Aotearoa New Zealanders’ views of policies and funding for human papillomavirus vaccination and screening for cervical and lung cancers: a national survey

Cancer prevention and early detection are central to reducing cancer incidence, inequities and avoidable mortality in Aotearoa New Zealand.¹ The country has made progress through vaccination and organised screening programmes, such as those for cervical, breast and bowel cancers currently available in Aotearoa New Zealand.¹ Yet preventable cancers continue and disproportionately affect Māori and Pacific people, reflecting gaps in access, coverage and system design.^1,2

Persistent infection with high-risk human papillomavirus (HPV) types is a necessary cause of virtually all cervical cancers³ and is causally associated with a substantial proportion of other anogenital and oropharyngeal cancers.⁴ Consequently, to reduce the burden of disease associated with HPV infection,⁵ Aotearoa New Zealand introduced a national HPV vaccination programme for females only in 2008 and has progressively expanded eligibility, adding males in 2017.⁶ Currently, HPV immunisation in Aotearoa New Zealand is free for all genders aged 9–26 years; however, vaccination coverage has declined in recent years and remains uneven by region, ethnicity and mode of delivery.^6,7

There is now strong international evidence that a single-dose HPV vaccination schedule provides substantial protection against HPV infection, and the World Health Organization (WHO) recommends the use of one-dose schedules to simplify delivery and improve uptake.⁸ Despite this, Aotearoa New Zealand currently requires two doses for most age groups, and policy advocacy groups have called for law change to enable single-dose scheduling and resource investment to improve vaccination coverage.⁹

Primary prevention and early detection through screening remain critical for cancers that are not vaccine preventable, and for cervical cancers occurring in people who were beyond the age of eligibility when HPV vaccination became available. Cervical screening programmes in Aotearoa New Zealand have played a major role in reducing cervical cancer incidence over time, particularly following the introduction of organised population screening.¹⁰ More recently, national cervical screening coverage has improved with the transition to HPV primary screening; however, participation remains lower among Māori and Pacific women than the national average.^11,12 HPV-based screening, including the option of vaginal self-testing, is more acceptable to under-screened populations and can improve participation.^12,13 However, persistently lower screening coverage among Māori and Pacific women is associated with a higher burden of cervical cancer, including elevated incidence and mortality, highlighting ongoing inequities in prevention and outcomes.^11,12 Cervical cancer screening in Aotearoa New Zealand is not universally free for all those eligible (people with a cervix aged 25–69).^12,14 Policy proposals to remove cost barriers, by making cervical screening free for all those eligible, aim to address this structural barrier to equitable early detection.¹⁵

Lung cancer remains the leading cause of cancer death in Aotearoa New Zealand, causing around 1,800 deaths each year.¹⁶ It is also a leading contributor to health inequity for Māori.¹⁷ Māori are over three times as likely to develop (and to die from) lung cancer as people of European/Other ethnicity.¹ While prevention remains key to tackling lung cancer, international randomised trials provide strong evidence that low-dose computed tomography screening of individuals at high risk detects lung cancer at earlier stages and results in a significant reduction of lung cancer mortality.¹⁸ Aotearoa New Zealand–specific modelling and qualitative research together suggest that targeted lung cancer screening for populations at highest risk would be cost effective and acceptable if designed to be equity focussed and culturally appropriate.^19,20 Currently, 11 countries have implemented organised national or regional lung cancer screening programmes. While parameters differ between countries, all utilise a risk-based approach to eligibility.²¹

To inform public debate on these prevention and early detection strategies, this study reports public opinion on HPV vaccination policies and the expansion of targeted and equitable cancer screening programmes in Aotearoa New Zealand.

Methods

This paper presents results from a nationwide cross-sectional online survey examining public attitudes towards evidence-informed vaccination and cancer screening policies in Aotearoa New Zealand. Comprehensive information is reported elsewhere in the study methodology.²² Essential details will be outlined in brief here, including that participants aged 18 years and older were recruited through a large commercial online research panel. Quota sampling was used to achieve approximate national representativeness across age, gender and ethnicity, with additional oversampling of Māori and Pacific people. Survey data were collected between November and December 2025 using a structured questionnaire. The survey consisted primarily of closed questions addressing policy for cancer prevention, early detection, treatment and care. The present paper focusses specifically on vaccination and screening, drawing on a subset of relevant survey items.

