DEVELOPING A CONTEXTUAL HPV VACCINATION MODEL FOR PAKISTAN: COMPARATIVE LEARNINGS FROM INDIA AND SRI LANKA
Main Article Content
Keywords
HPV vaccination, Cervical cancer prevention, Pakistan, Hybrid immunization model, Cervavac, Cecolin, Lady Health Workers (LHWs), School-based vaccination, Public health strategy, South Asia, NIMS
Abstract
The prevalence of cervical cancer among Pakistani women and the lack of a national HPV vaccination campaign have continued to make cervical cancer a major cause of cancer related deaths in women in Pakistan. The proposed approach to hybrid HPV vaccination in Pakistan is suggesting the synthesis of the strategies demonstrated as successful in India and Sri Lanka, which are the countries with similar regional, infrastructural, and cultural contexts. Through a sharing case study design involving secondary data, the study compares the cost-effective implementation of the locally produced Cervavac vaccine in India and the initial success demonstrated in Sri Lanka on the challenges of a school-based approach that integrates with the support of the community and religious leaders in centralized rollout. The model incorporates the low-cost sourcing of vaccines in Chinese manufacturers, two delivery models; urban school-based and rural Lady Health Worker-led outreach, and the culturally sensitive awareness efforts. It further suggests it should utilize the National Immunization Management System (NIMS) of Pakistan to track and coordinate policies in real-time at both federal and provincial levels. The results emphasize the fact that this kind of a model is not only possible but also scalable, culturally relevant and affordable in terms of the financial needs of the public health system in Pakistan.
References
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32. Noreen K, Naeem Khalid S, Murad MA, Baig M, Khan SA. Uptake and determinants of HPV vaccination in South Asia: a systematic review and meta-analysis. Front Public Health [Internet]. 2024 [cited 2025 Jun 19];12. Available from: https://pubmed.ncbi.nlm.nih.gov/39722717/
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35. Coursey K, Muralidhar K, Srinivas V, Jaykrishna P, Begum F, Ningaiah N, et al. Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study. BMC Public Health [Internet]. 2024 Dec 1 [cited 2025 Jun 19];24(1):1–15. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19485-8
36. Bhatla N, Lal N, Bao YP, Ng T, Qiao YL. A meta-analysis of human papillomavirus type-distribution in women from South Asia: Implications for vaccination. Vaccine [Internet]. 2008 Jun 2 [cited 2025 Jun 19];26(23):2811–7. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0264410X08003836
37. Luwen G, Hameed H, Aslam B, Liyan Z, Jabbar A, Syyam A. Understanding of cervical cancer, human papillomavirus (HPV) and HPV vaccine among women from Pakistan and Afghanistan. Ecancermedicalscience. 2025;19.
38. Life-saving HPV vaccine introduced nationwide into routine immunization schedule to prevent cervical cancer in Cambodia [Internet]. [cited 2025 Jun 19]. Available from: https://www.who.int/cambodia/news/detail/06-10-2023-life-saving-hpv-vaccine-introduced-nationwide-into-routine-immunization-schedule-to-prevent-cervical-cancer-in-cambodia
39. Setiawan ;, Oktora M, Puri ;, Hutubessy R;, Riewpaiboon A;, Postma MJ, et al. The health-economic studies of HPV vaccination in Southeast Asian countries: a systematic review. Expert Rev Vaccines [Internet]. 2017 [cited 2025 Jun 19];16(9):933–43. Available from: http://www.tandfonline.com/action/journalInformation?journalCode=ierv20
40. Shpendi S, Norman P, Gibson-Miller J, Webster R. Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review. Women’s Health. 2025 Mar 13;21.
41. Chughtai N, Perveen K, Gillani SR, Abbas A, Chunara R, Manji AA, et al. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC Public Health. 2023 May 5;23(1):834.
2. Satapathy P, Nazli Khatib M, Neyazi A, Qanawezi L, Said S, Gaidhane S, et al. Prevalence of human papilloma virus among cervical cancer patients in India A systematic review and meta-analysis. Medicine (United States) [Internet]. 2024 Aug 2 [cited 2025 Jun 19];103(31):e38827. Available from: https://pubmed.ncbi.nlm.nih.gov/39093777/
3. Shrestha AD, Neupane D, Vedsted P, Kallestrup P. Cervical cancer prevalence, incidence and mortality in low and middle income countries: A systematic review. Asian Pacific Journal of Cancer Prevention [Internet]. 2018 Feb 1 [cited 2025 Jun 19];19(2):319–24. Available from: https://pubmed.ncbi.nlm.nih.gov/29479954/
4. Shrestha AD, Vedsted P, Kallestrup P, Neupane D. Prevalence and incidence of oral cancer in low- and middle-income countries: A scoping review. Eur J Cancer Care (Engl). 2020 Mar 1;29(2).
