Can Pakistan overcome its vaccine hesitation to defeat Cervical Cancer?

Farah, a resident of Lahore, was 38 years old when she got diagnosed with cervical cancer, and she was the mother of two children at the time she tested positive for the illness.

She used to have pain during menstruation, but she took it as normal hormonal changes and relied on home remedies. After some time, she started experiencing severe bleeding and unbearable abdominal pain, which finally led me to a doctor. When she was diagnosed with cervical cancer, and there was no vaccine available for it. It was only available in private hospitals, which she was unable to afford. Farah stated,

“One thing that I am grateful for is that my family, especially my husband, supported me in my treatment, but that period feels like a blur of illness.”

HPV and the Global Solution

The Human Papillomavirus (HPV) is the cause of cervical cancer. In fact, HPV is responsible not just for cervical cancer but also for 14 other cancers, including vulvar, vaginal, penile, anal, and oropharyngeal cancers. HPV can be transmitted through intimate contact, skin-to-skin interaction, and, less commonly, via contaminated surfaces, such as swimming pools and showers. While most infections clear up on their own, some persist and develop into cancer.

Globally, the vaccine has been a game-changer. Countries like Australia, Norway, and the UK have dramatically cut cervical cancer rates by vaccinating both boys and girls before exposure to the virus.

The Reality of Pakistan

While countries abroad have curbed cervical cancer rates, Pakistan still struggles to manage the disease. GLOBOCAN/IARC estimates, Pakistan reported 4,700 to 4,800 new cervical cancer cases and around 3,000 deaths in 2023, with an age-standardized incidence of 5.4 per 100,000 women. A separate WHO study, which documented that 1,580 cases were reported in 18 healthcare facilities, which indicates under-reporting of such cases, limited screening facilities, and the absence of a national registry.

The HPV vaccine was introduced in 3 phases in Pakistan. Phase 1 covered Punjab, Sindh, Azad Jammu and Kashmir, and the Islamabad Capital Territory from September 15 to 27, 2025. According to the Federal Directorate of Immunization, to date, 9.2 million girls out of a 13 million cohort have already been vaccinated, representing 70% coverage.

Phase 2 will be launched in Khyber Pakhtunkhwa in 2026, and Phase 3 will cover Gilgit-Baltistan and Balochistan in 2027 (WHO EMRO, 2025).

Debunking the Roots of Hesitation

The campaign of HPV vaccine which was meant to protect millions from the third most common cancer, has sparked confusion and questions about transparency. Instead of being welcomed as a lifesaving measure, the campaign has been met with hesitation and fear from parents. This reaction is not surprising. Pakistan has witnessed similar patterns before. During the polio eradication campaigns, a similar pattern of rumors have been observed, which led Pakistan to be the second last country after Afghanistan, which was unable to eradicate Polio.

To understand why such hesitation exists, it helps to see how other countries overcame early skepticism. In the United States, the HPV vaccine was first recommended for women in 2006 and extended to men in 2011. Today, the U.S. Centers for Disease Control and Prevention (CDC) recommends that all children aged 11–12, regardless of gender, receive the HPV vaccine. Similarly, Australia offers the vaccine free under its National Immunization Program to all Australians aged 12 to 25. By 2023, 83.4% of Australian girls and 80.6% of boys had received at least one dose, with a target of 90% coverage for both genders by 2030.

Even in Muslim-majority nations—where cultural sensitivities are similar—the HPV vaccine has been safely adopted for over a decade. This vaccine is also available in many Muslim countries, with Saudi Arabia introducing it in 2010, Qatar in 2011, the UAE in 2008, Malaysia in 2010, Indonesia in 2016, Bangladesh in 2023, Morocco in 2022, and Tunisia in 2019.

One of the questions raised by parents in Pakistan is why this vaccine is just targeted for girls and not boys. Dr Saira Afzal, Dean of Institute of Public Health (IPH), who has also worked with Extended Program of Immunization (EPI) in the campaign of HPV vaccine, told

“These vaccines are available in a limited quantity and we don’t have much stock that can be provided to both girls and boys, that’s why it is targeting girls only because HPV is more common in women as compare to men. Girls are primarily targeted in this campaign so that the gender more prone to this cancer can receive the most vaccinations in the first phase.”

Even in the U.S., where uptake initially lagged among boys, vaccination rates are rapidly improving. In 2023, HPV vaccination rates among adolescents aged 13–17 stood at 59% for boys and 64% for girls, narrowing the gap each year. These examples show that equal vaccination for boys and girls is the global standard, reflecting the reality that HPV is not just a women’s issue but a shared public health challenge.

Beyond gender-specific targeting, another barrier lies in how little people know about the vaccine itself. Another pressing concern is the lack of transparency about the vaccine itself. In countries like Australia, Norway, the U.S., and the U.K., governments openly communicate which HPV vaccine is being used, whether it is the bivalent Cervarix, the quadrivalent Gardasil-4, or the non-valent Gardasil-9, along with their coverage, target age groups, and dosage schedules. Parents and young people can access clear, publicly available information explaining what the vaccine protects against and why it is safe.

In Pakistan, before launching the campaign, there was little clarity that which vaccine is use and how effective it is. However, after launching the campaign Federal Directorate of Immunization clarified that the Cecolin vaccine is supplied by Gavi in Pakistan, which is the Chinese version of this vaccine. Dr. Saira Afzal said,

“This vaccine is used in girls of age 9-14 because it is most effective in this age and increases the immune system to maximum in this age. The human immune system is still developing at this age, which is why a single dose is effective enough to prevent the most dangerous HPV types, 16 and 18.”

Many people think that this vaccine can cause infertility, changes in sexual behavior. Dr Saira Afzal also said,

“It is just a protein which increases the immunity against the virus, and there is no virus or DNA found in this vaccine, that’s why this vaccine can never be harmful. Also, this vaccine is used in more than 100 countries, and there was no evidence of such side effects found in any country.”

Without official communication before the launch of the HPV vaccine, people have been left to rely on hearsay and speculation. For a health initiative of this scale, transparency is not optional it is essential for public trust.

Conclusion

Stakeholders, including the Ministry of Health, the Expanded Program on Immunization (EPI), provincial health departments, and international partners like WHO, UNICEF, and Gavi, carry the responsibility of ensuring the public is well-informed before introducing any new vaccine. Their role is not only to deliver vaccines but also to build trust through transparent information, community engagement, and awareness campaigns. Failing to communicate the science, safety, and benefits of the HPV vaccine before its launch reflects a major flaw in planning and coordination. By not learning from past campaigns, stakeholders have once again underestimated how sensitive the public is to vaccine-related issues. In a country where misinformation spreads quickly, neglecting public education is not just an oversight; it is irresponsible.

Also read: Outsourcing public educational institutions: reform or a retreat from responsibility?