In 2021, the influenza vaccination rate among adults aged 18-59 in China was only 0.52%, and the vaccination rates for pneumonia and influenza among chronic patients such as chronic obstructive pulmonary disease are also worrying. "On December 5th, Liang Wannian, a professor at Tsinghua University and dean of the School of General Medicine at Southern University of Science and Technology, stated at the adult vaccine consensus conference and special seminar that challenges such as insufficient accessibility and convenience of vaccination services, high costs, and vaccine hesitancy continue to increase the risk of illness among adults, exacerbating the burden on families, society, and medical service systems.

"China has made remarkable achievements in children's immunization planning, but adult immunization faces weaknesses." Yin Zundong, a researcher at the Immunization Planning Center of the China Center for Disease Control and Prevention, said that in the context of population aging, infectious diseases such as influenza increase the risk of chronic disease becoming serious, and it is urgent to strengthen active immunization.

On the same day, the Expert Consensus on Health Promotion Strategies for Adult Vaccination in China, led by Tsinghua University, Peking University, Southern University of Science and Technology, Society of Public Safety Science and Technology, and Public Health Safety and Health Professional Committee, was released. Experts at the meeting called for the expansion of vaccination from children to the entire life cycle population, and to help adults achieve positive and effective health promotion through vaccination.

There are multiple checkpoints in adult immunity

In terms of major disease prevention and control, vaccination is a very powerful 'lever', "said Liu Jue, deputy director of the Department of Epidemiology and Statistics at Peking University School of Public Health. A large amount of research data shows that adult vaccination can bring health value. For example, the vaccination of seasonal influenza vaccine can reduce the hospitalization rate and mortality rate of elderly patients with diabetes by 45% and 38% respectively, which is also associated with reducing the risk of cardiovascular death.

But our research shows that some diseases that can be prevented by vaccines still bring a heavier burden of disease, "Liu Jue said, and even a heavier burden of death when combined with infections.

Compared to other regions internationally, there is still room for improvement in China's adult vaccination rate. In Western Europe and the United States, the influenza vaccination rate for heart failure patients is about 60%, while in China, the influenza vaccination rate for heart failure patients is less than 1%. Experts involved in forming consensus believe that the low vaccination rate among adults in China is caused by various factors, including the fact that vaccination mainly relies on individual self payment, and limited coverage of medical insurance and government subsidies. Only some regions have included the elderly or high-risk population in the public vaccination program or medical insurance reimbursement pilot program, making it difficult to form a nationwide guarantee mechanism.

The assessment of the proportion of vaccines as drugs in public hospitals greatly weakens the enthusiasm of medical institutions to carry out vaccination work. Liu Jue said that medical institutions are an important driving force for the integration of medical and prevention, and should break through the "bottlenecks" in the system and mechanism through policy innovation.

Jia Mengmeng, associate researcher at the Institute of Pathogenic Biology, Chinese Academy of Medical Sciences, introduced that her team's investigation and research have shown that some medical staff have concerns about recommending vaccination. If issues such as sense of responsibility can be resolved, nearly 80% of medical personnel who were originally unwilling to recommend vaccination will be willing to do so.

Actively promote the implementation of vaccination strategies

Regarding adult immunization bottlenecks, the Expert Consensus on Health Promotion Strategies for Adult Vaccination in China has planned a feasible strategy system, including policy guarantees, service systems, integration of medical and preventive measures, cost sharing, health education, and other dimensions, and proposed specific solutions. Yin Zundong stated that establishing a three in one service network of "adult vaccination clinics, medical institution vaccine prescriptions, and mobile vaccination vehicles" will greatly improve convenience.

In Chongqing, Shandong, Zhejiang and other places, more proactive adult vaccination strategies are gradually being implemented. In May 2024, Nan'an District of Chongqing launched a pilot program for adult vaccine prescriptions, which included three hospitals. The main vaccines were influenza vaccine, 23 valent pneumonia vaccine, and herpes zoster vaccine. Clinical doctors issued vaccine prescriptions to service recipients, and adult vaccination rooms were set up in clinical departments to facilitate adult vaccination.

Zhu Ling, the chief of the Immunization Planning Section of Chongqing Nan'an District CDC, said that the family doctor team will also issue vaccine health education prescriptions to eligible patients during the follow-up of patients with chronic diseases such as hypertension and diabetes.

Shandong Province has taken a crucial step in institutional innovation. In April 2023, the Shandong Preventive Medicine Association and the Shandong Standardization Association approved the release of two group standards to guide pilot medical institutions in increasing vaccine inventory and the "Preventive Vaccination Health Prescription" module in their information systems, promoting the integration of vaccine administration and diagnosis and treatment from the perspective of information data.

Zhang Weiyan, chief physician of the Immunization Management Institute of Shandong Provincial Center for Disease Control and Prevention, said that after the transformation of the vaccination information system, clinical doctors and general practitioners can directly obtain information such as immunization history and recommended vaccines, and can issue health prescriptions for vaccination from the hospital management information system.

Experts attending the meeting believe that existing practice has proven that measures such as standardizing the construction of adult vaccination clinics can help improve adult vaccination rates, and feasible vaccination strategies should be actively promoted through pilot projects.