Two decades of the HPV vaccine: its promise, progress, prospects, projections, and posterity.

Since its 2006 FDA approval, the Human Papillomavirus (HPV) vaccine has transformed the prevention of cervical, oropharyngeal, and other HPV-associated cancers in the United States. Despite notable progress, with 78.2% of adolescents initiating and 62.9% completing vaccination, support for the vaccine is at a critical point. Because the Department of Health and Human Services (HHS) mainly provides recommendations, state-level action is crucial. Only five states and territories have adopted school-entry HPV vaccination requirements, but with varying enforcement policies. Uptake varies across the U.S., from Massachusetts' 79.8% completion to Mississippi's 39.1%. Evidence shows that school-entry requirements can significantly improve vaccination rates. As we approach the vaccine's twentieth anniversary, maintaining the current gains and achieving the 80% Healthy People 2030 target for series completion demands a multipronged approach. State policies must become more robust, especially if federal support wanes. Preventing HPV-related cancers for future generations depends on continued progress. By prioritizing policy that strengthens prevention and access, states can safeguard this progress.