As the most popular self-paid vaccine in the past few years, when the HPV vaccine can become a public product for all has always been the focus of social attention. At the National People's Congress in recent years, deputies and members have continued to make suggestions on this. Nandu reporters learned that last year, the relevant suggestions were listed as key supervision suggestions by the National Health Commission. This year, deputies and members continued to speak out on this and called for the inclusion of HPV vaccines in the national immunization plan.

Because it can prevent cervical cancer, HPV vaccines have been sought after since their birth. The countries that first introduced the vaccination plan have observed a significant decline in HPV infection rates and cervical precancerous lesions. The World Health Organization recommends that 90% of girls should be vaccinated with HPV vaccines before the age of 15 by 2030 to achieve comprehensive protection for the younger generation.

In China, several provinces and cities have taken the lead in providing free HPV vaccines to girls of appropriate age in the form of livelihood projects. Limited by local financial capacity, the academic community has begun to pay attention to how to support vaccination in low-resource areas. Among them, the most core policy recommendation is to include HPV vaccines in the national immunization plan, funded by the national finance, and provided free of charge to all people.

Call for fiscal response to HPV vaccination demands

Dong Yuelin, a member of the National People's Congress and vice president of the School of Language, Culture and International Education of Liuzhou Institute of Technology, has been paying attention to this issue in recent years. Last year, she submitted the "Suggestions on Moving the Protection Barrier Forward to Promote Free Cervical Cancer Vaccination for Girls in Middle Schools" which was listed as a key supervision suggestion by the National Health Commission. In May last year, she was invited to Beijing to attend a symposium to exchange suggestions with all parties. At that time, many high-level experts attending the meeting also called for the inclusion of HPV vaccines in the national immunization plan.

Last year, the National Health Commission released information showing that starting from 2021, 11 provinces including Guangdong, Hainan, Fujian, Jiangsu, Jiangxi, Chongqing, Tibet, Zhejiang, Shandong, Hubei, and Guangxi, and cities including Zhengzhou, Ordos, and Chengdu have included HPV vaccination in the government's practical projects for the people, and provided free HPV vaccination services to girls aged 13-14 in the region through fiscal purchase of services and fixed-rate subsidies. As of then, the free HPV vaccination policy has covered about 40% of girls of school age nationwide. Dong Yuelin told Nandu reporters that according to her understanding, the number of provinces, cities, and autonomous regions that provide free HPV vaccines has expanded to 15.

As the only preventable cancer at present, the World Health Organization has even proposed to eliminate cervical cancer in this century, which involves a series of actions such as vaccines, screening, and treatment. Vaccination for girls of school age is the first step in this line of defense. However, due to differences in resources and action between regions, the incidence of cervical cancer in various parts of the world has shown a large gap, and cervical cancer is also described as "the cancer of inequality" internationally.

The above data also show that 60% of eligible girls are still not covered by the free vaccination policy. A data published by the China CDC in "China CDC Weekly" shows the gap across the country. Based on the estimation of the electronic vaccination registration data of the China Immunization Information System, in 2022, the coverage rate of the first dose of HPV vaccine for people aged 9 to 14 in China will be only 4%, ranking last among the seven age groups of 9 to 45 years old. Among them, the eastern region has the highest vaccine coverage rate, with the first dose HPV vaccination rate in Beijing reaching 25.40%, Shanghai 20.99%, and Xinjiang, Qinghai, Gansu, Tibet and Guizhou provinces all below 5%.

Therefore, the academic community has been calling for the inclusion of HPV vaccine in the national immunization plan, and the central government to support vaccination in various places, especially in low-resource areas, to form universal protection and avoid the "health gap".

Dong Yuelin introduced that when communicating with relevant departments some time ago, it was learned that the areas currently implementing free vaccination are all paid by local finances. The national immunization plan is mainly borne by the central finance. At present, the disease control department is communicating and coordinating with the financial department to promote related matters. Many parties hope that the financial department will increase its support so that HPV vaccines can be included in the national immunization program as soon as possible.

According to Jiupai News, Li Xia, a member of the National People's Congress and director of the National Blood Prevention Base Office of the Center for Disease Control and Prevention in Jiangling County, Jingzhou, Hubei, also proposed this year that HPV and Hib vaccines should be included first within 1 to 2 years, "the disease burden of the two is the heaviest and the cost-effectiveness ratio is the best." She also suggested that relevant departments work together to promote it. The financial department implements the funds needed for the new types of vaccines in the national immunization program, covering various aspects of funding support such as vaccine procurement, cold chain and vaccination information construction and maintenance, personnel training, and health education. The health department needs to formulate an implementation plan for the new vaccines and organize medical and health institutions at all levels to implement them. It is also necessary to widely publicize the policies of the national immunization program and the knowledge related to the new vaccines through various channels to improve the public's awareness and acceptance, enhance immunization awareness and willingness to be vaccinated, and create a good social atmosphere.

Vaccine prices continue to fall and have reached a level that can be afforded by the government

The new vaccines in the immunization program will inevitably involve the question of who will pay and whether the government can afford it.

Liu Xiaoqing, deputy to the National People's Congress and director of the Jiangxi Provincial Center for Disease Control and Prevention, is also paying attention to the HPV vaccine. In 2023, Jiangxi announced that HPV vaccines would be provided free of charge to girls of appropriate age. In his opinion, the inclusion of a new vaccine requires consideration of multiple factors, including disease burden and public health value, vaccine safety and effectiveness, the scientific and economic benefits of immunization planning, vaccine production and distribution capabilities, and fiscal purchasing power.

