In Malawi, financial sustainability for HPV vaccination is pursued against a backdrop of significant programmatic complexity and recurrent health emergencies, including COVID-19, polio, cholera outbreaks, and cyclone-related displacement. Cervical cancer is the leading cause of cancer death among women aged 15–49 in Malawi, with an age-standardised incidence of 67.9 per 100,000 women per year and approximately 2,905 annual deaths, providing a compelling public health rationale for sustained HPV investment. HPV vaccination was piloted from 2013–2015, introduced nationally via campaign in 2019 and 2020 with coverages of 83% and 72% respectively, then routinised in 2021; coverage subsequently declined to 12–14% during the COVID period before recovering to 38% by 2025, with a multi-age cohort campaign underway to accelerate catch-up. Gavi provided full financing from 2019 to 2022, with Malawi entering co-financing from 2023 at US$0.20 per dose — an obligation the country has consistently met. Key sustainability mechanisms include a 2019 government commitment that vaccine procurement funds will not be diverted, the integration of HPV financing into the National Immunisation Strategy 2025–2030, EPI annual work plans, and the Health System Strengthening grant, as well as strong multi-sectoral coordination through the Focused Supply Plan Team involving the Ministry of Health, UNICEF, WHO, and the Ministry of Finance. Barriers include foreign currency shortages that in 2025 affected disbursements to UNICEF, and the persistent risk of budget diversion during emergencies. Key lessons highlight political will — evidenced by a presidential launch of the HPV revitalisation — integrated programme design as a cost-efficiency lever, and PIRI as a complementary strategy to reach every eligible girl.