HPV Vaccine Uptake Barriers – National Vaccination Campaign 2025 in Pakistan

Abstract

Aims: In low- and lower-middle-income countries (LLMICs), the world's HPV-attributable mortality is highest. Human papillomavirus (HPV)-related malignancies, especially cervical cancer, continue to be a significant public health concern. Vaccination coverage is still poor in LLMICs, even after safe and effective vaccinations have been available for almost 20 years. Efforts to expand immunization programs in these contexts have been hampered by a number of obstacles, including systemic delivery issues and health misinformation.

Methodology: This study was an observational/cross-sectional comparative study to find the factors that motivated or blocked the uptake of the HPV vaccine at Lady Willingdon Hospital (LWH) during the national campaign in Pakistan during September 2025.

A questionnaire was administered to the girls and their parents coming to the vaccination center for vaccination, and mothers who were not willing to get the vaccination for their daughters. These mothers were selected from the patients coming into the OPD of LWH for their obstetrical or gynecological issues, and the study was completed from 15th September 2025 to 31st October 2025.

Results: Results show that vaccine uptake was higher in girls whose parents’ education was higher than that of the other group. In the group that did not get vaccination 56% girls were enrolled in school, whereas in the group that got vaccinated, 60% girls were enrolled in school at that time, so it was not statistically significant. Knowledge and awareness were poor in the non-vaccinated group and statistically significant. The strongest factor was social media misinformation, which acted as a barrier. At the same time, the strongest motivational factor was knowledge about the usefulness of the vaccine, which was acquired from doctors. The barrier, which was not included in the closed-ended question and came up from the open-ended question, was the misconception that this vaccine will decrease the reproductive capability of the girls, and it is the way adopted by the government to decrease population growth.

Scientific Novelty: It’s a policy-related, timely study that focuses on the behavior of society in response to a real campaign initiative by the government in Pakistan.  

Conclusion: Coordinated, multi-level interventions that concurrently address behavioral and structural variables are necessary to increase HPV vaccine coverage in LLMICs. The results show that in order to guarantee successful implementation, community involvement, adaptable delivery methods, and long-term sustainability planning are essential. These findings directly affect national immunization policies, the development of the health system, and the accomplishment of international goals for the eradication of cervical cancer in settings with low resources. To advance equity in HPV-related cancer prevention, implementation must be tailored to the contextual realities of LLMICs.