The HPV vaccine is not required in most of the United States. Only three jurisdictions mandate it for school attendance: Virginia, Rhode Island, and Washington, D.C. Everywhere else, it is recommended by the CDC but remains a voluntary decision for parents and individuals.
Where the HPV Vaccine Is Mandatory
Virginia, Rhode Island, and Washington, D.C. are the only places in the U.S. that require HPV vaccination as a condition for school entry. Rhode Island and D.C. apply the requirement to all students regardless of gender, while Virginia’s mandate applies only to female students.
Even in these three jurisdictions, opting out is straightforward. Virginia and D.C. both offer a specific parental opt-out for the HPV vaccine. Virginia’s administrative code spells out the reasoning plainly: “Because the human papillomavirus is not communicable in a school setting, a parent or guardian, at the parent’s or guardian’s sole discretion, may elect for the parent’s or guardian’s child not to receive the HPV vaccine.” In practice, this means the mandate functions more like a strong default than a hard requirement.
Four states have gone in the opposite direction. Arizona, Louisiana, South Carolina, and West Virginia have laws that explicitly exclude the HPV vaccine from school vaccination requirements.
It’s Not Required for College Either
States require a range of vaccines for college enrollment, including meningococcal, MMR, hepatitis B, varicella, and tetanus boosters. The HPV vaccine is not on any state’s list of required immunizations for college entry or on-campus housing, according to the National Conference of State Legislatures. If your university health portal lists it, that is likely a recommendation, not a requirement for enrollment.
What the CDC Actually Recommends
The CDC recommends two doses of the HPV vaccine at ages 11 to 12, with the series starting as early as age 9. If both doses are given before a child’s 15th birthday and spaced at least five months apart, two doses complete the series. Anyone who starts after turning 15 needs three doses spread over six months. People with weakened immune systems also need three doses regardless of when they start.
Routine vaccination is recommended through age 26. For adults 27 to 45, it is not broadly recommended but may make sense on a case-by-case basis after a conversation with a healthcare provider.
Why It’s Recommended Despite Not Being Required
HPV causes nearly all cervical cancers, most anal cancers, and a significant share of throat, vulvar, vaginal, and penile cancers. The vaccine’s track record at preventing these outcomes is striking. Countries with high vaccination coverage (above 50% of the target population) have seen cervical cancer rates drop by 34% to 87%. A large UK study found that women vaccinated at ages 12 to 13 had an 87% reduction in cervical cancer and a 97% reduction in the most severe precancerous cervical lesions. Denmark reported an 86% reduction in cervical cancer incidence among girls vaccinated by age 16.
The gap between “recommended” and “required” largely comes down to how HPV spreads. Traditional school vaccine mandates target diseases that can move through a classroom: measles, chickenpox, whooping cough. HPV is sexually transmitted, so the public health argument for a school-entry mandate is different, and politically more contentious. That distinction is why even Virginia’s own mandate language acknowledges that HPV is “not communicable in a school setting.”
How Vaccine Exemptions Work in Mandate States
All states with any vaccine mandates offer medical exemptions, which typically require a written statement from a licensed physician describing why vaccination would be unsafe for a specific child. Beyond that, the availability of religious and philosophical exemptions varies by state. Some states require parents to review educational materials about the benefits of vaccination and the risks of skipping it before an exemption is granted. Others require notarized written statements.
For the HPV vaccine specifically, Virginia and D.C. make opting out simpler than for other required vaccines. Parents do not need to claim a religious or philosophical objection. They can decline at their own discretion, no explanation needed.
Insurance Coverage for the HPV Vaccine
Even though the vaccine is not mandatory in most places, cost is rarely a barrier. The Affordable Care Act requires both public and private insurance plans to cover all vaccines recommended by the CDC’s Advisory Committee on Immunization Practices with no copay or cost-sharing. That includes the full cost of the HPV vaccine series, as well as related preventive services like Pap tests and HPV testing for women. For uninsured children, the federal Vaccines for Children program covers it at no cost through participating providers.
Outside the United States
Most countries that offer the HPV vaccine do so through national immunization programs as a recommendation, not a legal mandate. A few exceptions exist. Turkmenistan added HPV vaccination to its mandatory national immunization calendar in 2016 for boys and girls starting at age 9. Serbia made HPV vaccination mandatory and state-funded in 2022 for individuals aged 9 to 19. But globally, the approach mirrors what most U.S. states do: strongly recommend the vaccine without legally requiring it for school attendance.