Public attitudes towards HPV vaccination and cancer screening policy were assessed using four survey items included within the questionnaire (Appendix A). Further stratified analyses are reported in the supplementary tables (Appendix B). Respondents were provided with contextual information on each policy issue before being asked to indicate their level of support or opposition to two HPV vaccination policy statements—1) if one dose of the HPV vaccine gives enough protection, that the government reduce the number of doses children need from two to one, and 2) that the government spend more money to increase HPV vaccination rates—and two cancer screening policy statements—3) introducing a free lung cancer screening programme that focusses on people who are most at risk, so the disease can be found earlier and more lives saved, and 4) making the cervical screening programme free for all women aged 25–69. For each statement, respondents selected one response on a six-point scale ranging from strongly support, support, slightly support, slightly oppose, oppose to strongly oppose. A do not want to answer option was available for each item. Respondents were also asked about their willingness to pay more tax to increase healthcare funding, assessed with categorical response options (yes; yes if earmarked for healthcare; no; don’t know).

Total (design and poststratification) weighting was applied to align the sample with 2023 New Zealand Census population distributions for age groups, gender and Māori ethnicity. Analyses incorporated survey weights and results are reported for both the total adult population and separately by age group, gender, prioritised ethnicity and voting intention. After accounting for weighting, the effective sample size reduced to 1,161, and the approximate worst-case margin of error for a population estimate was ±2.9%. Ethical approval processes are detailed in the methodology publication.²²

Ethical approval

Ethical approval was granted by the University of Otago Human Ethics Committee (25/1184).

Results

Each of the HPV vaccination policies proposed in this survey had high levels of estimated public support. More than three-quarters of the population supported (combined strongly support, support and slightly support) reducing the number of HPV vaccine doses from two to one (77.5%) and increasing government spending to improve HPV vaccination rates (80.3%) (Table 1). The proportion selecting do not want to answer was 7.9% for dose reduction and 6.2% for increased spending.

View Table 1–2.

Support for both policies exceeded 70% across all age groups, ethnicities (except Other) and genders (Appendix B). Support for reducing the number of HPV vaccine doses was highest among New Zealanders aged 50–64 years (81.8%) and those aged 65 years and over (86.7%), and among those of Middle Eastern, Latin American and African (MELAA) ethnicity (87.2%). Similarly, increased spending to improve HPV vaccination rates was most strongly supported by those aged 65 years and over (87.4%) and those of MELAA ethnicity (92.1%). A slightly higher proportion of males supported increased spending compared with females (82.5% versus 78.1%); however, a greater proportion of females selected do not want to answer (8.2% versus 4.2%).

Table 2 presents overall support for the HPV vaccination policies by voting intention. There was consistent cross-party majority support for both policies. For reducing the number of HPV vaccine doses, support was lowest among Green (69.7%), Te Pāti Māori (69.6%) and undecided voters (69.0%); notably, 18.0% of undecided voters selected do not want to answer. For increased spending on HPV vaccination, support was lowest among NZ First and undecided voters (68.1% and 68.7%, respectively), with 14.8% of undecided voters selecting do not want to answer.

There was very high support for making the cervical screening programme free for all women aged 25–69 years (93.4%) (Table 1). Support was highest among those aged 65 years and over (97.2%) and exceeded 90% across all ethnic groups. Females reported slightly higher overall support than males (95.4% versus 91.2%), and a greater proportion of females strongly supported this policy (65.0% versus 51.2%).

Support for introducing a free lung cancer screening programme for people most at risk was also very high (93.3%). Support exceeded 90% across all age groups, with support ranging from 91.4% among those aged 30–39 years to 96.0% among those aged 65 years and over. Pacific people were the most supportive (95.7%), with support exceeding 90% across all ethnicities except the Other group. Females and males both favoured this policy, with females more likely to report strong support (54.0% versus 46.5%).

By voting intention (Table 2), support for making the cervical screening programme free remained very high among all voters. Green (97.9%) and Labour voters (95.2%) were highest, with only undecided voters falling below 90% support. While a clear majority supported introducing a free lung cancer screening programme across all voting groups, those intending to vote for ACT reported the lowest level of support (82.0%), compared with very high support among Green (97.1%) and Labour voters (95.5%).

