Pakistan’s first-ever national human papillomavirus (HPV) vaccine campaign, which aims to immunize more than 13 million girls between the ages of 9 and 14 in its initial phase, was launched in September.
HPV is the most common cause of cervical cancer, which kills eight Pakistani women every day, according to Dr Dapeng Luo, the head of the World Health Organization (WHO) in Pakistan. By 2030, the UN Health Organization intends to eradicate cervical cancer globally.
But the vaccine has met resistance in Pakistan, as conspiracy theories about inoculations have circulated.
More information is provided here about HPV, how cervical cancer is caused, and why Pakistan’s vaccination campaign has received a backlash.
What is HPV and what are the symptoms?
A cut or abrasion is a typical example of a group of viruses that can enter the body through skin-to-skin contact.
There are more than 100 types of HPV, and they are often spread through sexual contact. It can take years for cancer to develop because many people who have an HPV don’t have any symptoms at all.
Some types of the virus eventually cause warts on the genitals or other parts of the body. These might appear bumpy or flat.
How does HPV cause cervical cancer?
According to the WHO, HPV accounts for more than 95 percent of the 660, 000 cervical cancer cases that are diagnosed annually worldwide. In Pakistan, more than 5, 000 new cases of cervical cancer are reported every year, it said.
Cervical cancer, vulvar cancer, or vaginal cancer are some of the cancer types that HPV strains can cause. However, cervical cancer typically develops 20 years after the onset of the HPV infection.
Within two years of infection, the body’s immune system can expel a large number of HPV strains, but some are more persistent. When the body’s immune system is unable to fight off the more persistent HPV strains, the virus interferes with normal cell growth, causing cells to become abnormal and potentially leading to a pre-cancerous state. Cancer may develop if this is not treated.
Sufferers of cervical cancer do not experience symptoms in its early stages. The Mayo Clinic recommends that women between the ages of 30 and 65 get a pap smear every three years.
How have vaccines been rolled out in Pakistan?
On September 15, Pakistan’s HPV vaccine campaign started. While the first phase was scheduled to run until September 27, it was later extended to October 1.
The WHO has provided training to some 49, 000 government health workers, all of whom are women, to administer vaccines throughout the nation. The WHO and Pakistan’s government partnered to conduct this training with funding support from GAVI, the Vaccine Alliance, a public-private partnership that works to improve access to immunisations.
In public places like schools, vaccination centers were constructed in advance of the first phase. Health workers also went door-to-door to administer the HPV vaccine.
Cecolin, an HPV vaccine developed in China, was provided for free in one dose. While most HPV vaccines require either two or three doses, WHO confirmed in October last year that Cecolin could be used as a single dose.
Girls from Sindh, Punjab, Pakistan-administered Kashmir, Islamabad Capital Territory, and the first phase of the vaccination program in Pakistan were given the single-dose vaccine in the first phase of the rollout.
Syed Mustafa Kamal, the country’s federal health minister, urged all parents to make sure their daughters and sisters are immunized at a ceremony held on September 16 in Islamabad. Do not fall prey to negative campaigns. This vaccine is essential for our girls’ protection because it is safe, effective, and essential.
Kamal told Al Jazeera that when the vaccine campaign started, there was a lot of criticism and scepticism towards it. “Some unidentified individuals had distributed some fake videos and information.”
He said that during the first four days of the campaign, the response to the vaccine was negative. There were schools that had already committed to use as vaccination centers, but the refusals were so high that our employees were denied entry to the school.
On the fifth day, Kamal got his own daughter publicly vaccinated during a ceremony at the Drug Regulatory Authority of Pakistan (DRAP) office in Karachi. Kamal stated to reporters during the ceremony, “In my 30-year political career, I have never brought my family into the public eye.” But to put an end to these baseless rumours, I have taken this step”.
He claimed that as a result, acceptances increased and refusals decreased. He added that this upward trend of acceptance and vaccine administration continued till the end of the campaign.
“People started getting vaccines after being able to disprove rumors,” it was discovered. Especially, schools were requesting to send teams as parents were agreeing to get their daughters vaccinated”, Dr Azra Fazal Pechuho, the health minister of Sindh province, told Al Jazeera in a written statement.
She claimed that the initial reluctance caused the vaccination campaign to be shortened by four days.
What is Cecolin?
The live HPV virus is not present in the Cecolin vaccine. Instead, it contains recombinant L1 capsid proteins, laboratory-made proteins that mimic the outer shell of the virus but do not have any viral DNA and therefore cannot cause infection.
Other nations have used the recombinant L1 capsid proteins-containing Gardasil, which was produced in the US. It also does not contain the live HPV virus.
Why is the vaccine only being given to girls aged nine to 14?
According to the government, this particular age group of girls was chosen in accordance with the recommendations of the WHO’s National Immunization Technical Advisory Groups (NITAGs), which provide reliable immunization recommendations.
“As per WHO, the immune response generated by the body after the vaccine jab is maximum at this age of 9-14 years, and the child gets the best and long-term protection. Therefore, this particular age group,” Pechuho said.
“Currently, the vaccine is available free of cost for 9-14-year-old girls only. At the federal ministry level, there have been discussions about making this vaccine available for sale so that other people can also benefit, including boys, women, and adolescent girls.
What do recipients of the vaccine say about it?
After school hours, Sana Ali Manzoor and her husband, Sana Ali Manzoor, who claim to be in favor of vaccinations for their daughter, took her daughter, 11, to her private school campus in Karachi. The whole process took about 20 minutes.
Manzoor claimed to have been informed of the vaccine’s rollout through her daughter’s Haque Academy, a luxury neighborhood near Defence Housing Authority, through a mobile app. Parents were invited to register on the mobile app and accompany their children for the vaccination.
