., & Sulistya, H. A. (2024). The challenging journey of cervical cancer diagnosis and treatment at the second largest hospital in Indonesia. Gynecologic Oncology Reports, 51, 101325. https://doi.org/10.1016/j.gore.2024.101325
- Putri. (2025, April 26). Kemenkes komitmen eliminasi kanker serviks. Indonesia.go.id. https://indonesia.go.id/kategori/sosial-budaya/9248/kemenkes-komitmen-eliminasi-kanker-serviks?lang=1
- Putri, A. R., & Adyani, K. (2025). Faktor-faktor yang berhubungan dengan perilaku deteksi dini kanker serviks: Literature review. Jurnal Ilmiah Bidan, 9(2), 101–110. https://ibi.or.id/journal/index.php/jib/article/view/555/173
- Fadhliana, N., Malliny, I., Firdus, F., & Rosnizar, R. (2025). Imunogenitas vaksin HPV dalam pencegahan kanker serviks di Indonesia: Efikasi, kebijakan, dan hambatan. Jurnal Jeumpa, 12(1), 1–10. https://doi.org/10.33059/jj.v12i1.11681
- Kementerian Kesehatan Republik Indonesia. (2023). Rencana aksi nasional eliminasi kanker serviks. Kementerian Kesehatan RI. https://kemkes.go.id/id/rencana-aksi-nasional-ran-eliminasi-kanker-leher-rahim-di-indonesia-tahun-2023-2030
- Keputusan Menteri Kesehatan RI Nomor HK.01.07/MENKES/35/2025
- Keputusan Menteri Kesehatan Republik, Indonesia NOMOR HK.01.07/MENKES/6779/2021 TENTANG PROGRAM INTRODUKSI IMUNISASI HUMAN PAPILLOMAVIRUS VACCINE (HPV) TAHUN 2022-2023