HPV vaccine introduction in Pakistan: a strategic opportunity for multisectoral alliance

Pakistan has achieved a major public health milestone with the rollout of the human papillomavirus (HPV) vaccine in September 2025. This has been a long-awaited intervention for cervical cancer prevention, with an FDA-approved vaccine since 2006 that has been successfully rolled out in 144 countries.^1,2 Globally, approximately 662,301 women were diagnosed with cervical cancer, and 348,874 died from the disease in 2022.³ In Pakistan, there were 5008 women diagnosed with cervical cancer, and 3197 lost their lives (Globocan 2022).⁴ These are grave statistics, despite underreporting and the absence of an operational cancer registry. With the fact that the HPV vaccine has an association with sexual health and the target population is young girls (9–14 years), the risk of hesitancy was expected to be a huge challenge due to gendered stigma. Thus, the introduction of the HPV vaccine in Pakistan was a test of its strategic juncture and the grassroots reaction.

The push to introduce the HPV vaccine in Pakistan, starting in 2018, struggled against institutional distrust, harmful misinformation, and low community awareness. The program's existing challenges were exacerbated by the COVID-19 pandemic, which not only diverted critical resources but also fostered a wave of vaccine misinformation. The initiative needed robust political commitment to compete with other health priorities, financial limitations, constrained fiscal space, and support from international donors for sustainability. To build a compelling case and ensure cultural relevance, policy planners integrated evidence from successful HPV vaccine rollouts in countries like Bangladesh, the UAE, Egypt, Indonesia, Malaysia, and Saudi Arabia.

A multi-faceted strategic approach was used to align the support of various stakeholders and win the trust of the community, media, and religious leaders, thereby strengthening campaign implementation. The critical collaboration between national authorities, including the Ministry of National Health Services, Regulations, and Coordination (MoNHSRC), the Federal Directorate of Immunization (FDI), and the Ministry of Education, was significantly enhanced by global partners. The partners include GAVI (Global Alliance for Vaccines and Immunization), WHO, UNICEF, Save the Children, and JHPIEGO, among others, who collaborated strategically with the government to ensure an effective national vaccine rollout. The EPI Program (Expanded Program on Immunization) leveraged the technical expertise of academicians, researchers, and health professionals to provide policy and governance stewardship for cold chain management, equitable access, vaccine demand, community mobilization, and planning for sustainability.

To establish this foundation, a dedicated budget was essential, alongside collaboration with the Ministry of Education for school-based delivery and the Ministry of Religious Affairs to mitigate potential socio-cultural barriers. A community-level strategy leveraged trusted figures like public health professionals, doctors, teachers, health workers (especially Lady Health Workers), influencers, and religious leaders to build trust, counter misinformation, and tackle sensitive misconceptions about fertility and safety.

GAVI provided significant support by fully funding an HPV vaccination campaign from September 15 to 27, 2025. The campaign planned to reach 13 million girls aged 9–14 years (cost: $0.55 each). Under the original co-financing agreement with GAVI, the government was required to contribute 45%; however, this share has now been reduced to 33% to facilitate the vaccine's integration into routine immunization.⁵ Pakistan planned to implement a single-dose HPV vaccine regimen for girls aged 9–14, following the WHO's 2022 guidance and GAVI-backed national protocols. The selected vaccine is Cecolin®, a bivalent formula that immunizes against HPV types 16 and 18, the strains responsible for most cervical cancers.⁶ The initial national campaign targeted Islamabad Capital Territory (ICT), Punjab, Sindh, and Azad Jammu & Kashmir, with a phased expansion to Khyber Pakhtunkhwa and Baluchistan planned for 2026.

Organizations like the Pakistan Pediatrics Association, the Society of Obstetrics and Gynecologists of Pakistan, civil society organizations, religious leaders, media, and women's groups drew insights from the launch in Muslim countries to break the taboos, win the trust of the community, and secure effective operationalization. Prioritizing evidence-based decision-making and investing in robust Social and Behavior Change (SBC) strategies is essential for driving vaccine uptake. This is not only a medical intervention but will also be an interplay of sociopolitical constraints. The following years will witness coordination, gender-sensitive communication, active surveillance, and a vaccine distribution ecosystem. It is an unprecedented chance to engage stakeholders to save the lives of women from cervical cancer through commitment, compassion, transparency, and accountability. Failure to fulfill these measures will risk credibility and damage the reputational integrity of government institutions.

With robust monitoring and a rapid response mechanism, this initiative is expected to yield significant benefits: increased vaccine uptake, equitable coverage across provinces, enhanced inter-agency cooperation, and a sustainable foundation for future adolescent health programs. The successful integration of the HPV vaccine would represent a landmark advancement for women's health in Pakistan.

Contributors

SNK: Wrote the original draft, edited, and searched the literature.

JSK: Edited the correspondence and did a critical review of the final draft.

All the authors have approved the final version of the manuscript to be published.

Declaration of interests

The authors declare no competing interests.