I have just spoken about the role of CSOs in implantation of the HPV screening in the MENA region. So that’s basically an area consisting of many Asian and Arab and African countries and we share quite a few of our socioeconomic and sociocultural characteristics. Basically, this is exploring the role of what we can offer to the governments in the form of helping to prevent and eliminate cervical cancer.
What has so far been implemented to increase HPV screening in Pakistan?
We are just starting our journey in that respect. We have applied for the vaccination to be provided by GAVI and in autumn 2025 we are hoping to have the vaccination available in the expanded programme of immunisation in Pakistan. At the moment we are just getting ready for the advocacy efforts and also for the awareness raising among the families, mothers, parents, teachers and the religious leaders so that there’s a take-up of the vaccine.
As far as the screening for cervical cancer is concerned, at the present time it is only being offered as an opportunistic screening programme. We do not have an organised screening programme but the country has just finished a situation analysis for breast and cervical cancer prevention, screening and treatment under the leadership of WHO and we are hoping that with those results being tabled we should be able to set up a screening programme in the country.
Is there a structured plan to implement HPV vaccinations in Pakistan in accordance with international guidelines?
It will be exactly as the international guidelines are and, luckily, now WHO has already stated that we can just do well with one single dose. It will be a part of the expanded programme of immunisation which is a very successful one being run in the country. So we are hoping to get the girls 9-15 years old in school to be vaccinated.
Another issue that we have is that almost 36% of our girls are actually out of school so reaching out to them is going to be something that we really need to be vigilant about. Hopefully, in the autumn of 2025 this programme will be rolled out.
What are the current and future obstacles to HPV screening and vaccination in Pakistan and how will you overcome them?
This is a question which can take a long time to answer. It is a loaded question, indeed. But, like all the low- and middle-income countries, obviously there are restrictions in the form of financial constraints then the country often has other natural disasters which drain the resources and attention of the government. Then we have a lot of displaced people in the country. All this means that the government’s attention and priority has to be specifically channelled towards cervical cancer prevention and screening and that is what we are hoping to get on board.
On the other side, the awareness amongst the girls and women and families in general, health literacy and the value of health for women, it is something that needs to be propagated well. Women usually would do everything for the family but nothing for themselves. So that culture, the status of women in society, their empowerment, their education and priority for health, that has to be really highlighted by the government and by society so that women actually will come and use the services.
Then, finally, the status of health services, we have a long way to go. We are hoping that the cervical cancer screening will be included in the universal health package so that it can be offered to women in the primary care centres, secondary as well as tertiary centres. So looking forward to that.
What is the current status of screening efforts in Pakistan, and are there any success stories related to these screening programmes?
The actual screening situation is not very good. We hardly manage to scan 1.5-2% of our population and that’s just totally opportunistic. There is no organised national cancer screening programme but we do have a very well organised system where there are peripheral small units like the basic health units which are then looked after by the rural health centre, then there are [?? 4:53] and district headquarter hospitals.
So we are hoping that if we are able to train all the staff, right from the specialists down to the community workers, and they can help us not only in getting the vaccination to the people who need it but also in cervical cancer screening. For the situation analysis we have actually recommended that we should resort to HPV testing which is the actual preferred method by WHO. So hopefully we will get it going.
The success of breast cancer screening programmes in certain regions has been encouraging; could this serve as a model for implementing HPV screening?
You are very, very right because the situation analysis, we’ve just finished writing it and reporting it, we have taken breast and cervical cancers together because, after all, it is the same woman. Once she comes to the facility she can have both the services. So we are hoping that the government will tag it as women’s cancer screening initiative and we can offer the breast as well as the cervical cancer screening at the same time.
Are there any existing plans to implement gender-neutral vaccination programmes?
If you had asked for my wish list I would have put it at the top. But at the moment we are trying to make an economically feasible case, in which case it has been proven in other parts of the world and we should also be able to make a case for gender-neutral vaccination. But for now, at the moment, within the next 3-5 years’ term, even if we get it rolling for the girls that would be a good output.
Is there anything else you would like to add to the interview?
The final message, really, is that cervical cancer is a cancer which should no longer be here. We know that a virus causes it, we know that there is a 10-15 year latent period from slight abnormalities to developing the cancer. Even if we pick up the cancer at an early stage, the life of the woman can be saved. It’s not only the life of the woman and the pain and the misery, when the mother dies the whole family is devastated. Cervical cancer causes so many deaths, so many deaths of the mother, every one [other] one mother dies because of this in our region.
Cervical cancer is also responsible for one fourth of cancer orphans in the whole world. So we all need to make a promise and do our bit to make it a cancer elimination, a real reality which is the need of the hour.
