Peer-reviewed article
HPV vaccine uptake in Pakistan: A qualitative study to identify barriers and facilitators before the first HPV national rollout.
Noreen K, Khalid SN, Noor M, Maryam S, Ahmad AMR et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This qualitative study explores why families in Punjab, Pakistan accept or refuse HPV vaccination before the country's first national rollout. Researchers interviewed community workers, healthcare providers, teachers, adolescent girls, and parents to understand what helps and hinders vaccine uptake. The study found that fear of side effects, religious concerns, and patriarchal decision-making were major barriers, while health worker support, school trust, and community norms were key facilitators. The researchers recommend culturally sensitive and trust-building strategies to improve vaccine confidence.
Key points
- Barriers included fear of side effects, vaccine skepticism, misinformation on social media, religious perceptions, patriarchal decision-making, and long waiting times for services
- Facilitators included recognition of vaccine benefits, supportive family and community norms, health worker counseling, and trust in school authorities
- Diverse stakeholder engagement (community workers, healthcare providers, teachers, adolescents, and parents) provided multilevel understanding of vaccine acceptance
- Financial constraints and health system fragility were identified as factors that could act as both barriers and facilitators depending on context
- Gender-neutral vaccine messaging and door-to-door outreach were identified as effective approaches to improve uptake
Limitations
This study was qualitative and exploratory, conducted only in Northern and Southern Punjab, so findings may not represent all of Pakistan or predict actual vaccine uptake rates during rollout. The study does not measure or compare actual vaccination behaviour or outcomes.
Abstract
Although vaccines remain a mainstay tool for the prevention of infectious diseases, their efficacy, safety, and trust among the population remain controversial. For an effective rollout of the HPV vaccine in Pakistan, financial constraints, health system fragility, and complex cultural values should be kept in mind, and these should be apprehended as both facilitators and barriers, since these findings will help policymakers to design effective interventions and improve public trust. To explore barriers and motivators to HPV vaccine uptake in Pakistan, the study used a descriptive qualitative study design. It was conducted from February 2025 to August 2025 across districts of Northern Punjab and Southern Punjab. Inclusion of diverse stakeholders such as community workers/religious scholars, healthcare providers, teachers/school administrators, adolescent girls, and their parents/guardians allowed us a better understanding of multilevel influencers on HPV vaccine acceptance. Barriers to HPV vaccination were summarized under BeSD framework, including fear of side effects, vaccine skepticism, misinformation via social media, religious perception, restricted social and peer norms, fear-based motivation, long waiting time, service dissatisfaction, patriarchal decision-making, and community resistance. Conversely, facilitators included recognition of vaccine need and benefits, supportive family and community norms, health worker counseling, public health advocacy, trust in school authorities, religious belief, self-determination, effective outreach and door-to-door services, and gender-neutral vaccine acceptance. The findings underscore the need for culturally sensitive, trust-building strategies that go beyond a clinical approach to effectively strengthen equitable HPV vaccine uptake, improved vaccine confidence, and ultimately reduced HPV-related diseases.