Pakistan's Inaugural HPV Vaccination Campaign Faced Public Resistance
Pakistan initiated its first-ever human papillomavirus (HPV) vaccination campaign in the fall, targeting girls aged 9 to 14. The vaccine is designed to protect against cervical cancer, which is the third most common cancer in Pakistan, with approximately 5,000 cases reported annually. Globally, cervical cancer accounts for about 300,000 deaths each year, predominantly in regions with limited access to screening and treatment.
Campaign Implementation and Results
The campaign involved vaccinators deploying to schools and other locations in parts of Pakistan and Pakistan-administered Kashmir. They aimed to offer the free vaccine to around 13 million eligible girls, with a goal of achieving 90% coverage. Khurram Akram, technical director at Pakistan's Federal Directorate of Immunization, estimated that the actual vaccination rate reached approximately 70%.
Challenges and Parental Concerns
Vaccinators encountered significant resistance from some parents during the two-week campaign. Primary concerns and reasons for hesitancy included:
- Gender-specific vaccination: Parents questioned why the vaccine was administered solely to girls. While boys are also eligible and vaccinating them can protect future female partners, the campaign's focus was on cervical cancer prevention in women.
- Fertility rumors and misinformation: Concerns were raised regarding the vaccine's potential impact on daughters' future fertility. These fears were fueled by online rumors, particularly via WhatsApp groups, suggesting the vaccine was a population control tactic by Western organizations. Health experts have stated there is no data to support a link between the HPV vaccine and infertility.
- Involvement of international organizations: The participation of global health bodies such as Gavi, the Vaccine Alliance, UNICEF, and the World Health Organization (WHO) also raised questions among some parents.
- Cultural and religious sensitivities: Messaging around HPV transmission, which can be sexually transmitted, proved challenging due to prevailing religious and societal values. Some parents perceived the vaccine's introduction as implying that their teenage daughters were sexually active.
Operational difficulties included schools returning permission forms marked 'no' prematurely and administrators denying vaccinators entry.
Context of Vaccine Hesitancy
This community response is consistent with existing vaccine skepticism in Pakistan. The country, along with Afghanistan, is one of only two nations where wild polio remains endemic. Vaccine hesitancy has been exacerbated by the 2011 revelation that the CIA used a vaccination drive in its search for Osama Bin Laden, as well as by general misinformation campaigns.
Efforts to Address Concerns
Pakistani officials, including federal health minister Mustafa Kamal, publicly vaccinated their own daughters in an effort to reassure the public. Vaccinators also conducted door-to-door visits to engage with parents directly. Messaging was adjusted to emphasize less common transmission routes for HPV, such as during childbirth or through contact with contaminated objects, to mitigate sensitivities around sexual transmission.
Despite the challenges, some individuals proactively sought vaccination. A 13-year-old girl in Islamabad was vaccinated after conducting her own research and convincing her mother. Similarly, a 36-year-old father, who avoids social media, brought his 10-year-old daughter for the shot, citing positive past experiences with routine vaccines for his family.