Vaccine campaigns have long been a controversial subject in Pakistan, from the fake polio drive organised by the CIA to track Osama bin Laden to the many conspiracy theories that surrounded the Covid vaccine. Hence, the recent rollout of the human papillomavirus (HPV) vaccine against cervical cancer also faced public scrutiny.

This time, however, the alarm was amplified, since the campaign focused on girls aged 9 to 14, leading to concerns and questions about its impact on fertility and reproductive health.

The HPV vaccine drive’s initial campaign was planned from September 15-27, 2025, but was later extended to October 1. It aimed to immunise 13 million girls aged 9-14 across Punjab, Sindh, Azad Jammu and Kashmir, and the federal capital Islamabad. In the drive, the vaccine — which has a retail price of Rs7,500 — is being provided free of charge through a partnership between the government of Pakistan, the World Health Organisation and vaccine alliance GAVI.

While vaccinators and public health experts expected resistance, the rate of refusal was shockingly high. On September 24, the state minister for national health revealed that only 34 percent — around 4.5 million girls — had been vaccinated.

The misinformation around the HPV vaccine was so great that it threatened an entire campaign. It was yet another demonstration of how viral online lies can have deadly consequences

A few days earlier, federal health minister Mustafa Kamal had his own daughter vaccinated in front of the press. “The refusal rate was extremely high in the first few days,” Kamal tells Eos. “I realised that the best way to allay parents’ concerns was to get my daughter inoculated,” he adds. Kamal says that it worked, with coverage improving drastically during the remainder of the campaign.

By the end of the campaign, nine million girls had received the shot. But that number could have been higher, if not for the many disinformation campaigns that amplified suspicion and mistrust.

THE DISINFORMATION ECHO CHAMBER

A video on a YouTube channel, called Eon Podcast Reloaded with 176,000 followers, claimed that HPV only affects those with multiple sexual partners and its vaccine causes infertility. The host in the clip, Amanullah Tariq, tied HPV with promiscuity, calling for that to be stopped instead of vaccines to be administered.

In the video, Tariq claims, “as a fact that can be Googled”, that the vaccine’s introduction in India led to the death of 125 girls. A 2010 HPV vaccine pilot in India targeting 30,000 girls was indeed suspended after seven girls died, but an Indian government investigation revealed that none of the deaths were caused by the vaccine.

The podcast has since been removed from the YouTube channel, but snippets remain available online. Tariq claims he is unaware if the video was removed or deleted due to a YouTube strike. The podcaster, who continues to host high-profile guests, also doubled down on his opinions, asserting that he has the right to them, even if they are based on misinformation.

Misinformation also spread through viral videos, including one which has 350,000 views on one post on X (formerly Twitter). It shows schoolgirls fainting, with the caption claiming it was the after-effect of the HPV vaccine. This is just one metric for a video that has been shared multiple times and across platforms, including WhatsApp groups. By the time fact checkers revealed that the claim was fake and the video was from a different event, the damage had already been done.

These are only two examples from an ever-expanding digital universe powered by clicks and views — easiest to acquire through fearmongering — that adversely impacts individuals and families. One such example is Bushra, a schoolteacher in Islamabad, who convinced her sister not to get her niece vaccinated, as she was suspicious of the government. “It could be that Pakistan’s rapidly growing population might have pushed the government to accept an IMF condition to make girls infertile,” she tells Eos.

UNDERSTANDING VACCINE MISINFORMATION

“Whenever vaccines are free or mandatory, people start questioning intentions,” says Dr Naeem Majeed, a public health professional based in Karachi. “Anti-vaxxer movements exist worldwide and have grown stronger with increased online polarisation,” he tells Eos.

Within Muslim-majority countries, Dr Majeed continues, there is a recurring fear that vaccines, especially those targeted at women and girls, will interfere with fertility or family planning. “This perception resurfaces every few years, even though it has no basis in science.”

The HPV vaccine, however, had an added layer of controversy from the start because it targeted adolescent girls. Many young girls themselves began asking why boys were not receiving the vaccine, as misinformation online often framed HPV as exclusively linked to female sexual behaviour.

“Parents dislike the implication that the HPV vaccine is only for people who are sexually active,” Dr Majeed says. “They don’t realise that ‘sexually active’ can mean being active with a single partner later on, even a husband. It has nothing to do with promiscuity.”

While HPV is transmitted through sexual contact and most infections clear naturally, certain strains can cause cervical cancer years or decades later. The vaccine prevents these cancer-causing infections, which is why it’s administered before girls become sexually active — offering protection for their future health.

GENDERED DISINFORMATION

Surprisingly, HPV resistance was higher in urban centres as compared to rural areas, which is the opposite of what public health campaigns usually encounter. Dr Majeed explains that this is largely because urban populations, such as Karachi, consume far more social-media content, where gendered misinformation is spreading aggressively. Rural families, by contrast, are less aware of the vaccine and its controversies, and show lower levels of organised resistance, he adds.

Government restrictions around messaging, imposed due to security concerns, also prevented health workers from addressing misconceptions with full transparency. “Technical experts were not allowed to answer certain questions and that vacuum was quickly filled by online disinformation,” says Dr Majeed.

Beyond misinformation, awareness itself remains low. Cervical cancer has relatively low visibility in Pakistan because most cases are detected after age 45, while the HPV vaccine is administered years earlier. “People know breast cancer,” Dr Majeed continues, “but many have never even heard of cervical cancer, so they assume it’s a new disease or something created by the state.”

However, according to the Aga Khan University Hospital, cervical cancer remains a significant public health threat in Pakistan, with over 5,000 new cases and approximately 3,000 deaths reported annually in the country.

Despite these challenges, the campaign managed to achieve 77 percent coverage, lower than previous drives but still higher than what many other countries achieved in their first HPV rollout. Routine HPV immunisation will now be incorporated into Pakistan’s schedule for all girls aged nine, beginning January. The campaign phase will not be repeated in the covered regions unless major outbreaks or multi-year gaps occur. However, Khyber Pakhtunkhwa, Balochistan, and Gilgit-Baltistan are still pending implementation and are scheduled for campaigns in 2026 and 2027.

But before rolling out the next phase, the government and health experts need to ensure that online misinformation — which has real, offline consequences — is tackled and debunked. In the case of the HPV vaccine, denying an adolescent girl access to immunisation means potentially putting her future health at risk. Parents, teachers, opinion leaders and health experts share a responsibility to exercise due diligence, verify facts and approach public health guidance with care, rather than dismissing it as a state conspiracy without evidence.

Unless that happens, Bushra and many others like her, will continue to resist the vaccine, leaving out girls facing another potential challenge that could have been avoided.

The writer is Research and Grants Lead at the Digital Rights Foundation, Lahore.
She can be contacted at seeratkhan13@gmail.com

Published in Dawn, EOS, November 30th, 2025

Header image: A vaccinator administers the HPV vaccine to a girl at a local school in Karachi at the start of the nationwide drive on September 15, 2025 | Fahim Siddiqi/White Star