As the price of domestically produced bivalent HPV vaccines continues to drop, most industry insiders believe that the above conditions are gradually being met. There are three bivalent HPV vaccines in the world, two of which are from Chinese manufacturers, namely Xiamen Wantai and Zerun Bio, a subsidiary of Watson Bio. These two domestic vaccines passed the WHO prequalification (PQ) in 2021 and 2024, respectively, which means that their safety and effectiveness have been recognized, and their production and quality management capabilities have reached a high level and have been recognized internationally. This also means that the country can provide a stable supply of vaccines at a lower cost and achieve free vaccination for all without having to rely on international procurement.

The competitive landscape of multiple manufacturers has also led to a continuous decline in vaccine prices. In 2022, when Wantai Bio won the bid for the Guangdong People's Livelihood Project, the price was still 329 yuan/unit. After that, Watson reduced the bidding price in Fujian to 245 yuan/unit. In 2023, the two companies took turns to reduce prices. Finally, in the Shandong bidding in August last year, Watson offered a low price of 27.5 yuan/unit.

A model study published by Zhao Fanghui's team at the Cancer Hospital of the Chinese Academy of Medical Sciences in October last year showed that if two doses of routine vaccination were given to 14-year-old girls nationwide, the cost-effective purchase price should not exceed US$26-37 per dose, and the cost-saving purchase price should not exceed US$5-10 per dose. "Cost-effective" means that the money spent by the government for this is efficient, while "cost-saving" means that the funds invested in disease prevention reduce future medical expenses and reduce the overall economic burden.

Coincidentally, the author's original intention was to provide a reference for government procurement negotiations through model estimation results, but when the paper was published, in reality, market competition made the pricing of domestic 2-valent HPV vaccines close to the "cost-saving" price.

For finance, there is another noteworthy perspective for the inclusion of new vaccines in the national immunization program. At present, the rapid decline in the number of births has reduced the cost of vaccine procurement, and the fiscal surplus for the immunization program has also increased. According to industry estimates, the target population of the immunization program has also dropped sharply from 188.3 million in 2016 to 9.56 million in 2022. The unused funds have accumulated and can be considered to be reallocated to increase vaccines. (See: "National Immunization Program to be Expanded: Can the Public Have More Free Vaccines After the Birth Rate Declines")

According to Liu Xiaoqing, Jiangxi has a heavy burden of cervical cancer, which made the local government determined to provide free vaccines. In order to solve the funding problem, the local government adopted a model of joint funding by the provincial, municipal and county governments to purchase vaccines. As the price of domestic vaccines drops, the burden on local finances has also been alleviated, and there is more confidence in promoting livelihood projects.

Dong Yuelin also talked about that if financial resources are indeed limited, free vaccination can be distributed and promoted, first supporting the vaccination of eligible girls in rural and mountainous areas, and then transitioning to towns and areas with better economic conditions.

To improve the vaccination rate, the focus is on popular science and organizational implementation

At the beginning of this year, Beijing announced in its "Important Livelihood Projects in 2025" that in order to implement the national action to accelerate the elimination of cervical cancer, Beijing will provide free voluntary human papillomavirus (HPV) vaccination for newly enrolled first-year girls in 2025. This move has made the industry increasingly look forward to national-level actions and responses.

The "Action Plan for Accelerating the Elimination of Cervical Cancer (2023-2030)" jointly issued by the National Health Commission and 10 other departments shows that areas with conditions are encouraged to carry out HPV vaccination pilots and explore multiple channels to support vaccination of girls of school age in resource-deficient areas. This year is a key node in the action. The document goal states that by 2025, pilot promotion of HPV vaccination services for girls of school age will be carried out.

Many provinces have also accumulated experience in promoting HPV vaccination through pilot projects. Liu Xiaoqing recalled that Jiangxi Province began bidding for vaccines in March 2023. After completing the bidding in the middle of the year, vaccination work began in August, and local preparations such as training and mobilization were carried out simultaneously. Initially, the industry was still worried about the insufficient vaccination rate, but the free policy was welcomed by the public, and Jiangxi has exceeded the vaccination task in the past two years.

Liu Xiaoqing believes that an important step in the vaccination work is to work with the education department to do a good job in publicity and popular science, so that the public can realize the value of HPV vaccination. At the same time, vaccination services should be provided, adverse reactions should be responded to in a timely manner, and vaccination safety should be ensured. In addition, governments at all levels should be mobilized to implement vaccination work. "It is not necessarily how much money is invested. Whether the work can be done well depends mainly on organization, publicity, and mobilization, which are very critical." He said.

Qiao Youlin, a distinguished professor at the School of Population Medicine and Public Health of Peking Union Medical College, is one of the most important scholars in China who studies cervical cancer prevention and control. He has participated in the promotion of monitoring, screening and vaccination work in many regions. In November last year, Qiao Youlin was interviewed by a reporter from Nandu and said that China's existing vaccination service system is relatively mature and capable of completing the various tasks required to include HPV vaccines. The top priority is to include it in the national immunization plan.

"Inclusion in the national immunization program is the most difficult step (in vaccine policy), but what we want to promote is the immunization program. It is the most basic guarantee provided by the government to the people. The poor can be vaccinated and the rich can also be vaccinated. This is what the country should do." said Qiao Youlin.

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