as a reduction in the incidence of anal and penile cancers and other hpv-related diseases. in addition to the direct benefit to males, it was estimated that routine hpv vaccination of adolescent males would contribute to the reduction of vaccine hpv-type infection and associated disease in women through herd immunity. in 2012, the australian government announced it would be extending the national hpv vaccination program to include males, through the national immunisation program schedule. updated results were reported in 2014. from february 2013, free hpv vaccine is being provided through school-based programs for: males and females aged 12–13 years (ongoing program); and males aged between 14 and 15 years – until the end of the school year in 2014 (catch up program). canada hpv vaccines were first approved in canada in july 2006 for use in females, and february 2010 for use in males. the vaccines cervarix, gardasil, and gardasil 9 are authorized for use in canada, with gardasil 9 the primary vaccine used. all provinces and territories (except quebec) administer gardasil 9 on a two or three dose schedule: individuals under age 15 are given two doses, while individuals who are immunocompromised, living with hiv, or age 15+ are given three doses. quebec provides two doses to individuals under 18 years (the first dose is gardasil 9, and the second dose is cervarix) and three doses of gardasil 9 to people age 18+. the administration of free vaccination programs is provided by individual province and territory governments. all provincial and territorial governments offer free vaccination for school-aged children, irrespective of gender. the school grades in which the vaccine is provided varies by province and territory: grade 4 and secondary 3 (quebec); grade 6 (british columbia, manitoba, newfoundland and labrador, nunavut, prince edward island, saskatchewan, yukon); grades 6 and 9 (alberta); grades 4-6 (northwest territories); or grade 7 (new brunswick, nova scotia, ontario). publicly funded hpv vaccines are also provided in certain provinces and territories for other groups of people, such as men who have sex with men, individuals living with hiv, and individuals who identify as transgender. individuals who do not qualify for any of the publicly-funded programs can privately purchase the three-dose hpv vaccine series for $510 to $630. china glaxosmithkline china announced in 2016, that cervarix (hpv vaccine 16 and 18) had been approved by the china food and drug administration (cfda). cervarix is registered in china for girls aged 9 to 45, adopting 3-dose program within 6 months. cervarix was launched in china in 2017, and it was the first approved hpv vaccine in china. colombia the vaccine was introduced in 2012, approved for girls aged 9. the hpv vaccine was initially offered to girls aged 9 and older, and attending the fourth grade of school. since 2013 the age of coverage was extended to girls in school from grade four (who have reached the age of 9) to grade eleven (independent of age); and no schooling from age 9–17 years 11 months and 29 days old. costa rica since june 2019, the vaccine is administered compulsorily by the state, free of charge to girls at ten years of age. europe country date of introduction gender(s) target age group financed by policy austria 2006 m/f 10–12 fully financed by national health authorities for everyone age 9 to 20 years voluntary immunization belgium 2007 f 10–13 fully financed by national health authorities mandatory; part of the national immunization schedule croatia 20 may 2016 m/f 12 fully financed by national health authorities voluntary immunization for women not yet sexually active denmark 1 january 2009 m/f 12 fully financed by national health authorities part of the danish childhood vaccination program finland 21 november 2013 for female, 20 may 2020 for male m/f 11–12 fully financed by national health authorities part of the finnish national vaccination program france 11 july 2007 f 14–23 financed 65% by national health authorities voluntary immunization for women not yet sexually active germany 26 march 2007 m/f 9–14 fully financed by mandatory health insurance voluntary immunization greece 12 february 2007 f 12–26 fully financed by national health authorities mandatory for all girls entering 7th grade hungary 2014 m/f 12 fully financed by national health authorities. in addition subsidised by local councils for 13- and 14-year-olds. iceland 2011 12 fully financed by national health authorities ireland 2009 m/f 12–13 fully financed by national health authorities offered to males and female in first year of secondary school. non-mandatory. hpv vaccination introduced to national immunisation scheme for males in 2019. italy 26 march 2007 m/f 12 fully financed by national health authorities initially for girls only. offered to boys from 2017. latvia 2009 12 fully financed by national health authorities luxembourg 2008 12 fully financed by national health authorities netherlands 2009 f 12–13 fully financed by national health authorities north macedonia 2009 f 12 fully financed by national health authorities mandatory; part of the national immunization schedule norway 2009 f 12–13 part of the national immunization program portugal 2007 f 13 fully financed by national health authorities part of the national immunization program for both boys and girls romania november 2008 f 10-18 fully financed by national health authorities part of the national immunization program, but not mandatory for 10–14 years old girls until august 2021, up to 18 years old as of 3 september 2021 slovenia 2009 11–12 fully financed by national health authorities spain 2007 11–14 fully financed by national health authorities sweden 2012 m/f 10–11 the school-based vaccination program is fully financed by national health authorities, initially for girls only. offered to all children in fifth grade from august 2020 (boys born 2009 are included). all vaccinations within the national vaccination programme for children are voluntary. switzerland 2008 11–14 fully financed by national health authorities uk september 2008 m/f m: 9–45 f: 9–45 fully financed by national health authorities initially for girls only. offered to boys aged 12 and 13 years from september 2019. the hpv vaccine is available for