Coverage Without Consensus: An Evolutionary Game-Theoretic Analysis of Punjab’s 2025 HPV Vaccination Campaign

https://doi.org/10.65161/recfllILbBss2Y9Dz

The September 2025 Human Papillomavirus (HPV) immunization drive in Punjab marked the country's largest-ever vaccination campaign for a single disease, since the polio eradication drive. This study reports three simultaneous outcomes: provincial coverage of 81 percent of the eligible cohort against a target of 8.54 million girls (93 percent against an operational target of 7.27 million girls), while 2.74 million households refused the vaccines; the level of coverage varied considerably across districts, ranging from 73 percent in Rajanpur to 91 percent in Okara. The campaign accomplished these results without spending any money on formal enforcement, at an incremental administrative overhead of roughly Rs. 0.85 per girl vaccinated (a marginal cost figure that excludes vaccine and cold-chain costs borne by Gavi). The school-based delivery channel underperformed, in contrast to the community outreach program, which overperformed. To formalise these dynamics, we construct a three-player evolutionary game between households, the state, and misinformation actors and fit it to the 2025 campaign outcomes. The parameterized model identifies conditions under which an interior equilibrium can be locally stable. We then use the parameterized model to simulate four counterfactual policy scenarios. Findings show that contact intensity rather than demand-side persuasion is the dominant lever for coverage.