Finally, a majority of New Zealanders supported paying more tax to increase healthcare funding (62.3%), including 49.9% who preferred that additional revenue be directed exclusively to healthcare. Willingness to pay more tax was highest among Māori (66.9%) and slightly higher among males than females (63.5% versus 60.8%). There was considerable cross-party support for paying more tax to increase healthcare funding. Only those intending to vote for ACT or responding don’t know did not achieve majority support, although both were higher than those answering no. Those intending to vote Green or Te Pāti Māori reported the greatest willingness to pay more tax (both >70%).

Discussion

This survey indicates strong public support for prevention and early detection–focussed health policies, with each proposed HPV policy receiving more than 75% support and the two screening policies more than 90% support. Although some variation of support for these policies was shown by voting intention, substantial majority support was still shown for all policies across all voting intentions. Furthermore, approximately two-thirds of New Zealanders are willing to pay more tax to increase healthcare funding, especially if it is earmarked for this purpose.

The most effective way to reduce the burden of cancer in communities is to prevent cancers that are avoidable and to identify disease early through accessible and equitable primary healthcare and screening programmes.²³ Cervical cancer is highly preventable, and there is a significant opportunity to eliminate this disease by increasing HPV vaccination rates and improving early detection of pre-cancerous lesions and early-stage disease through screening. Aotearoa New Zealand has committed to the WHO’s Global Strategy for the Elimination of Cervical Cancer, which sets the 90-70-90 targets for HPV vaccination, screening and treatment by 2030.²⁴ Despite this commitment, New Zealand’s total HPV vaccination rate remains substantially below the WHO target, with only 59.3% of 15-year-olds fully immunised (55% Pacific and 51.4% Māori).⁷ This survey demonstrates clear support for increased government investment in the vaccination programme (80.3%) and for adopting a single-dose schedule (77.5%). Given the evidence of improved uptake coupled with substantial protection against infection,^8,25 we strongly encourage the government to implement this schedule as soon as possible.

Support for a fully funded cervical screening programme was extremely high across all voting groups (>90%) except don’t know voting intention (87.7%). Cervical cancer places a large burden on individuals, whānau and the health system; it is unacceptable that financial barriers continue to prevent some individuals from accessing screening.^26,27 Strengthening primary screening alongside HPV vaccine uptake is essential to achieving elimination goals and addressing persistent inequities for Māori and Pacific people.

Lung cancer is the leading cause of cancer-related mortality in Aotearoa New Zealand, with marked and enduring inequities for Māori.^1,17 It causes one-third of all Māori cancer deaths, about the same number as the next six leading causes of cancer deaths for Māori combined.²⁸ Nearly half of all lung cancers in Aotearoa New Zealand are diagnosed via the emergency admissions route,²⁹ and Aotearoa New Zealand has poorer survival outcomes compared with other countries.^30,31 Yet most lung cancers are preventable and early detection by screening for people with a substantial history of smoking can reduce mortality risk by 20–36%.¹ A screening programme aimed at detecting lung cancer at an earlier stage for high-risk groups would lead to earlier diagnoses, less intensive treatment and improved survival rates and improve equity for Māori.³² This survey clearly demonstrates substantial support for the introduction of a fully funded lung cancer screening programme for those at highest risk, with support remaining strong across all metrics, including voting intention.

The general strengths and limitations of the study are discussed in the accompanying methodology article,²² including reasonable overall precision of estimates and the potential for selection and participation biases associated with the use of a commercial research panel. In addition, there are limitations specific to this paper. Survey items assessed support for policy directions that are evidenced as effective and were framed as equity focussed and government funded, which may have elicited higher levels of support than would be observed if respondents were required to consider competing priorities and implementation challenges. Questions focussed on broad policy principles rather than programme design details, and did not assess baseline knowledge of HPV, cancer risk or screening effectiveness, which may influence expressed support. Finally, willingness to pay more tax was assessed without specifying the magnitude or duration of tax increases and therefore reflects general acceptability rather than commitment to specific fiscal trade-offs.

Conclusion

This survey provides clear evidence that the Aotearoa New Zealand population firmly favours investment in HPV vaccination and screening for cervical and lung cancers. Furthermore, the majority of New Zealanders are willing to pay more tax to enable increased investment in healthcare. This indicates a clear public mandate to governments to strengthen HPV vaccination and screening for cervical and lung cancers to protect individuals from cancer now and in the future.

View Appendix.