In Pakistan, cervical cancer silently claims thousands of lives each year. Over 5,000 women are diagnosed annually, many at advanced stages when treatment options are limited and outcomes are poor. The tragedy lies not just in the numbers but in the fact that most of these deaths are preventable.
The cause of cervical cancer is well known: a common virus called human papillomavirus (HPV). The solution is equally clear: a vaccine that can stop the virus before it causes harm. Yet, despite decades of scientific progress and global success stories, Pakistan remains dangerously behind in protecting its girls and women.
HPV is one of the most widespread infections in the world. While many strains are harmless, high-risk types, particularly HPV 16 and 18, are responsible for nearly all cases of cervical cancer. These same strains are also linked to other cancers, including anal, penile, vaginal, and oropharyngeal cancers. The good news is that vaccines exist to prevent infection from these high-risk strains. Countries that introduced the HPV vaccine have seen dramatic declines in infection rates and cervical cancer incidence. Australia is on track to eliminate cervical cancer within a decade. Rwanda, a low-income country, has achieved over 90 percent coverage. Pakistan, however, has yet to introduce the vaccine at the national level.
This gap is not due to a lack of resources alone. It is driven by silence, stigma, and misinformation. Myths suggesting that the vaccine causes infertility, promotes promiscuity, or leads to harmful side effects continue to circulate, despite being thoroughly debunked by science. The World Health Organization (WHO), the US Centers for Disease Control and Prevention (CDC), and numerous global studies have confirmed the vaccine’s safety and effectiveness. Millions of doses have been administered worldwide. In Pakistan, however, public conversations around sexual health remain taboo, and these silences allow fear to take root.
Religious and cultural concerns also shape public hesitation. Yet here too, the facts are clear. Islamic scholars in several countries have reviewed and approved the HPV vaccine. In Malaysia, a Muslim-majority nation, the vaccine was successfully integrated into the national immunisation programme by framing it as a cancer prevention measure, not as a commentary on sexual behaviour. The approach worked. Parental consent was high, religious leadership offered support, and vaccine coverage exceeded expectations.
The vaccine is most effective when given to children between the ages of 9 and 14, before exposure to the virus. Two doses are sufficient for most children in this age group, while three are recommended for those with compromised immunity or for individuals above 15 years of age. However, until the vaccine becomes part of Pakistan’s national immunisation programme, access will remain limited to those who can afford it. That must change.
Encouragingly, steps are now being taken to change this. Pakistan is working to introduce the HPV vaccine as part of the Expanded Programme on Immunisation (EPI) to help prevent cervical cancer. Although the HPV vaccine was initially introduced in Pakistan several years ago, it has not yet been formally added to the EPI. Now, it is essential to gather full support from the national, provincial, and district levels for this initiative.
To promote greater acceptance of HPV vaccination in communities across Pakistan, a multifaceted approach is essential, emphasising both health education and cultural sensitivity. Firstly, it is important to present the HPV vaccine not just as a means of protection against a sexually transmitted infection, but rather as “a protective measure against cervical cancer,” which affects thousands of women annually. Public health messaging should carefully avoid sexual references, as these can alienate certain segments of the population.
Collaboration with respected organisations, such as the Council of Islamic Ideology (Islami Nazriati Council), is crucial. Securing endorsements in the form of fatwas from esteemed religious scholars can help dispel misconceptions. This strategy should draw on the success of initiatives from countries like Malaysia and Indonesia, where similar religious endorsements have led to significant increases.
Building on these efforts, implementing school-based pilot vaccination programmes in provinces such as Punjab and Sindh, where healthcare infrastructure and political support are relatively strong, could serve as a model for broader implementation. Alongside this initiative, providing parental consent forms and conducting pre-vaccination counselling sessions can help address any concerns parents may have regarding the vaccine’s safety and efficacy.
To counter the prevalent myths surrounding the HPV vaccine, partnerships with influential digital personalities, paediatricians, and gynaecologists can be instrumental in creating engaging short videos and infographics in multiple languages. These resources should present clear evidence to debunk misinformation and educate the public. Moreover, sharing data and positive testimonials from countries such as Rwanda, the UAE, Malaysia, and Indonesia can further reinforce the message that HPV vaccination aligns with Islamic values and is a vital component of public health agendas. By integrating these strategies, we can develop a comprehensive approach that not only promotes vaccination but also respects and understands the cultural context of communities in Pakistan.
To translate this strategy into action, the way forward is to initiate a phased introduction of supplementary immunisation activities (SIAs) targeting girls aged 9 to 14 years. This can be accomplished by utilising schools and madrasas as platforms. Our experience from other countries shows that starting with a few phased SIAs can help gain community acceptance and improve immunity levels. This initiative can be implemented on a provincial or district basis, depending on national priorities.
We do not need to reinvent the wheel. We only need the will to act. If Pakistan vaccinates just 70 percent of girls aged 9 to 14 over the next ten years, it could prevent more than 100,000 cases of cervical cancer. Combined with better awareness, screening, and early detection, this disease could one day be eliminated entirely.
The science is available. The solution is within reach. Now is the time for Pakistan to act-for the health of our girls, the future of our women, and a world where no one dies from a preventable disease.
The writer is Associate Professor & Vice Chair, Department of Paediatrics and Child Health at The Aga Khan University Hospital, Karachi