Summary
In April 2021, the National Health Commission (NHC) proposed the Cervical Cancer Elimination Action Plan being integrated into the Healthy City initiative to promote the HPV vaccination and enhance the implementation of tertiary prevention of cervical cancer. In September of the same year, the pilot plan was first launched in 15 cities (districts) to implement a comprehensive cervical cancer prevention and control strategy [1]. In January 2023, ten departments, including the NHC, jointly issued the Action Plan for Accelerating the Elimination of Cervical Cancer (2023-2030). This chapter summarizes the status and experiences of local free HPV vaccination pilot programs in China to provide a reference for other cities and countries in HPV vaccination promotion.
As of May 2024, 9 provinces (autonomous region/municipality) have announced free HPV vaccination as part of the livelihood projects initiated by local government. The 9 provinces include Guangdong, Hainan, Fujian, Xizang (Tibet), Jiangsu, Chongqing, Jiangxi, Zhejiang, and Hubei. At the municipal level, Ordos is the first city in China to conduct free HPV vaccination. It is also the only city with bivalent, quadrivalent, and nine-valent HPV vaccines included in the program among all the Healthy China Action Plan Innovative Model pilot cities. Table 1 summarizes 7 provincial and 27 municipal/prefectural governments’ initiatives of HPV vaccination programs for school girls (as of August 2023).
The local pilot HPV vaccination programs apply multiple financing support, including free-of-charge, flat-rate subsidies, and medical insurance coverage. Most regions provide free domestic-manufactured bivalent HPV vaccine and flat-rate subsidies for other HPV vaccines. In some regions, such as Zhejiang, Shenzhen, and Guangxi, money from the individual accounts of basic medical insurance can be used to pay for HPV vaccinations. The target population of the HPV vaccination programs is mostly 13- to 14-year-old schoolgirls with local residential or school registration records. Some regions expand or limit the age range to girls of school age in certain grades of junior high school. Vaccination implementation mainly relies on school-based mobilization. Some regions also target females from poor households for the vaccination.
To expand the impact of the program, the advocacy and education work is mainly carried out by schools, media, and healthcare facilities, using different formats such as educational videos, lectures, training, voluntary medical services, popularization of science, thematic courses, consulting activities, thematic activities, community activities, health education competitions, press conferences, door-to-door visits and communication, media reports, etc. Multiple communication channels have been utilized, including newspapers, bulletin boards, brochures, branding items, posters, books, TV, live stream platforms, WeChat, APPs, and radio.
In some regions, disseminating vaccination knowledge among people of all ages has applied a “small hands pulling big hands” strategy, meaning children receiving health education at school can share the knowledge with their parents. Rose Action, which is an adolescent health education campaign initiated by the China Women’s Development Foundation (CWDF), mobilizes schools, families, and the whole of society involved in the program. The campaign targets school doctors, primary healthcare providers, and junior and senior high school female students to advocate HPV vaccine-related health knowledge [2]. Many places have also adopted innovative practices to promote the pilot program, including setting up weekend or holiday vaccination sessions, adopting digital tools for vaccination management, and financing assistant policies in favor of poor areas.
