Introduction: Cervical cancer is the leading cause of cancer deaths among women in Russia. This high early-age mortality emphasizes the need to strengthen the human papillomavirus (HPV) vaccination program among adolescent girls and include it in Russia’s national immunization schedule. Methods: Using data from the Moscow Department of Health, we analyzed the economic burden of cervical cancer, estimated girls’ 2022 vaccination coverage, explored challenges and approaches to improve coverage, and compared the cost-effectiveness of strategies to improve coverage scenarios and reduce HPV vaccine costs. Conversations with healthcare workers at healthcare facilities validated coverage estimates from procurement data based on previous trends and 2020 demographic data. Results: In 2022, we estimated that 24% of girls aged 12-13 years were vaccinated. The total cost for a two-dose vaccination per girl was USD 226.86. HPV vaccination gains 215 quality-adjusted life years (QALYs) per 100,000 females. The discounted cost of treating cervical cancer per patient over 29 years is USD 4,889. Comparing the costs of the HPV program and cervical cancer treatment per 100,000 females, the program proves to be cost-effective and cost-saving even with costs over USD 200 per fully vaccinated girl. This study provides evidence for expanding the HPV vaccination program to other regions of Russia. The study seeks to reduce cervical cancer morbidity and mortality and achieve 50% coverage by 2030. We recommend shifting to a one-dose HPV vaccination strategy and including HPV in the national immunization schedule.