In October 2025, a health worker named Waheed Ali Soomro arrived at a school in Hyderabad, Pakistan, to vaccinate girls against human papillomavirus, or “HPV”.
The parents were already angry.
Their daughters had been lined up without prior notice, and WhatsApp rumors about the vaccine causing infertility had reached the community before Soomro did.
He coordinated an emergency meeting with teachers and available parents on the spot, managing to vaccinate most of the eligible girls that day.
But the experience left him with a question that no training manual had prepared him to answer: What should he have done before he arrived?
Soomro was one of a massive, open cohort of health professionals from India, Pakistan, and many other countries that participated in a peer learning course called “Get started with HPV vaccination and keep it going,” offered by The Geneva Learning Foundation (TGLF) in partnership with UNICEF in November 2025.
The course was not a lecture.
It was not a webinar.
It was an experiment in whether frontline health workers, given a shared vocabulary and a structured way to exchange stories, could teach each other something that experts could not.
The answer, it turns out, was yes.
And the lesson they converged on was not a technique.
It was a posture.
The virus, the vaccine, and the gap between them
Human papillomavirus is the most common sexually transmitted infection in the world.
Most infections clear on their own, but persistent infection with high-risk strains, particularly HPV types 16 and 18, can cause cells to change over years or decades, eventually leading to cervical cancer.
The link is causal and well established: virtually all cervical cancer is caused by HPV.
This makes it one of the only cancers that can be prevented by a vaccine.
The HPV vaccine is safe and highly effective when given to girls between the ages of 9 and 14, before they are likely to encounter the virus.
Global targets call for 90% coverage by 2030.
Meeting those targets could prevent 62 million deaths from cervical cancer over the next century.
But global coverage remains far from that goal.
A 2025 analysis found that only about 20% of girls worldwide have received full doses.
The gap between the vaccine’s promise and its delivery is not primarily a supply problem.
In recent years, 19 Gavi-supported countries have adopted a single-dose schedule following WHO guidance, dramatically expanding the number of girls that can be reached with existing supply. The bottleneck is on the demand side: convincing parents, navigating rumors, reaching adolescent girls who may not be in school, and having conversations about a sexually transmitted infection with families for whom the topic is deeply sensitive.
These are not challenges that can be solved by shipping more vials.
This is the terrain that Nicolas Theopold, a senior program officer at the Gates Foundation who has helped shape Gavi’s HPV vaccination strategy, has described as the frontier of the global effort.
His work has emphasized that accelerating introduction is only half the problem.
The other half is sustaining coverage after the campaign tents are packed away, which requires granular, subnational knowledge about what actually works in communities.
That knowledge, as a December 2024 expert review noted, must contend with “uncertainty in funding, risk to ongoing prioritization of health equity and to vaccine confidence in the current global public health environment.”
A curriculum written by the workforce
The TGLF course was built on a premise that sets it apart from conventional training: its content was not written by distant experts.
It was assembled from the real experiences of thousands of health workers who had participated in previous rounds of Teach to Reach, TGLF’s peer learning network that has connected over 80,000 health professionals globally.
The result was a different kind of curriculum.
Instead of clinical guidelines and policy frameworks, learners encountered short, first-person testimonies from colleagues in more than 40 countries.
A nurse in Burkina Faso described how she convinced a cousin who initially refused to vaccinate his daughter because of sterilization rumors.
A public health specialist in Zimbabwe recounted how her colleagues were ridiculed by a workforce that dismissed the idea of an anti-cancer vaccine.
A nurse in Kenya described bringing her own daughter to a school where no girl would accept the vaccine, vaccinating her child in front of the students, and watching the others come forward one by one.
These stories formed a practitioner-generated corpus that complements technical knowledge in a way that guidelines cannot.
A WHO position paper can explain the immunological rationale for vaccinating before sexual debut.
It cannot tell you what to say when a grandmother in rural Nigeria is afraid, or how to organize a last-minute meeting with teachers when parents are already arriving at the school gate in protest.
The course placed that operational, relational, and deeply contextual knowledge at the center of the learning experience.
Each module followed the same rhythm: two or three short field testimonies, followed by a reflection question connecting the story to the learner’s own context.
The seven strategies that organized the content ranged from preparing health workers to answer difficult questions with empathy, to engaging religious and traditional leaders, to listening to the community’s fears before speaking.
All were drawn from what practitioners had actually done, not from what theory suggested they should do.
