Abstract
The Aotearoa New Zealand (NZ) Cervical Screening Programme (NCSP) commenced in 1990. The NCSP has failed to equally reach its eligible population, consequently, cervical cancer rates by ethnicity are inequitable. In 2008, the Aotearoa NZ human papillomavirus (HPV) vaccination programme was introduced. The aim of this study was to determine the impact of HPV vaccination on the occurrence of high-grade cervical abnormalities and cancer in the cohort of people who were eligible for vaccination and underwent cervical screening. Data on the NCSP register were matched to the national vaccination register and the incidence of detected cervical abnormalities by vaccination status, ethnicity, birth cohort, and year of vaccination was determined. HPV vaccination was associated with a marked reduction in cervical cancer (hazard ratio [HR] 0.32) and adenocarcinoma in situ (HR 0.26). Vaccinated people were also less likely to experience a high-grade squamous cervical cytology (HR 0.75) or histology (HR 0.71). We observed equitable access to vaccination and protection against HSIL among Māori, Pacific, and European people. This data is important evidence of the real-world effectiveness of HPV vaccination in Aotearoa NZ. Vaccination improves outcomes equitably for Māori, Pacific peoples, and NZ Europeans. Increased vaccination rates are required for cervical cancer elimination.