Dr Shabana Safdar Khan
Pakistan’s historic attempt to roll out the world’s first nationwide cancer-prevention vaccine has turned into a sobering lesson in the limits of medical science when public trust is missing. The 12-day campaign, which concludes tomorrow, sought to vaccinate 13 million girls against the human papillomavirus (HPV) — a virus that causes cervical cancer. Yet by its final stretch, just 4.5 million girls had received the shot, barely a third of the target.
The stakes could not be higher. Cervical cancer is the second most common cancer among women in Pakistan, and the prognosis is grim: two in three women diagnosed with the disease do not survive. The HPV vaccine, safe and widely used across the globe, dramatically reduces the risk. It is already part of the routine immunisation schedule in Saudi Arabia, Indonesia, and Bangladesh. But in Pakistan, where the vaccine is being offered free of cost, it has struggled to gain acceptance.
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The uneven rollout exposes a deeper malaise: the gap between modern medical solutions and community trust. In Karachi, Pakistan’s largest city, only about one-third of eligible girls were vaccinated. In Keamari district, uptake was a dismal 12 percent. Yet smaller interior Sindh districts crossed the 80 percent mark, thanks to proactive local leaders who directly urged families to participate. Where trusted figures stepped forward, families complied. Where they did not, the silence was filled by social media-driven conspiracies that fuelled fear and resistance.
The crisis mirrors Pakistan’s long battle against polio. Despite decades of effort, myths and rumours continue to dog polio vaccination campaigns. At their worst, health workers have been harassed, kidnapped, and even killed. Now, HPV vaccinators are facing similar hostility. In Mandi Bahauddin, a Lady Health Worker was beaten during door-to-door outreach, starkly illustrating the risks borne by those on the frontlines. Such incidents deepen mistrust, intimidate volunteers, and ultimately leave millions of girls unprotected against a deadly but preventable disease.
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What Pakistan’s HPV campaign demonstrates most clearly is that logistics alone cannot deliver public health victories. Vaccines can be made available, cold-chain infrastructure can be secured, and health workers can be trained, but if families are unwilling to open their doors, the science cannot save lives. The missing link is awareness. A few government press releases, some social media posts, or even a minister publicly vaccinating his daughter are not enough to build trust. Sustained, community-level engagement is essential.
Parents must hear directly from voices they already trust. Teachers, local elders, and religious leaders carry enormous influence and can dismantle misinformation more effectively than distant officials. Civil society groups also have a vital role in mapping refusal hotspots, understanding the roots of suspicion, and addressing concerns in local languages. Out-of-school girls — who make up nearly half of the target group — must be reached through dedicated, community-based strategies rather than relying on school-based drives alone.
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The government must take lessons from this first phase. Risk-mapping resistance, investing in parental counselling, and integrating HPV shots into routine immunisation are non-negotiable. Above all, HPV vaccination must not be treated as a one-off campaign to be checked off a list. It requires a long-term, consistent effort rooted in community trust. The global benchmark set by the World Health Organization is ambitious but achievable: 90 percent of girls worldwide vaccinated against HPV by 2030. Pakistan, too, has pledged to meet this target.
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Reaching that goal demands that communication be treated as seriously as logistics. Myths do not fade on their own — they must be countered with persistent dialogue, evidence, and reassurance. If Pakistan can transform its HPV campaign into a model of trust-building, it will not only save countless lives from cervical cancer but also set the stage for future public health initiatives to succeed where polio has long faltered. Vaccinating girls today means protecting women tomorrow, and in that effort lies a chance to bridge the painful gap between science and society.
