Nepal’s struggle with vaccine hesitancy is no longer limited to remote or marginalised communities. Health officials say resistance to free vaccination programmes is increasingly visible among educated and well-off families, particularly in Kathmandu Valley, where uptake of the human papillomavirus (HPV) vaccine has been among the lowest in the country.
During a government-led HPV vaccination drive earlier this year, immunisation workers faced difficulties entering some renowned private schools in the Valley. Even after access was granted, school authorities insisted on parental consent, and many parents ultimately refused to allow their children to be vaccinated.
According to public health officials, some parents consulted private doctors who discouraged participation in the free campaign. “The HPV vaccine is expensive in private clinics, and conflicts of interest may have influenced refusal,” said Satish Bista of the Public Health Office Kathmandu. The same vaccine can cost more than Rs 6,000 in private facilities.
What troubles officials is that refusal rates in Kathmandu Valley exceed those in Madhesh Province, where public health coverage is typically lower due to poverty, unemployment, and limited awareness. “Low uptake among disadvantaged communities is understandable,” said Dr Abhiyan Gautam of the Department of Health Services. “But educated families buying the same vaccine privately while rejecting it from the government is deeply concerning.”
Health workers report that persuading people in remote districts of Karnali and Sudurpaschim is often easier than convincing urban residents. In cities, female community health volunteers are sometimes dismissed as “less educated,” denied entry into apartments, or even threatened while carrying out their duties.
Officials warn that low participation in public health programmes, combined with poor water and sanitation in urban areas, increases the risk of outbreaks of communicable and vaccine-preventable diseases in major cities.
Human papillomavirus is a leading cause of cervical cancer, which remains one of the most common and deadly cancers among Nepali women. Although exact figures are unavailable, health experts estimate that at least four women die from cervical cancer every day in Nepal. Widespread immunization could significantly reduce these deaths.
The Ministry of Health and Population plans to launch a month-long HPV vaccination campaign from mid-January, targeting all 10-year-old girls or those studying in grade six. Officials estimate around 3 lakh 50 thousand girls fall within this age group. While the vaccine is now part of the routine immunization list, authorities acknowledge that public trust remains a major challenge.
As vaccine refusal grows among those with greater access to information and resources, health experts say Nepal faces a paradox where privilege, rather than poverty, is becoming a barrier to public health.