When her daughter got her vaccination, according to Manzoor, a lactation specialist who works with new mothers, 30 to 40 other children were also present.
“So we went to school, and there were two or three tables set up. There were also health professionals. They first checked if our name was on the list. After that, we traveled to the vaccination facility. And then right after that, there was a manual card entry filling that was done, then they gave us the card”.
She called the procedure “very organized.” Manzoor says she was encouraged by friends, including a paediatrician and a gynaecologist, to get the HPV vaccine for her daughter. She traveled to Dubai to get her children’s chickenpox vaccine.
How successful has the vaccination drive been so far?
Authorities claim that the rollout did not hit its mark, despite their claims that the campaign is a success in spite of this.
“Around 13 million girls were supposed to be vaccinated in the first phase of the HPV vaccine campaign. 9.2 million people have been vaccinated thus far, or 78 percent of the target total, according to Pechuho.
In the southern province of Sindh, the estimated target for the HPV campaign was 4, 081, 279 girls. 2, 674, 210 girls received vaccinations, making up 66 percent of the overall target.
The low take-up is down to a general hesitancy towards vaccines in Pakistani society, experts say. Additionally, misinformation, particularly online, has contributed to some concerns about the HPV vaccine.
Will others get the vaccine?
In 2026, Balochistan and Gilgit-Baltistan will eventually receive the vaccine, along with Khyber Pakhtunkhwa and Balochistan and Gilgit-Baltistan. The government has not yet announced when the next phase will begin.
According to Kamal, the federal minister, “every age girl will be vaccinated occasionally.” He added that the government hopes to vaccinate boys and men against HPV once girls and women have been vaccinated.
What causes Pakistan’s vaccine hésitation?
While vaccine hesitancy is a global phenomenon, in Pakistan it was aggravated by the CIA’s use of a fake hepatitis B vaccination campaign in Pakistan’s Abbottabad as cover for a manhunt for fugitive al-Qaeda leader Osama bin Laden.
In order to find connections to bin Laden and his family, the vaccine campaign, which was carried out in collaboration with a local doctor, was used to covertly collect blood samples. The plan was to compare the DNA of any of bin Laden’s children to that of his sister, who had died in Boston in 2010. US Marines in Abbottabad ultimately shot the al-Qaeda leader in a military operation in 2011.
It was never revealed whether the CIA obtained any DNA from bin Laden’s family. However, according to the time, one source claimed the operation had failed.  , In 2014, the White House promised that the CIA would never again use a false vaccination campaign for espionage. However, there was persistent mistrust in vaccines.
This was apparent during the COVID-19 pandemic, when vaccines were free, but according to a recent study, 30 percent of people in Pakistan did not want to get vaccinated. A Pakistani doctor co-authored an opinion piece that read, “Misconceptions that the COVID vaccine may lead to infertility, death, or be tied to shadowy foreign agendas circulated quickly through social media and community gossip.”
Manzoor said she has herself noticed “anti-vaxxer” sentiment among some of her clients. She recalled telling a young mother to keep her unvaccinated newborn at home, explaining that the house is not sterile. The young mother responded, “It’s fine, we don’t believe in such things”.
What particular issues does the HPV vaccine raise?
The HPV vaccine has faced especially heated pushback in Pakistan.
Some claim that consensual sex before marriage is against the law and is not required because HPV is a sexually transmitted infection in Pakistan.
A Pakistani user wrote on X, “Cerv. Sexual contact is NOT permitted in Pakistan for children aged 9-14, but only in the west.
Another user wrote, referring to the vaccine, “its common in societies where women has multiple sex partners”!
Manzoor claimed that having her daughter vaccinated was because it made sense for her to keep her daughter safe from the virus.
“It’s not even about being sexually active, it’s even about, God forbid, molestation. It’s not always mutual, Manzoor said.
In 2023, Islamabad-based NGO Sahil reported that, on average, one child was sexually abused every two hours in Pakistan. In Pakistan, 5, 867 rape cases were identified in 2023, according to the World Population Review.
Another conspiracy theory circulating online is that the HPV vaccine causes infertility. This assertion lacks supporting evidence. Pakistan, with a population in excess of 250 million, is the fifth most populous country in the world, according to World Population Review. Pakistan’s birthrate is 3.32, which is above the replacement rate of 2.1 required to maintain population levels, despite the country’s birthrates having decreased, similar to the rest of the world.
In May 2020, a peer-reviewed US study found no evidence of increased infertility among women who received the HPV vaccine. This study was conducted in the US, and the sample was given a different vaccine, Gardasil.
Other rumours, along with pictures and videos, have spread online. Girls in school uniforms collapsing in a video that received more than 340, 000 views on X this year, with the claim that these girls became ill after receiving “forced vaccinations” in the caption.
In fact, the video was filmed last year and shows a scene in which police are clashing with protesters over electricity taxes in Pakistan-administered Kashmir. The girls at the school suffocated because of the police’s use of tear gas shells.
Is the HPV vaccine safe?
“The vaccine has a strong safety profile,” the spokesperson said. It has been around for almost two decades now. The HPV L1 protein is the active component, Pechuho said, but it doesn’t contain any viruses.
In an assessment of Cecolin published last year, the WHO said that “the vaccine was safe and showed a good immunogenicity”.
According to Pechucho, it has a few minor side effects. “Most common side effects are related to any other vaccine, like fever, pain at the injection site and, rarely, allergic reactions”, he said.
Kamal added that an over-the-counter medication helps a fever, which is the most common side effect, which subsides in a day or two.
“People used to die of diseases like polio and tuberculosis. Because vaccines are available now, they are not dying today. People are not dying of COVID because we have vaccines. According to Kamal, “the world has moved toward prevention.”
Source: Aljazeera
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