HPV vaccine uptake in Pakistan: A qualitative study to identify barriers and facilitators before the first HPV national rollout.

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.