TITLE:
HPV Vaccination Barriers in Pakistan: Reflections from a Resource-Limited Setting and a U.S. Academic Cancer Center: A Narrative Review
AUTHORS:
Rida Asghar, Annekathryn Goodman, Aqsa Aman, Naseem Saba, Hina Ayub
KEYWORDS:
HPV Vaccination, Cervical Cancer, Pakistan, Barriers, Academic Cancer Center, Health Disparities, Implementation Strategies
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.17 No.8,
August
28,
2026
ABSTRACT: Cervical cancer remains a significant public health challenge in Pakistan. According to the Global Cancer Observatory (GLOBOCAN 2024), there were 2722 new cervical cancer cases and 1640 deaths in Pakistan in 2024, with an age-standardized incidence rate (ASR) of 3.0 per 100,000 women and a five-year prevalence of 6642 cases. Despite the proven efficacy of human papillomavirus (HPV) vaccination in preventing cervical cancer, Pakistan’s vaccination coverage remains critically low at approximately 3.1% of the adult population. This estimate reflects a pre-rollout study calculation defined by a small regional subset of the population. Mixed age groups were evaluated and reflected at least one dose of vaccine. The geographic scope was localized to specific urban samples rather than complete national implementation. Thus, data is sparse about HPV vaccination in Pakistan as a whole. This narrative review examines the multifaceted barriers to HPV vaccination in Pakistan through the dual lens of a Pakistani doctor from a resource-limited peripheral city and current observership experience at Massachusetts General Hospital’s Division of Gynecologic Oncology. Drawing from recent literature, this review systematically analyzes socio-cultural, religious, knowledge-based, structural, and healthcare system barriers that impede vaccine uptake in Pakistan. In contrast, the review explores evidence-based strategies employed in U.S. academic cancer centers, including provider education, electronic health record (EHR)-based reminder systems, patient navigation, and multidisciplinary quality improvement initiatives. Comparative reflections highlight critical lessons that Pakistan can adapt from high-resource settings, while acknowledging the necessity for context-sensitive implementation. Evidence-based recommendations are proposed for Pakistan, including integration of HPV vaccination into the national Extended Immunization Program, school-based delivery models, culturally sensitive community engagement, provider training, and strategic partnerships with international organizations. This review underscores that while resource disparities are substantial, targeted interventions informed by global best practices can significantly improve HPV vaccination coverage and ultimately reduce cervical cancer mortality in Pakistan.