5. Brüggmann D, Quinkert-Schmolke K, Jaque JM, Quarcoo D, Bohlmann MK, Klingelhöfer D, et al. Global cervical cancer research: A scientometric density equalizing mapping and socioeconomic analysis. PLoS One. 2022 Jan 6;17(1):e0261503.
6. Koutsky LA, Ault KA, Wheeler CM, Brown DR, Barr E, Alvarez FB, et al. A Controlled Trial of a Human Papillomavirus Type 16 Vaccine. New England Journal of Medicine. 2002 Nov 21;347(21):1645–51.
7. Bedell SL, Goldstein LS, Goldstein AR, Goldstein AT. Cervical Cancer Screening: Past, Present, and Future. Vol. 8, Sexual Medicine Reviews. Elsevier B.V.; 2020. p. 28–37.
8. Eun TJ, Perkins RB. Screening for Cervical Cancer. Medical Clinics of North America. 2020 Nov;104(6):1063–78.
9. Gillison ML, Chaturvedi AK, Lowy DR. HPV prophylactic vaccines and the potential prevention of noncervical cancers in both men and women. Cancer. 2008 Nov 3;113(S10):3036–46.
10. Meites E, Szilagyi PG, Chesson HW, Unger ER, Romero JR, Markowitz LE. Human Papillomavirus Vaccination for Adults: Updated Recommendations of the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2019 Aug 16;68(32):698–702.
11. Chaturvedi AK, Graubard BI, Broutian T, Pickard RKL, Tong ZY, Xiao W, et al. Effect of Prophylactic Human Papillomavirus (HPV) Vaccination on Oral HPV Infections Among Young Adults in the United States. Journal of Clinical Oncology. 2018 Jan 20;36(3):262–7.
12. Chatterjee A. The next generation of HPV vaccines: nonavalent vaccine V503 on the horizon. Expert Rev Vaccines. 2014 Nov 26;13(11):1279–90.
13. Ben-Ari E. More evidence that one HPV vaccine dose protects against cancer-causing infections [Internet]. 2022 [cited 2025 Jun 2]. Available from: https://www.cancer.gov/news-events/cancer-currents-blog/2022/cervical-cancer-hpv-vaccine-one-dose-kenya
14. Gunasekera SK, Perera KA, Fernando C, Udagama PV. A shifting paradigm in the aetiology of oral and pharyngeal cancer in Sri Lanka: A case-control study providing serologic evidence for the role of oncogenic HPV types 16 and 18. Infect Agent Cancer [Internet]. 2015 Apr 1 [cited 2025 Jun 19];10(1). Available from: https://pubmed.ncbi.nlm.nih.gov/25908938/
15. Nagaraja M, Narendra H, Venkataramana B, Kalawat U. HPV genotype prevalence in Indian women with cervical disease and estimation of the potential impact of HPV vaccines on prevention of cervical cancer. Indian J Med Microbiol [Internet]. 2023 May 1 [cited 2025 Jun 19];43:73–8. Available from: https://pubmed.ncbi.nlm.nih.gov/36241529/
16. Das P, Thomas A, Mahantshetty U, Shrivastava SK, Deodhar K, Mulherkar R. HPV genotyping and site of viral integration in cervical cancers in Indian women. PLoS One [Internet]. 2012 Jul 16 [cited 2025 Jun 19];7(7). Available from: https://pubmed.ncbi.nlm.nih.gov/22815898/
17. Man I, Georges D, de Carvalho TM, Ray Saraswati L, Bhandari P, Kataria I, et al. Evidence-based impact projections of single-dose human papillomavirus vaccination in India: a modelling study. Lancet Oncol. 2022 Nov 1;23(11):1419–29.