Table 1 HPV vaccination pilot programs in recent years (by August 2023)
| Guangdong Province | ||
| Region | East | |
| Policy | Work Program for Free Human Papilloma Virus (HPV) Vaccination for Girls of School Age in Guangdong Province (2022-2024) | |
| Population | Girls with provincial school registration who are new to the first year of junior high school from September and are under 14 years of age, with no history of HPV vaccination | |
| Vax | Bivalent (Domestic Brand) | |
| Cost | No charge | |
| Announced | Nov 2021 | |
| Implemented | 2022-2024 | |
| Link | Click to visit | |
| Xizang (Tibet) Autonomous Region | ||
| Region | West | |
| Policy | People’s livelihood projects (2022, 2023) | |
| Population | Female students aged 13-14 years in school with local household registration and no history of HPV vaccination | |
| Vax | Bivalent (Domestic Brand) | |
| Cost | No charge | |
| Announced | Jan 2022 | |
| Implemented | 2022 onwards | |
| Link | Click to visit | |
| Hainan Province | ||
| Region | East | |
| Policy | Implementation Plan for the HPV Vaccination Program for Girls of School Age in Hainan Province in 2022, Qiong Wei Women and Children [2022] No. 3, People’s Livelihood Project (2022, 2023) | |
| Population | 2022: 18 cities and counties in the province and Yangpu; 2023: 18 cities and counties in the province (except Sansha City) The age of the 1st dose of vaccination is 13 years old – 14 ½ years old girls without contraindications to vaccination, no history of HPV vaccination | |
| Vax | Bivalent (Domestic Brand) | |
| Cost | No charge | |
| Announced | Feb 2022 | |
| Implemented | Mar 2022 onwards | |
| Link | Click to visit | |
| Fujian Province | ||
| Region | East | |
| Policy | Work Plan of the Provincial Party Committee and Provincial Government for the People (2022, 2023) | |
| Population | Girls with school or household registration in the province, aged 13 to 14 ½ years old, with no history of HPV vaccination | |
| Vax | Bivalent (Domestic Brand) | |
| Cost | No charge | |
| Announced | Feb 2022 | |
| Implemented | May 2022 onwards | |
| Link | Link 1 Link 2 | |
| Chongqing Metropolitan | ||
| Region | West | |
| Policy | Implementation Program of HPV Vaccination for Female Students of School Age in Chongqing Municipality (Yu Wei Fa [2022] No. 48) | |
| Population | Girls in the second year of junior high school in the city | |
| Vax | Bialent, quadrivalent | |
| Cost | Flat-rate subsidy: up to $600 per person ($300 per dose for 2 doses; $200 per dose for 3 doses) | |
| Announced | Dec 2022 | |
| Implemented | 2023 onwards | |
| Link | Click to visit | |
| Jiangxi Province | ||
| Region | Central | |
| Policy | Action to Accelerate the Elimination of Cervical Cancer in Jiangxi Province and HPV Vaccination for Girls of School Age: Livelihood Practices | |
| Population | Girls who have not received HPV vaccine in junior high school grades in this province (school registration or household registration) and who were under 14 years old at the time of the actual first dose of vaccine. | |
| Vax | Bivalent (Domestic Brand) | |
| Cost | No charge | |
| Announced | Feb 2023 | |
| Implemented | Aug 2023 onwards | |
| Link | Click to visit | |
| Jiangsu Province | ||
| Region | East | |
| Policy | Circular on the Provincial Government’s 55 Livelihood Matters in 13 Categories for the Year 2023 | |
| Population | First-year girls (born after September 1, 2009) who have school registration in the province and are in school in the first half of the year, without contraindications to HPV vaccination, and who have not completed the full course of vaccination | |
| Vax | Bivalent (Domestic Brand) | |
| Cost | Free of charge (pre-pilot in Wuxi, a district in Lianyungang, and two districts in Nanjing and Yangzhou, respectively) | |
| Announced | Mar 2023 | |
| Implemented | Mar 2023 onwards | |
| Link | Click to visit | |
| Ordos, Inner Mongolia | ||
| Region | West | |
| Policy | Implementation Plan for the Prevention and Control Program of Two Cancers for Women of Age in Ordos City (Efu Banfa [2020] No. 95) | Healthy Inner Mongolia Initiative |
| Population | Female students aged 13-18 years old with no history of HPV vaccination who are household members in the city | Girls from the third grade of senior high school in Jungar and Dalat Banners, Ordos City |
| Vax | Bivalent | Quadrivalent, Nine-valent |
| Cost | No charge (first in the country, piloted in Junggar Banner) | No charge (Piloted in Jungar and Dalad banners) |
| Announced | Dec 2020 | Aug 2022 |
| Implemented | Dec 2020 onwards | Aug 2022 onwards |
| Link | Click to visit | |
| Jinan city, Shandong Province | ||
| Region | East | |
| Policy | Pilot work on comprehensive prevention and treatment of cervical cancer in the city and livelihood projects (2022) | |
