Pakistan can join the global efforts towards eliminating Cervical Cancer if we vaccinate our young girls against HPV, offering them lifelong protection and reducing the number of maternal orphans.

According to the Globocan International Agency for Research (IARC) data of 2022, Cervical cancer is the 4th most common cancer among women in Pakistan, accounting for around 5000 incident cases and 3000 deaths. Most cases are detected at late stage, making it difficult to treat. HPV screening and PAP test are available in Pakistan, having poor uptake due to unawareness, unaffordability, and difficult access 

The HPV vaccine is globally available, preventing about 90 percent of cervical cancer cases, making it one of the preventable cancers in the world. In Pakistan, the HPV vaccine was first introduced 6 to 7 years ago. It costs about $17 to $42 USD. The coverage is unknown but appears to be below due to unaffordability and lack of awareness. 

To meet the WHO’s recommended cervical cancer elimination strategy to eliminate cervical cancer by 2030 8(i.e. 90% girls should get vaccinated for HPV by the age of 15); the Government of Pakistan, with support of UNICEF, GAVI Alliance, Jhpiego, and WHO, introduced the first roll out of free-of-cost single-dose HPV vaccine for girls aged 9 to 14 years of age. In the first phase, the vaccine was introduced in Sindh, Punjab, Azad Jammu and Kashmir (AJK) and Islamabad, from 15th September to 27th September, 2025 aiming to target 13 million girls. The campaign ran in schools while making vaccines available at Madrassas and Public healthcare facilities 

In recent decades, people have turned to social media to know others’ experiences and viewpoints, while they rely on AI in this age. A single negative comment or wrong feed can mislead individuals relying on AI or social media for their decision-making. 

Though this campaign resulted in approximately 72% coverage, about 90 thousand girls were left unvaccinated. Soon after the launch of the vaccination campaign in the country, misinformation surfaced on social media as it is found to be a challenge when any new vaccine is introduced 12. Vaccine hesitancy is not uncommon and is witnessed during similar vaccination campaigns globally. With only 2% of caregivers being aware of the HPV vaccine as a preventive measure for cervical cancer, this campaign was more challenging 8. Further, despite being FDA approved3 and WHO pre-qualified and its wide acceptance in the Muslim countries for a decade, vaccination against HPV was still portrayed to be new and unverified. It was thought to affect the fertility among vaccinated girls and the development of autoimmune disorders, which had no basis of evidence. The vaccine has already been taken up by 150 countries in the world 8 .No such adverse effects have been reported by any of the countries that have adopted this vaccine and added it in their Expanded Programme for Immunization (EPI) schedule, for example, Saudi Arabia, Qatar, and UAE. People against the campaign raised concerns on social media about the vaccine not preventing all strains of HPV. The vaccine prevents HPV strains 16 and 18, the most aggressive types responsible for the most invasive cervical cancers, accounting for about 70% of all cervical cancer cases worldwide.

The citizens thought it is too early to vaccinate a 9-year-old girl for this cancer as they are not prone to engage in sexual activity at this age in Pakistan. However, evidence shows the vaccine is highly effective in individuals aged 9 to 14 years before they become sexually active, with reduced efficacy of the vaccine with increase in age.

Usually, citizens desire for the government to offer free vaccinations, but it was surprising to witness that the citizens of Pakistan were rather questioning the willingness and capability of the government to offer a free-of-cost vaccine, without verifying the extensive financial and logistic support received from WHO and other international agencies. Moreover, teachers who were responsible for motivating parents to get their daughters vaccinated started to discourage them.

In my opinion, mistrust in the healthcare system, myths and misconceptions and low perception of the disease severity were the most pronounced factors during the recent HPV vaccination campaign in Pakistan. Health experts and government officials tried to dispel the myths but they prevailed and affected the overall uptake of the vaccination. Factors like availability of health information from a reliable source, guidance from the expert and influence of religious and community stakeholders should be studied beforehand to better plan the future campaign.

Leaders who themselves vaccinate their daughters, set a visible example. Communities place their deepest trust in physicians they visit most often. If these physicians are trained not only to counsel parents and dispel myths, but also to recommend vaccination, they can be a huge support to such campaigns. Further, parents look to community stakeholders and religious leaders who continue to influence. That is why the Ministry of Health must engage these figures early, co-producing culturally relevant materials that address community fears before the campaign begins.

Government, healthcare, and community leaders can proactively share accurate information on social media, monitor misinformation, and correct it in real time.

References: 

1. https://www.cancer.org/cancer/risk-prevention/hpv/types-of-hpv.html
2. https://www.aku.edu/mcpk/paeds/Pages/hpv.aspx
3. .https://ecommons.aku.edu/cgi/viewcontent.cgi?article=2020&context=pakistan_fhs_mc_chs_chs
4. https://www.who.int/news/item/18-08-2015-vaccine-hesitancy-a-growing-challenge-for-immunization-programmes
5. https://gco.iarc.fr/today/data/factsheets/populations/586-pakistan-fact-sheets.pdf
6. https://www.cancer.gov/types/cervical/causes-risk-prevention
7. https://www.cochrane.org/about-us/news/our-daughters-our-future-pakistans-hpv-vaccination-campaign-offers-hope
8. https://www.gavi.org/vaccineswork/turning-point-womens-health-pakistan
9. Centers for Disease Control and Prevention. Cancers Associated with Human Papillomavirus. Centers for Disease Control and Prevention, U.S. Department oHealth, and Human Services; 2024.
10. Burney A, Zafar R. HPV Vaccination as a Mode of Cervical Cancer Prevention in Pakistan. South Asian J Cancer. 2023 Feb 25;12(1):51-52. doi: 10.1055/s-0043-1764211. PMID: 36851930; PMCID: PMC9966174.
11. Oliveira, C. R., Shapiro, E. D., Sheth, S. S., Ellingson, M. K., Johnson, N. P., Sullivan, E. L., Querec, T. D., Unger, E. R., & Niccolai, L. M. (2025). Clinical effectiveness of HPV vaccine by age at vaccination: a matched case-control study. Lancet regional health. Americas, 51, 101225. https://doi.org/10.1016/j.lana.2025.101225
12. Rodrigues, F., Ziade, N., Jatuworapruk, K., Caballero-Uribe, C. V., Khursheed, T., & Gupta, L. (2023). The Impact of Social Media on Vaccination: A Narrative Review. Journal of Korean medical science, 38(40), e326. https://doi.org/10.3346/jkms.2023.38.e326

Author

Salima Khowaja

Salima is a nursing instructor, researcher and health equity leader in Karachi, Pakistan. Her work focuses on improving nursing education, patient and public engagement, health equity and advocacy for cancer prevention. She is a Senior Atlantic Fellow for Health Equity.

Declaration of interests

I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.