18. Rajkhowa P, Patil DS, Dsouza SM, Narayanan P, Brand H. Evidence on factors influencing HPV vaccine implementation in South Asia: A scoping review. Glob Public Health [Internet]. 2023 [cited 2025 Jun 19];18(1). Available from: https://www.tandfonline.com/doi/pdf/10.1080/17441692.2023.2288269
19. The Lancet Oncology. HPV vaccination in south Asia: new progress, old challenges. Lancet Oncol [Internet]. 2022 Oct 1 [cited 2025 Jun 19];23(10):1233. Available from: https://www.thelancet.com/action/showFullText?pii=S1470204522005678
20. Petersen Z, Jaca A, Ginindza TG, Maseko G, Takatshana S, Ndlovu P, et al. Barriers to uptake of cervical cancer screening services in low-and-middle-income countries: a systematic review. BMC Womens Health. 2022 Dec 2;22(1):486.
21. Siddiqa A, Zainab M, Qadri I, Bhatti M, Parish J. Prevalence and Genotyping of High Risk Human Papillomavirus in Cervical Cancer Samples from Punjab, Pakistan. Viruses. 2014 Jul 17;6(7):2762–77.
22. Ali A, Manzoor MF, Ahmad N, Aadil RM, Qin H, Siddique R, et al. The Burden of Cancer, Government Strategic Policies, and Challenges in Pakistan: A Comprehensive Review. Front Nutr. 2022 Jul 22;9.
23. Tufail M, Wu C. Exploring the Burden of Cancer in Pakistan: An Analysis of 2019 Data. J Epidemiol Glob Health. 2023 Apr 25;13(2):333–43.
24. Noreen K, Khalid SN, Javaid M, Khan SA. Public Health Implications of Introducing Human Papillomavirus (HPV) Vaccination in Pakistan: A protocol for a mixed-method study to explore community perceptions and health system preparedness. PLoS One [Internet]. 2025 May 1 [cited 2025 Jun 19];20(5):e0323826. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0323826
25. Shamsi U, Anwar A, Samad Z. Time for Reintroducing HPV Vaccine in Pakistan for Primary Prevention of Cervical Cancer. Journal of the College of Physicians and Surgeons Pakistan. 2022 Oct 1;32(10):1377–8.
26. Why Pakistan needs HPV vaccination to safeguard women and girls | UNICEF Pakistan [Internet]. [cited 2025 Jun 19]. Available from: https://www.unicef.org/pakistan/stories/why-pakistan-needs-hpv-vaccination-safeguard-women-and-girls
27. Cervical cancer Pakistan 2021 country profile [Internet]. [cited 2025 Jun 19]. Available from: https://www.who.int/publications/m/item/cervical-cancer-pak-country-profile-2021
28. Burger EA, Campos NG, Sy S, Regan C, Kim JJ. Health and economic benefits of single-dose HPV vaccination in a Gavi-eligible country. Vaccine. 2018 Aug 6;36(32):4823–9.
29. FOGSI-UNICEF presents for every child “A Guide Book for Master Trainers: Preventing Cervical Cancer through HPV Vaccination in India” “A Guide Book for Master Trainers: Preventing Cervical Cancer through Vaccination in India” HPV.
30. Debellut F, Gamage D, Kumar S, Wickramasinghe S, Ruwanpathirana T, Kariyawasam M, et al. Human papillomavirus (HPV) vaccination program in Sri Lanka: Ongoing costs and operational context of a routinized program. Vaccine X [Internet]. 2024 Mar 1 [cited 2025 Jun 19];17:100456. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC10877402/
31. Drolet M, Laprise JF, Martin D, Jit M, Bénard É, Gingras G, et al. Optimal human papillomavirus vaccination strategies to prevent cervical cancer in low-income and middle-income countries in the context of limited resources: a mathematical modelling analysis. Lancet Infect Dis. 2021 Nov 1;21(11):1598–610.