free on the nhs up until a person's 25th birthday if they were eligible and missed the hpv vaccine offered in year 8 at school,: girls born after 1 september 1991 boys born after 1 september 2006 also fully financed by national health authorities since 2018 for men aged up to and including 45 years of age who have sex with other men (msm) when they visit sexual health clinics and hiv clinics in england. trans women (people who were assigned male at birth) are eligible in the same way as msm if their risk of getting hpv is similar to the risk of msm who are eligible for the hpv vaccine. trans men (people who were assigned female at birth) are eligible if they have sex with other men and are aged 45 or under. offered to males and female in second year of secondary school, as well as at sexual health and hiv clinics in england. non-mandatory. hong kong hpv vaccines are approved for use in hong kong. as part of the hong kong childhood immunisation programme, hpv vaccines became mandatory for students in the 2019/2020 school year, exclusively for females at primary 5 and 6 levels. india hpv vaccination has been recommended by the national technical advisory group on immunization, but has not been implemented in india as of 2018. ireland the hpv vaccination programme in ireland is part of the national strategy to protect females from cervical cancer. since 2009, the health service executive has offered the hpv vaccine, free of charge, to all girls from first year onwards (ages 12–13). secondary schools began implementing the vaccine program on an annual basis from september 2010 onwards. the programme was expanded to include males in 2019. two hpv vaccines are licensed for use in ireland: cervarix and gardasil. to ensure high uptake, the vaccine is administered to teenagers aged 12–13 in their first year of secondary school, with the first dose administered between september–october and the final dose in april of the following year. males and females aged 12–13 who are outside of the traditional school setting (home school, etc.) are invited to health service executive clinics for their vaccines. hpv vaccination in ireland in not mandatory and consent is obtained prior to vaccination. for males and females aged 16 and under, consent is granted by a parent or guardian, unless it is explicitly refused by the child. any male or female aged 16 and over may provide their own consent if they want to be vaccinated. hiqa has stated the vaccine will provide further protection, particularly to men who have sex with men. the vaccine has been extended following evidence that 25% of hpv cancers occur in men. additionally, hiqa is aiming to replace the current vaccination, which covers 4 major hpv strains, with an updated vaccine providing protection from 9 strains. the over cost with the "gender-neutral nine-talent" vaccine is estimated to be nearly €11.66 million over the next five years. israel introduced in 2012. target age group 13–14. fully financed by national health authorities only for this age group. for the year 2013–2014, girls in the eighth grade may get the vaccine free of charge only in school, and not in ministry of health offices or clinics. girls in the ninth grade may receive the vaccine free of charge only at ministry of health offices, and not in schools or clinics. religious and conservative groups are expected to refuse the vaccination. japan introduced in 2010, widely available only since april 2013. fully financed by national health authorities to females aged 11 to 16 years. in june 2013, however, japan's vaccine adverse reactions review committee (varrc) suspended recommendation of the vaccine due to fears of adverse events. this directive has been criticized by researchers at the university of tokyo as a failure of governance since the decision was taken without presentation of adequate scientific evidence. at the time, ministry spokespeople emphasized that "the decision does not mean that the vaccine itself is problematic from the viewpoint of safety," but that they wanted time to conduct analyses on possible adverse effects, "to offer information that can make the people feel more at ease." however, the suspension of the ministry's endorsement was still in place as of february 2019, by which time the hpv vaccination rate among younger women fell from approximately 70% in 2013 to 1% or less. over an overlapping time period (2009–2019), the age-adjusted mortality rate from cervical cancer increased by 9.6%. japan to resume active promotion of hpv vaccinations in april 2022. in december 2021, the ministry of health, labour and welfare has decided to allow free vaccines to women born between fiscal year 1997 and 2005 after eight-year hiatus. a panel of japan's ministry of health, labour and welfare agreed to give women (born between fiscal 1997 and fiscal 2005), free vaccinations, if they missed the country's free vaccination program. kenya both cervarix and gardasil are approved for use within kenya by the pharmacy and poisons board. however, at a cost of 20,000 kenyan shillings, which is more than the average annual income for a family, the director of health promotion in the ministry of health, nicholas muraguri, states that many kenyans are unable to afford the vaccine. laos in 2013, laos began implementation of the hpv vaccine, with the assistance of the gavi alliance. mexico the vaccine was introduced in 2008 to 5% of the population. this percentage of the population had the lowest development index which correlates with the highest incidence of cervical cancer. the hpv vaccine is delivered to girls 12 – 16 years old following the 0-2-6 dosing schedule. by 2009 mexico had expanded the vaccine use to girls, 9–12 years of age, the dosing schedule in this group was different, the time elapsed between the first and second dose was six months and the third dose 60 months later. in 2011 mexico approved a nationwide use of hpv vaccination program to include vaccination of all 9-year-old girls. new zealand immunization as of 2017 is free for males and females aged 9 to 26 years. the public funding began on 1 september 2008. the vaccine was initially offered only to girls, usually through a school-based program in year 8 (approximately age 12), but also through general practices and some family planning