The listening revelation
After reading their colleagues’ stories, learners were asked to describe a specific, recent challenge they had faced in HPV vaccination, select one strategy from the course that would have produced a better result, and write a concrete action plan for next time.
When the responses came in, a pattern emerged that was not designed into the course.
It was discovered in the data.
Of the learners who completed the full peer exchange, more than one in three independently chose the same strategy as the most relevant: listening to the community’s fears before speaking.
This was more than twice as frequent as any other option, emerging from practitioners in Pakistan, Nigeria, Kenya, the Democratic Republic of the Congo, India, The Gambia, and Cambodia.
The convergence matters because it challenges the dominant model of how vaccine hesitancy is understood.
The conventional framing treats hesitancy as a knowledge deficit: parents do not know the facts, so we must supply better information.
Misinformation is the enemy, and the antidote is more data, more pamphlets, more talking.
The health workers in this course arrived at a different diagnosis.
The problem, they said repeatedly, was not that communities lacked information.
It was that communities had not been heard.
Fatima Bintu Dawuda, a health worker in The Gambia, articulated the shift in the starkest terms: “Before, when a parent resisted the HPV vaccine, my immediate professional reaction was to launch into an educational lecture to correct misinformation. I saw the problem as a lack of knowledge that needed to be filled. My participation in this exercise showed me that my first action should not be speaking, but listening.”
She described a fundamental reframing of her professional identity: “This shifted my identity from being an information provider to a trust builder and fear analyst. My work is now about diagnosing and treating the fear first, so the medical intervention can reach its target.”
Dr. Imam Wada Bello, a public health advocate in Kano State, Nigeria, described the same shift from a different angle: “When we paused the HPV rollout and let the parents voice their worries, especially the fertility rumors, it turned a standoff into a dialogue. By truly hearing them, we could tailor our messages, bring in a trusted local health worker, and address the root concern instead of just dumping facts.”
What makes this finding significant is that listening was presented in the course as one of seven strategies with equal prominence.
The others included engaging religious leaders, working with teachers, using personal stories, and planning with the education system.
Yet practitioners from radically different contexts independently concluded that the listening gap was the one that had cost them the most.
The course report, developed by TGLF’s Insights Unit, calls this “strong evidence that it addresses a structural feature of community-based vaccination, not a locally specific cultural pattern.”
The Pakistan test case
The timing of this course was not accidental.
In September 2025, Pakistan launched its first-ever HPV vaccination campaign, targeting 13 million girls aged 9 to 14 across Punjab, Sindh, Islamabad Capital Territory, and Pakistan-Administered Kashmir.
The campaign was funded by Gavi using Cecolin, a bivalent vaccine against HPV types 16 and 18.
The push to introduce the vaccine had started in 2018 but struggled against institutional barriers, the COVID-19 pandemic, and deep community skepticism.
Learners from Pakistan enrolled in the TGLF course just weeks after this national launch, carrying fresh field experience.
Their submissions revealed the same anatomy of resistance that appeared across the entire dataset: rumors that precede the vaccination team, parents who feel their concerns are dismissed as ignorance, and health workers trained to respond with knowledge rather than acknowledgment.
Soomro’s account from Hyderabad became one of the most discussed case studies in the peer review process.
In his reflection, he wrote: “Parents’ refusal was driven mainly by fear and misinformation rather than a lack of access. Although we were able to address concerns by sharing facts and guidance, I realized that parents became more receptive only after they felt their worries were heard and respected.” His planned action was specific and operational: before any future session, he would organize an advance meeting with teachers, share all facts and materials, listen to their suggestions, and incorporate their input into the vaccination plan.
Another Pakistani participant, Hafiz Zaheer Abbas, offered a revealing window into the misinformation landscape.
He described parents citing social media content as their reason for refusal and his own creative counter-strategy: telling parents that “TikTok is a foreign media agency and everything that is going on there is not verified.” It was not a textbook response.
It was a real-world improvisation from a health worker who understood that the authority of the messenger mattered as much as the message.
The course report notes that this approach “extends well beyond the standard information-provision model.”
India’s quiet contribution
India contributed the third-largest national cohort to the course, after Pakistan and Nigeria.
The country is scaling up HPV vaccination as part of a broader adolescent health agenda, and its health workers face a distinct set of challenges: vast geographic diversity, complex bureaucratic coordination at multiple levels of government, and communities where awareness of cervical cancer prevention remains extremely low.
One Indian public health specialist quoted in the course content identified a gap that resonated across the entire dataset: “Service providers should be given very good training on HPV vaccine. More time to be spent on orienting staff on behaviour change communication.”