32. Noreen K, Naeem Khalid S, Murad MA, Baig M, Khan SA. Uptake and determinants of HPV vaccination in South Asia: a systematic review and meta-analysis. Front Public Health [Internet]. 2024 [cited 2025 Jun 19];12. Available from: https://pubmed.ncbi.nlm.nih.gov/39722717/
33. HPV prevalence and incidence study in Sindh [Internet]. [cited 2025 Jun 19]. Available from: https://www.aku.edu/mcpk/paeds/Pages/hpv.aspx
34. Kaarthigeyan K. Cervical cancer in India and HPV vaccination. Indian J Med Paediatr Oncol [Internet]. 2012 [cited 2025 Jun 19];33(1):7. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3385284/
35. Coursey K, Muralidhar K, Srinivas V, Jaykrishna P, Begum F, Ningaiah N, et al. Acceptability of HPV vaccination for cervical cancer prevention amongst emerging adult women in rural Mysore, India: a mixed-methods study. BMC Public Health [Internet]. 2024 Dec 1 [cited 2025 Jun 19];24(1):1–15. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-024-19485-8
36. Bhatla N, Lal N, Bao YP, Ng T, Qiao YL. A meta-analysis of human papillomavirus type-distribution in women from South Asia: Implications for vaccination. Vaccine [Internet]. 2008 Jun 2 [cited 2025 Jun 19];26(23):2811–7. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0264410X08003836
37. Luwen G, Hameed H, Aslam B, Liyan Z, Jabbar A, Syyam A. Understanding of cervical cancer, human papillomavirus (HPV) and HPV vaccine among women from Pakistan and Afghanistan. Ecancermedicalscience. 2025;19.
38. Life-saving HPV vaccine introduced nationwide into routine immunization schedule to prevent cervical cancer in Cambodia [Internet]. [cited 2025 Jun 19]. Available from: https://www.who.int/cambodia/news/detail/06-10-2023-life-saving-hpv-vaccine-introduced-nationwide-into-routine-immunization-schedule-to-prevent-cervical-cancer-in-cambodia
39. Setiawan ;, Oktora M, Puri ;, Hutubessy R;, Riewpaiboon A;, Postma MJ, et al. The health-economic studies of HPV vaccination in Southeast Asian countries: a systematic review. Expert Rev Vaccines [Internet]. 2017 [cited 2025 Jun 19];16(9):933–43. Available from: http://www.tandfonline.com/action/journalInformation?journalCode=ierv20
40. Shpendi S, Norman P, Gibson-Miller J, Webster R. Identifying the key barriers, facilitators and factors associated with cervical cancer screening attendance in young women: A systematic review. Women’s Health. 2025 Mar 13;21.
41. Chughtai N, Perveen K, Gillani SR, Abbas A, Chunara R, Manji AA, et al. National cervical cancer burden estimation through systematic review and analysis of publicly available data in Pakistan. BMC Public Health. 2023 May 5;23(1):834.
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Jun 23, 2025
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Nazneen Iqbal, Ayesha Aftab Mirza, Usman Iqbal, Hira Nizam, Muhammad Awais, Sikandar Ehsan, Bakhtmeena Nizam, & Eman Nadeem. (2025). DEVELOPING A CONTEXTUAL HPV VACCINATION MODEL FOR PAKISTAN: COMPARATIVE LEARNINGS FROM INDIA AND SRI LANKA. Journal of Population Therapeutics and Clinical Pharmacology, 32(5), 1092-1101. https://doi.org/10.53555/1bksbx07
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Author Biographies
Nazneen Iqbal
MBBS, MRCOG (UK), FRCOG (UK), Head of department of Obstetrics and Gynaecology Shaheed Saif-ur-Rehman Government Teaching Hospital, Gilgit.
Ayesha Aftab Mirza
MBBS, Graduate of Ayub Medical College, Abbottabad.
Usman Iqbal
MBBS, Graduate of Sahara Medical College, Narowal.
Hira Nizam
MBBS, FCPS (II), Senior Resident General Surgery, Rehman Medical Institute, Peshawar.
Muhammad Awais
MBBS, Graduate of Sahara Medical College, Narowal.
Sikandar Ehsan
Student of Shaikh Zayed Al Nahyan Medical and Dental College, Lahore.
Bakhtmeena Nizam
Student of Women Medical and Dental College, Abbottabad.
Eman Nadeem
Student of Women Medical and Dental College, Abbottabad.
How to Cite
Nazneen Iqbal, Ayesha Aftab Mirza, Usman Iqbal, Hira Nizam, Muhammad Awais, Sikandar Ehsan, Bakhtmeena Nizam, & Eman Nadeem. (2025). DEVELOPING A CONTEXTUAL HPV VACCINATION MODEL FOR PAKISTAN: COMPARATIVE LEARNINGS FROM INDIA AND SRI LANKA. Journal of Population Therapeutics and Clinical Pharmacology, 32(5), 1092-1101. https://doi.org/10.53555/1bksbx07