HPV Vaccine Rollout Sparks Debate in Pakistan: Why Target Girls as Young as 9, and How Does It Differ from the UK? Pakistan launches its first nationwide HPV vaccination campaign targeting over 13 million girls aged 9 to 14.

Islamabad, Pakistan – Sep 17, 2025 – As Pakistan launches its first nationwide HPV vaccination campaign targeting over 13 million girls aged 9 to 14, prominent British-Pakistani journalist and political activist Reham Khan has voiced confusion and concern on social media platform X (formerly Twitter). In a post garnering thousands of views, Khan questioned the rationale behind vaccinating pre-pubescent girls against a virus linked to cervical cancer, a disease she described as sexually transmitted. "Can a medical expert explain to me why the HPV vaccine has been rolled out to girls as young as 9 yrs old in Pakistan? I thought cervical cancer was a sexually transmitted disease," Khan wrote, adding that in the UK, parents often opt out for "sexually inactive girls." Her query highlights a broader global debate on HPV vaccination policies, but experts emphasize that the timing is precisely to prevent future infections before any sexual activity begins.

The campaign, which kicked off on September 15 and runs through September 27, marks a historic milestone for Pakistan, the 150th country to introduce the human papillomavirus (HPV) vaccine into its national immunization program. Backed by the World Health Organization (WHO), Gavi the Vaccine Alliance, and UNICEF, the initiative aims to vaccinate at least 90% of eligible girls in the first phase, covering Punjab, Sindh, Islamabad Capital Territory, and Pakistan-administered Kashmir. A single dose of the Chinese-made Cecolin vaccine is being administered free of charge at schools, health centers, and mobile outreach sites, with plans to integrate it into routine immunization for 9-year-olds moving forward. Expansion to other provinces like Khyber Pakhtunkhwa is slated for 2026, and Balochistan and Gilgit-Baltistan for 2027.

Understanding HPV and the Rationale for Early Vaccination

HPV is a common virus spread primarily through skin-to-skin contact during sexual activity, including vaginal, anal, or oral sex. While most infections clear on their own without symptoms, persistent infection with high-risk strains (like HPV 16 and 18) can lead to cervical cancer, as well as other cancers of the anus, penis, throat, vulva, and vagina, and genital warts. Globally, HPV causes nearly all cases of cervical cancer, which kills about 350,000 women annually. In Pakistan, the disease claims over 3,000 lives each year—eight women daily—making it the third most common cancer among women and the second most prevalent in those aged 15 to 44. Limited screening programs exacerbate the issue, with incidence rates estimated at 6 to 10 per 100,000 women, though underreporting is likely due to cultural stigmas around reproductive health.

Medical experts, including Dr. Muslima Ejaz, an infectious diseases epidemiologist at Aga Khan University Hospital in Karachi, stress that vaccinating girls as young as 9 is not about current sexual activity but proactive prevention. "The vaccine is most effective before exposure to HPV, which typically begins with sexual debut," Ejaz explained in recent interviews. The WHO recommends targeting girls aged 9-14 because the immune response is strongest at this stage, providing lifelong protection with just one dose. This aligns with the global strategy to eliminate cervical cancer by 2030, which calls for 90% of girls to be vaccinated by age 15, 70% of women screened by ages 35 and 45, and 90% of diagnosed cases treated. In Pakistan, where adolescent girls are often underserved by health interventions, early vaccination safeguards their future health, potentially averting 77,200 to 102,000 cervical cancer deaths by 2100, according to modeling studies.

The vaccine's safety is well-established: Over 280 million doses have been administered worldwide, including in Muslim-majority countries, with mild side effects like arm soreness or low-grade fever being common. Concerns about infertility or menstrual disruptions—raised in awareness sessions across Pakistan—are unfounded, as confirmed by WHO prequalification. Health Minister Syed Mustafa Kamal, who launched the campaign, urged parents to prioritize it, countering misinformation: "This is an investment in our daughters' futures, safe and essential for preventing a deadly disease." Pakistan's Urgent Push: High Burden and Global Support

Pakistan's rollout comes amid a high cervical cancer burden and low prior vaccination coverage (below 5%). Funded by Gavi, the program addresses barriers like recent floods damaging infrastructure in Punjab, which has challenged reaching 2.5 million out-of-school girls. Over 49,000 health workers have been trained in microplanning and outreach, with civil society groups like Aman and the Health Education Literacy Program (HELP) tackling hesitancy through community sessions. A cervical cancer survivor, Yasmin Bhurgri, shared her story at a Karachi school event: "After recovering, I vaccinated my younger daughter. Now, one free jab does the job."

This initiative builds on global successes, where HPV vaccination has reduced infections by up to 56% in vaccinated groups. In low- and middle-income countries like Pakistan, it's a cost-effective step toward equity, with Gavi aiming to reach 86 million girls by year's end to prevent 1.4 million future deaths.

Contrast with the UK: A Mature Program with High Uptake and Opt-Out Options In contrast, the UK's HPV vaccination program, established in 2008, is one of the world's most advanced, with coverage exceeding 80% and dramatic results: A 90% drop in genital warts among young people and significant declines in HPV infections. The NHS offers a single dose of Gardasil 9 (protecting against nine HPV strains) to boys and girls aged 12-13 in school Year 8, with catch-up available until age 25 for those who missed it. Men who have sex with men up to age 45 can access it free at sexual health clinics. Like Pakistan, the UK emphasizes pre-exposure vaccination for maximum efficacy, and experts there also debunk myths about needing prior sexual activity.

Khan's mention of opting out for "sexually inactive girls" appears to stem from a common misconception or personal anecdotes rather than official policy. The NHS does not condition eligibility on sexual history; the vaccine is recommended universally before potential exposure, as HPV can spread even in low-risk scenarios. Consent forms allow parental opt-out for school-based vaccinations, and some families choose this due to religious, cultural, or misinformation concerns—particularly in ethnic minority communities, where awareness is lower (e.g., only 12% among Pakistani women in older UK studies). However, UK guidelines from the Joint Committee on Vaccination and Immunisation (JCVI) and NHS explicitly state that the vaccine benefits all adolescents, regardless of activity, and opting out is not tied to inactivity. "If you are sexually active, you should still have the vaccine," per NHS guidance, as it protects against unencountered strains.

Why the Difference? Burden, Timing, and Context

The key disparities between Pakistan and the UK reflect their public health contexts. Pakistan's program is a catch-up effort in a high-burden, low-coverage setting, starting younger (9-14) to rapidly build immunity amid infrastructure challenges and cultural taboos. The UK, with a 17-year head start, focuses on routine single-dose delivery at 12-13, with established screening reducing urgency for broader age targeting. Both follow WHO guidelines, but Pakistan's Gavi-supported push prioritizes scale to meet elimination goals, while the UK's mature system allows for opt-outs without compromising overall success.

As Khan's post continues to spark discussion—with replies from users sharing expert explanations and personal stories—public health officials in Pakistan are ramping up awareness to address similar puzzlement. Dr. Dapeng Luo, WHO Representative in Pakistan, summed it up: "This is more than a vaccine; it's an investment in healthier futures for every girl." For those in the UK or Pakistan seeking advice, consulting a healthcare provider is recommended to dispel myths and ensure access. With global momentum building, these efforts could eradicate cervical cancer as a public threat within our lifetimes.