The distinction between technical training, how to administer the vaccine, and communication training, how to have the conversation, proved to be one of the course’s most generative tensions.
Health workers know the science.
What they lack, many of them said, is preparation for the human encounter that determines whether the science ever reaches the patient.
Misinformation as a community event
One of the sharpest qualitative insights to emerge from the course was a reframing of how misinformation operates.
Learners did not describe misinformation as an individual problem, a parent who happens to believe something false.
They described it as a community-level event: a rumor that moves through WhatsApp groups, a single influential voice in a village, a story passed from one family to another before the vaccination team arrives.
The structural similarity across contexts was striking.
In Pakistan, parents had withdrawn consent at the last moment due to WhatsApp rumors about fertility.
In Nigeria, Dr. Imam Wada Bello described a local influencer who spread rumors that the vaccine could cause fertility issues, causing clinic attendance to drop sharply.
In another Nigerian case, a learner named Abdullahi Olawuyi described a mother who became “visibly upset and shared a harrowing story: her niece, in a nearby village, had required emergency surgery just one day after receiving the HPV vaccine. She blamed the vaccine entirely, swore she would withdraw her child, and vowed to mobilize other parents to do the same.”
The health workers’ responses to these situations were not uniform, but they shared a common element: the most successful interventions involved pausing the planned activity and creating space for dialogue.
Dr. Wada Bello described gathering community leaders for a quick town hall and bringing in a nurse who could answer questions in Hausa.
Soomro described his improvised emergency meeting.
The course helped these practitioners name what they had already intuited: that responding to a community-level event with an individual-level intervention (more facts for the hesitant parent) addresses the wrong unit of analysis.
Teachers, religious leaders, and the architecture of trust
Beyond listening, the course’s practitioner-generated content illuminated two additional strategies that learners found particularly powerful: engaging teachers as trust intermediaries and enlisting religious leaders as partners.
Jael Miroya Rubia, a health worker in Kenya, described a planned action with unusual specificity: “Before any future HPV vaccination activity, I will first hold a brief, deliberate meeting with the head teacher and selected teachers, before sending consent forms home, to explain the vaccine clearly, address their concerns, and intentionally ask for their partnership so they can confidently support the program and reassure parents.”
Her reasoning was precise: “Parents trust teachers more. If you understand this vaccine and believe in it, they will listen to you more easily than to us as visitors.”
A peer reviewer from Burkina Faso validated this strategy with cross-national evidence: “In our country we use this approach because pupils and more parents listen and respect their teachers’ opinions.”
This kind of exchange, a health worker in East Africa receiving confirmation from a colleague in West Africa that a strategy works in a completely different context, is the distinctive contribution of the peer learning model.
The engagement of religious leaders proved to be the most complex theme.
Learners described these leaders in two distinct roles: as the source of resistance and as the most powerful possible ally.
The transition between these roles was itself a described learning moment.
Ayodele Ajayi from Nigeria made one of the most analytically significant observations in the entire dataset: he drew a direct parallel to the successful engagement of religious leaders during polio vaccination campaigns, arguing that the same approach could be adapted for HPV.
“Having seen similar results in other vaccination programs, e.g., Polio,” he wrote, the strategy of educating religious leaders and collaborating with them “will surely produce positive results.”
This kind of cross-program knowledge transfer is exactly what peer learning is designed to generate, and exactly what top-down training rarely captures.
The power of personal testimony
A recurring theme in the course was the discovery that personal stories outperformed clinical data in changing minds.
Rebecca Maidawa Sulaiman, a health worker in Nigeria, shared that she had paid to receive her own HPV vaccination as an adult, having passed the eligibility age for the free program.
The course report identifies this as “among the most powerful personal testimonies in the dataset. It reframes the health worker not as an information provider but as a committed community member whose actions speak louder than any clinical communication.”
A nurse in Kenya described bringing her own daughter to a school where every girl had refused the vaccine, vaccinating her child in front of the students, and watching the others come forward one by one.
A midwife in Uganda described using routine baby weigh-in sessions as an opportunity to talk with mothers about vaccinating their older daughters.
These were not innovations that emerged from a policy meeting.
They were micro-innovations from the front lines, solutions that only someone standing in the room could have devised.
The course explicitly positioned this practitioner-generated wisdom as a complement to, not a replacement for, technical guidelines.
- A health worker in Cameroon told the story of discovering a Vatican position paper from the Catholic Medical Association to counter a local church leader’s opposition to the vaccine.
