To the Editor, Pakistan’s first HPV vaccination program launched on September 15, 2025, to address the alarming number of cervical cancer cases per annum. In accordance with the WHO report published in 2024, cervical cancer caused 35 0000 deaths globally in 20221. In Pakistan, 5008 women are diagnosed with cervical cancer, and around 3197 women die from the disease every year. Among many types, HPV 16 and 18 cover 70% of cervical cancer cases globally, affecting, i.e., the vagina, vulva, and penis2. Historically, Pakistanis have remained reluctant to every vaccination drive initiated by the government. From polio to COVID-19 and now HPV, various conspiracy theories have originated. Misconceptions such as the belief that vaccines cause infertility, track personal data, put microchips in the body, and are based on Western propaganda are deterring people from the health benefits of vaccines3. When such arguments are promoted by public figures and social media platforms, they add even more skepticism to the immunization debate. In Pakistan, certain religious influencers made fatwas that vaccines are designed to control the population, further aggravating the situation. The fact that HPV vaccination targets only girls has reinforced such ideas, as people ask why males are excluded, unaware that women are disproportionately affected by HPV-related cancers4. Social media platforms (SMPs), particularly those such as TikTok that reach a wide lay audience, have played a powerful role in spreading stigma and misinformation. For the sake of likes, followers, and small financial rewards, some individuals create sensational and misleading news. People without any medical background present themselves as authorities, guiding others outside their domain of expertise. In 2019, a fake video about adverse events linked to the polio vaccine surfaced on social media in Pakistan. Since then, 2 million children are unvaccinated, and a surge in refusals was recorded. In Nowshera, Khyber Pakhtunkhwa, refusal cases rose dramatically from 256 in March to 88 000 in April 2020. Such incidents illustrate the destructive power of misinformation5. Pakistan’s first-ever national HPV vaccination program is a significant step towards coming to terms with the long-time problem of over 5000 new cervical cancer cases and about 3197 deaths due to cervical cancer among women each year1,2. The issue of vaccine hesitancy, which is mainly due to misinformation that is very hard to remove and is further exacerbated by unregulated social media platforms, is a huge threat to this public health program3–5. The Achilles heel of the program could well be the rapid spread of false accusations linking vaccination to infertility, population control, or foreign conspiracies with the help of famous people who are not even in the medical field, which might result in the same huge refusals we experienced with polio and COVID-19 immunization campaigns where millions of children were unprotected and the disease re-emergence was of preventable sort3,5. Thus, the success of this program will depend on very quickly reinforcing health-literacy initiatives that are adapted to the specific cultural and religious contexts, actively involving and preparing community and religious leaders who are highly regarded to be the trustful advocates, and conducting very strict regulatory supervision of social media content to stop the uncontrolled dissemination of sensational but untrue medical claims made by unqualified people. Only with the strong, coordinated, and evidence-based efforts can Pakistan turn its weak HPV vaccination program into a successful cancer-prevention model that protects the lives of women – our daughters, sisters, and mothers. This letter to the editor adheres to the Transparency in the Reporting of Artificial Intelligence in Research (TITAN) guideline6.
Khalil et al. (Tue,) studied this question.