Dr Atta Ur Rehman
Every year on March 4, HPV Awareness Day serves as a vital reminder of the urgent need to address the widespread threat posed by the human papillomavirus (HPV) and its direct link to cervical cancer. Globally, HPV is responsible for more than 99% of cervical cancer cases, with types 16 and 18 being the most oncogenic and harmful. In Pakistan, cervical cancer is the second most common cancer among women of reproductive age, with thousands of new cases diagnosed and hundreds of lives lost each year.
The World Health Organization’s (WHO) Global Strategy for the Elimination of Cervical Cancer sets clear and ambitious targets: vaccinating 90% of girls by age 15 and ensuring that 70% of women undergo high-precision screening by the time they turn 35 and 45. While these goals are essential for reducing cervical cancer rates globally, Pakistan faces considerable hurdles in achieving them. A significant barrier is the lack of widespread availability and access to the HPV vaccine. Although vaccines such as Merck’s Gardasil and GlaxoSmithKline’s Cervarix have been available in the private healthcare sector, they remain out of reach for the majority of Pakistan’s population due to their high cost. Importantly, the HPV vaccine is not yet included in Pakistan’s National Immunization Program (EPI), meaning the majority of the population is unaware or unable to access this life-saving intervention.
In Pakistan, the situation remains dire. According to the International Agency for Research on Cancer (IARC), in 2020 alone, there were 5,008 new cases of cervical cancer and 3,197 deaths. Cervical cancer is the third most common cancer among women in the country, with approximately 73.8 million women aged 15 and older at risk. The absence of a national vaccination program, combined with limited access to screening, has allowed the cancer to spread largely undetected in its early stages. With most women diagnosed at an advanced stage, their treatment options become limited, and the likelihood of survival decreases significantly.
The solution lies in the aggressive implementation of HPV vaccination, especially among girls aged 9-14 years—the group most vulnerable to HPV infection. Early vaccination, ideally before sexual exposure, can prevent HPV-related cancers from developing. Given that cervical cancer primarily affects women, prioritizing the vaccination of girls is crucial.
School-based vaccination campaigns should be a key component of any strategy to curb cervical cancer rates. By partnering with the education sector, the government can ensure that both in-school and out-of-school girls are reached. These campaigns would not only provide the vaccine but also serve as an important platform for educating communities about the life-saving benefits of vaccination. Public awareness campaigns should focus on dispelling myths and addressing cultural and religious concerns that may hinder vaccine acceptance. For instance, engaging local influencers, community leaders, and religious figures in awareness campaigns will be crucial in a country where misinformation can easily spread.
Equally vital is ensuring that the vaccine reaches rural and underserved areas, where healthcare access is limited and knowledge about HPV and its preventive vaccine is scarce. Expanding the vaccine’s availability, particularly in these regions, will be essential for achieving equitable healthcare outcomes and reducing the health disparities between urban and rural populations.
Early detection plays a pivotal role in preventing the progression of cervical cancer. Pakistan’s screening infrastructure, however, is still underdeveloped, particularly in rural and remote areas. The majority of Pakistani women, especially in rural regions, lack access to basic cancer screening tools such as Pap smears, HPV DNA tests, or Visual Inspection with Acetic Acid (VIA), all of which can detect early signs of cervical cancer. As a result, the majority of women are diagnosed only when the cancer has advanced, significantly reducing their chances of survival.
To address this issue, the government must focus on expanding and upgrading screening services across the country. This includes equipping health centers, especially in rural areas, with the necessary resources and trained personnel to conduct effective screening. Establishing mobile clinics and utilizing telemedicine platforms can further help extend screening services to remote areas, ensuring that women who live far from healthcare centers can still access vital cancer screenings.
The implementation of a nationwide HPV vaccination program and the strengthening of cervical cancer screening infrastructure should be a priority for Pakistan’s health policymakers. These measures would not only reduce cervical cancer mortality but also contribute to the broader goal of eliminating cervical cancer as a public health problem by 2030, in line with the WHO’s global strategy. On this HPV Awareness Day, Pakistan must recognize the scale of the challenge and take decisive steps to protect its future generations. By prioritizing HPV vaccination, improving early detection facilities, and ensuring equitable access to healthcare, the country can significantly reduce cervical cancer rates and pave the way for a healthier, cancer-free future. Let us commit to turning this vision into reality, so that cervical cancer is no longer a silent killer, but a preventable and manageable disease.
The writer can be reached at attaurrehman1987@yahoo.com
