While countries with soaring cervical cancer rates would dearly love to offer citizens the HPV vaccine, their governments struggle most to afford it. In the poorest parts of the world, shortages, dosage costs, and barriers to distribution and delivery have made HPV vaccine access like winning a “life lottery” – garnering them no more than 13 percent of the global share. Despite the efforts of nonprofit agencies like Gavi – a vaccine-funding provider for the world’s poorest countries – this potent source of prevention remains elusive for “caught-in-the-middle” nations deemed above the funding cut-off. No such shortage exists in the United States, which pays $160 USD a dose and recently expanded vaccine eligibility in females up to forty-five, despite peak efficacy in teen girls. Market forces perpetuate the battle for this precious resource, even though widespread screening and pre-cancer treatment won’t be enough to stop the disease. In the absence of widespread HPV vaccination, global cervical cancer elimination remains a distant hope.