The HPV Vaccine Affordability Paradox: A Critical Analysis of Global Willingness-to-Pay Data

Alireza Mosavi Jarrahi; Soheila Rajaie; Samad Azari; Zeinab Karimi; Fereshte Karimi

doi:10.31557/APJEC.2892.20260308

Authors

Alireza Mosavi Jarrahi Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Soheila Rajaie Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Samad Azari Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
Zeinab Karimi Tuberculosis and Lung Diseases Research Center, Ilam University of Medical Sciences, Ilam, Iran.
Fereshte Karimi Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran.

DOI:

https://doi.org/10.31557/APJEC.2892.20260308

Keywords:

HPV Vaccine, Willingness to Pay, Health Economics

Abstract

Background: The human papillomavirus (HPV) vaccine is a cornerstone of cervical cancer prevention. However, global access is hampered by affordability, particularly in low-income countries (LICs) where the burden is highest. "Willingness to pay" (WTP) studies are frequently used to inform pricing and policy, but their interpretation can be complex. This mini-review synthesizes evidence from a comprehensive systematic review to analyse a critical paradox in global WTP data for the HPV vaccine.

Methods: This review is based on a synthesis of findings from a recent systematic review that analysed 33 WTP studies for the HPV vaccine across World Bank income classifications. We extracted and re-interpreted the key data points on WTP proportions and absolute monetary values (standardized to 2023 USD) to delineate the relationship between demand and purchasing power.

Results: A striking paradox was identified. LICs demonstrated the highest proportion of the population willing to pay (65.38%), yet the lowest absolute mean WTP ($48.16). In contrast, high-income countries (HICs) showed a similar proportion (64.75%) but a mean WTP of $84.18, and upper-middle-income countries showed a mean WTP of $628.70. This disconnect is driven by methodological differences in survey design (e.g., lower price anchors in LICs) and the high perceived value of the vaccine in high-burden settings.

Conclusion: A superficial interpretation of WTP data risks creating a false narrative of market readiness in LICs, potentially delaying critical subsidies and public-sector programs. Global health stakeholders must shift from interpreting "willingness to pay" to establishing evidence-based "affordability thresholds" to ensure equitable access and prevent the entrenchment of health inequities.