Pakistan’s HPV and Cervical Cancer Elimination Efforts: Keeping Girls and Women in Focus

Dr. Noreen Zafar vividly remembers her introduction to cervical cancer. It was 1987 and as a new medical graduate, she was assigned to care for a young Pakistani woman in the hospital who had advanced, stage-four cervical cancer.   

“No one would go into her room because of the strong, offensive smell except for her mother and her three little children,” Zafar recalls. When she came to check on the patient after a weekend, the room was empty and being cleaned. “It was such a tragedy, she left behind three young orphans, and it shook me as she was the first death I had witnessed.” 

Five years later, Zafar was in graduate training in London and her professor performed a loop excision on a patient with CIN3. “He said, ‘She would have certainly developed cervical cancer, but now she’s disease-free.’” Zafar vowed she would set up a cervical cancer screening program.  

“Every single time that I talk about cervical cancer or HPV vaccination, I can see that young mother’s face very clearly and how helpless she was.”  

Zafar was a featured speaker on a panel hosted by the Global HPV Consortium at the 37th Annual Conference of the International Papillomavirus of the International Papillomavirus Society (IPVC 2025) in Bangkok, Thailand in October. The panel focused on the importance of storytelling in advocacy and patient engagement for cervical cancer prevention and HPV immunization. Zafar shared what she calls her “hot off the press” experiences engaging young women and their parents in the first-ever HPV vaccination campaign in Pakistan this fall, including lessons learned and how it is shaping the future. She gave us a preview here. 

With this story as background, it’s very clear why you are so passionate about cervical cancer elimination. 

Ever since I came into the medical profession, I’ve believed it’s all about focusing on human beings. In medical school, we learn the numbers, the diseases, and the treatments. But for me, as an OB-GYN, since day one of my training, the most important context of the entire situation is the woman herself. It is imperative to put a human face to all of this science that we have learnt. Without empathy, it is impossible to do justice in our job.  

You must be delighted that the HPV vaccine has now been introduced in Pakistan. 

Absolutely! I’m really glad that we finally reached this milestone.  

How prevalent is cervical cancer in Pakistan?  

The human cost of this disease in Pakistan is roughly 5,300 new cases of cervical cancer every year. This is just the tip of the iceberg, as many, many women never actually get to the hospital. And out of those 5,300, around 3,400 die every year. So that’s like 15 women developing the disease every single day, and eight or nine women dying every day from a cancer which is either preventable or completely treatable. This is like a Boeing 777 crashing every month! 

How was the vaccine program initiated and what is your role in this? 

The WHO cervical cancer elimination targets of 90% vaccination-70% screening -90% treatment gave low- and middle-income countries hope that this is achievable and served as the impetus for HPV vaccine.  

The Girls and Women’s Health Initiative (GWHI) was founded three decades ago with the goal of reaching out to girls and women who cannot reach us. We have been working to raise awareness about cervical cancer, advocacy for screening, and better treatment facilities. We conduct regular, ongoing series of workshops and courses in cervical screening and coloscopy as part of our capacity-building initiative.  

Gavi, the Federal Directorate of Immunization (FDI) of Pakistan, the Expanded Program on Immunization (EPI), UNICEF, WHO, and Jhpiego have been actively engaged in the HPV launch campaign, and the Pakistan Alliance for Cervical Cancer Elimination (PACCE) — an offshoot of Global Women’s Heath Initiative (GWHI) — has been working with professional bodies, pediatricians, religious leaders, teachers, and parents to make this milestone campaign a success.   

How long has it been going on and what are you learning as it is rolling out? 

It’s all very recent. The campaign ran between September 15 and October 1. We focused on a multi-age cohort of girls between 9 and 14 years old. Following the campaign, the vaccine is available, free of cost, under Pakistan’s EPI program for all 9-year-olds.  

That seems like a short period of time to vaccinate millions of young girls. 

Absolutely. We started a phased rollout with three provinces. You might be aware that we had terrible flash floods in the country at the same time, which caused a lot of displacements. Yet, we vaccinated almost 9 million girls, about 68-70% of our target. It was the first time, and we learned so many lessons. 

Such as? 

It is very important to remain flexible. The initial days of the campaign showed a rather low uptake of the vaccine. The campaign was extended for four days and we got 1.4 million shots delivered during these days. Also, as social media filled up with misinformation about the campaign, our Health Minister, Mr. Mustafa Kamal, brought his daughter to be vaccinated on live television. The graph of those immunized immediately rose after she was vaccinated. It was a great job done. We learned many things that we can do better. 

What is one key lesson you would pass along to the next country rolling out the HPV vaccine? 

Can I say two? 

I think the biggest one that we are now evaluating is that there was not enough time to inform and engage the schoolteachers, parents, parent-teacher associations, and the student and youth representatives. Partly that was due to the floods, because school re-opening following summer holidays was delayed and the time we had set aside between the start of school and the beginning of the campaign disappeared.  

The second thing was that the day the campaign started, there was lot of misinformation popping up on social media all over the place. TikTok, YouTube, Instagram, you name it, every source was flooded with misinformation and wrong information, and advising people not to have their daughters vaccinated. We should have worked on debunking and creating a pro-vaccine media campaign with our partners in the media and the schools well before we actually went into the vaccination itself. That’s a good lesson learned. 

Is there going to be an HPV media campaign like that developed now? 

Yes, absolutely. The doctors and OB-GYNs can’t do this alone. We all have to work together. GWHI and PACCE are working on a campaign featuring influential people — celebrities from sports, cinema, media, plus government and academia for their testimonials. This documentary will serve as a rolling information campaign on all social and digital platforms so that everyone gets to know how important this is. This is different from other vaccines, particularly since for the moment in Pakistan, it’s only for girls, so correct information dissemination will have to continue 24/7, 365 days a year. We are also actively engaged in addressing misinformation in person and through media. 

Are you hopeful cervical cancer can be eliminated in Pakistan? 

I’ve always firmly believed that this cervical cancer can end. Every single morning, I wake up and I think that we have to do something to make cervical cancer a thing of the past. Now, with the vaccine, I believe that even more. I think it might not be within our lifetimes, but I certainly hope that our grandchildren will be talking about cervical cancer as a cancer that used to be.  

But we have a long way to go for that. Right now, we screen less than 2% of our women and this is an area that needs a lot of work. Likewise, the treatment facilities and services need a lot more improvement  

What are you hoping those who attend your session at the IPVC conference learn?  

I hope young people who will hear us talking remember that the best care is the woman-centric and we have to give her our best. She has to feel heard, respected, and valued. It is also a great opportunity to share experiences, learn from peers, and build bridges to help each other.  

If, through all our efforts, we manage to spare one woman of the misery, so that she doesn’t develop cervical cancer, or if she does, that she gets quality comprehensive, that is worth all this work. That is everything.