- A team in Senegal described convening religious leaders, imams, and Koranic schoolmasters in a town known for its deep mistrust of vaccination.
In each case, what made the strategy work was not the authority of the evidence alone but the relational context in which it was deployed: by a known person, to a specific audience, with an understanding of local power dynamics that no global guideline could encode.
Solidarity as pedagogy
The course design deliberately mixed learners across countries in the peer review process.
- A practitioner from Pakistan might review the work of a colleague from Ghana.
- A nurse in the DRC might give feedback to a health worker in India.
The result was something the course report calls “solidarity as pedagogy”: the discovery that a colleague in another country faces the same rumors, uses the same words to counter hesitancy, and has found the same strategies to work.
The emotional dimension of this discovery was profound.
Noelly Zola Watusadisi from the DRC wrote: “I read my colleagues’ stories and I was touched by the events on fields. That was not easy but I liked my colleagues’ resilience to reach the goal.”
Through the course forum, she shared the story of Safi, a medical student colleague whose mother died of cervical cancer and who channeled that grief into launching a student-led advocacy platform years before the HPV vaccine reached the DRC.
The act of sharing that story, and having it validated by peers across the world, was itself described as professionally transformative.
Vitus Ejiogu Chibueze from Nigeria described the change in relational terms: “My participation expanded my network by connecting me with colleagues who share similar goals and challenges. These new relationships have encouraged mutual learning and support. I now collaborate more frequently and feel more comfortable reaching out for advice or offering help when others need it.”
The most valued peer reviews were not evaluative in the academic sense.
They were contextually resonant.
The most helpful comment was often some version of: “In my country, we face the same thing, and here is what we tried.”
Learners rated the feedback they received from untrained peers as genuinely useful, precisely because it came from colleagues facing similar challenges.
It is difficult for an expert trainer, however knowledgeable, to replicate the validation that comes from a fellow health worker saying: I have stood where you stood, and here is what I learned.
New tools from old wisdom
Several learners translated the peer exchange into tangible, operational tools.
- Dawuda in The Gambia created a “Listen First Protocol” and a “48-hour pre-planning checklist,” procedural innovations that emerged directly from peer feedback on her original submission.
- Dr. Wada Bello described a “Fear-Listening Circle,” a structured moment before vaccination sessions where community fears are invited and named.
- Soomro committed to organizing advance meetings with teachers before any future school session.
These are not communication strategies in the conventional sense.
They are new procedural elements in vaccination campaign design.
The course report argues that they represent a fundamental reframing of the public health challenge: “If vaccine hesitancy is driven by unheard fears rather than missing facts, then arriving at a vaccination session with improved information materials addresses the wrong problem. What is needed is a structured moment before the session begins when the community’s fears are invited, named, and acknowledged.”
Dawuda captured the transformation with unusual precision: “Previously, I viewed success purely as achieving the target number of vaccinations by the end of the day, a quantity-based measure. Now, I see success as building sustainable trust and achieving informed consent. My new focus is on the quality of the interaction. This new understanding has redefined my work from a program completion task to a community relationship mission.”
The lesson for the global effort
In the race to vaccinate 90% of the world’s girls against HPV by 2030, the global health establishment has focused heavily on supply chains, funding mechanisms, and single-dose schedules.
These are necessary conditions.
The shift to a single-dose recommendation alone has allowed Gavi-supported countries to target millions of additional girls. But the workers on the front lines are saying something that the global architecture has been slow to hear.
The TGLF course demonstrated that health workers across 40 countries, when given the chance to learn from a curriculum built on the authentic field experiences of their peers, and then to exchange their own stories with colleagues facing identical challenges in radically different contexts, converge on an insight that challenges the prevailing model.
The obstacle to HPV vaccination is not ignorance.
It is the experience of not being heard.
The solution is not a better script.
It is a different kind of silence: the silence of listening first.
Dr. Imam Wada Bello, writing from Kano State, offered what may be the most resonant statement of what this kind of learning can produce: “The new understandings of the situation from peers around the globe regarding HPV vaccination gave me more hope that together we can change the world.”
The world has the vaccine.
The question is whether it has the method to deliver it.
Health workers from India, Pakistan, Nigeria, and more than 20 other countries just offered an answer, drawn not from a textbook but from the accumulated wisdom of a global workforce that knows, better than anyone, what happens in the last ten feet between a health worker and a hesitant parent.
What happens in those ten feet, it turns out, is not about information at all.
It is about trust.
And trust begins with listening.
References
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