| Population | Girls aged ≤14 years (before 15 years of age) in the first year of school in the 15 districts and counties (functional areas) of the city, with no history of HPV vaccination | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge | |
| Announced | Oct 2021 | |
| Implemented | Nov2021 onwards | |
| Link | Click to visit | |
| Chengdu city of Sichuan Province | ||
| Region | West | |
| Policy | Implementation Plan for HPV Vaccination for Comprehensive Prevention and Control of Cervical Cancer in Chengdu City (2021 Edition) | |
| Population | Girls aged 13-14 years old in schools throughout the city | |
| Vax | Bialent, Quadrivalent | |
| Cost | Subsidy:600RMB/person(first in the country) | |
| Announced | Nov 2021 | |
| Implemented | 2021-2025 | |
| Link | Click to visit | |
| Wuxi City, Jiangsu Province | ||
| Region | East | |
| Policy | Implementation Plan for Mass Immunization of HPV Vaccine for School-Age Girls in Wuxi City | |
| Population | Second year girls (age <15) in the 6 municipalities of the city who are permanent residents. | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge (first in the province) | |
| Announced | Nov2021 | |
| Implemented | Dec 2021-Dec 2022 | |
| Link | Click to visit | |
| Shijiazhuang City, Hebei Province | ||
| Region | Central | |
| Policy | People’s livelihood projects (2022, 2023) | |
| Population | Girls aged 14 years with school or household registration in the city, with no history of HPV vaccination | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge (first in the province) | |
| Announced | January 2022 | |
| Implemented | From March 2023 | |
| Link | Click to visit | |
| Tangshan city, Heibei Province | ||
| Region | Central | |
| Policy | People’s livelihood projects (2022, 2023) | |
| Population | Girls 14 years old in school in the city with no history of HPV vaccination | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge | |
| Announced | Jan 2022 | |
| Implemented | April 2022 onwards | |
| Link | Click to visit | |
| Nanjing City, Jiangsu Province | ||
| Region | East | |
| Policy | Implementation Plan of the Free Vaccination Program for School-Age Girls in Nanjing, People’s Livelihood Project (2022, 2023) | |
| Population | First-year girls in the city | |
| Vax | bivalent, quadrivalent, nine-valent (nine-valent newly included in 2023) | |
| Cost | 1. No charge for domestic brand; 2. Subsidies: 492RMB/person for imported vaccine (the first in the province) | |
| Announced | April 2022 | |
| Implemented | April 2022 onwards | |
| Link | Click to visit | |
| Yantai City, Shandong Province | ||
| Region | East | |
| Policy | Implementation Plan of the Free HPV Vaccination Program for Girls of School Age in Yantai City | |
| Population | Citywide junior girls in school ≤14 years of age with no history of HPV vaccination | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge | |
| Announced | Oct 2022 | |
| Implemented | November 2022 onwards | |
| Link | Click to visit | |
| Yuxi City, Yunnan Province | ||
| Region | West | |
| Policy | Yuxi Bivalent Human Papillomavirus (HPV2) Vaccine “Health Beneficiary Project” Three-Year Action Program (2023-2025)” Yuzhengbanfa [2022] No. 38 | |
| Population | With local household registration, aged 9-30 years old on the day of vaccination (1. Girls of first year at junior high school are the first prioritized group; 2. Promote other age group of the target population for vaccine uptake. | |
| Vax | Bivalent (Domestic brand) | |
| Cost | 1. Free of charge (first-year girls in schools throughout the city); 2. Other women aged 9-30 years old can enjoy preferential prices (one-third of the market price) (the first in the province) | |
| Announced | Nov 2022 | |
| Implemented | 2023-2025 | |
| Link | Click to visit | |
| Qingdao City, Shandong Province | ||
| Region | East | |
| Policy | People’s livelihood projects (2023) | |
| Population | Citywide first-year girls aged ≤14 years in school with no history of HPV vaccination | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge (sector by sector) | |
| Announced | Jan 2023 | |
| Implemented | Sep 2023 onwards | |
| Link | Click to visit | |
| Handan city, Hebei Province | ||
| Region | Central | |
| Policy | People’s livelihood projects (2023) | |
| Population | Girls aged 14 (born between January 1, 2009 and December 31, 2009) with school or household registration in the city, with no history of HPV vaccination | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge | |
| Announced | Feb 2023 | |
| Implemented | Mar 2023 onwards | |
| Link | Click to visit | |
| Songyuan city, Jiling Province (other support) | ||
| Region | East | |
| Policy | Notice of the subsidy given by the Preventive Health Care Station of Qian Guo Town, Qian Guo County, Songyuan on the domestic bivalent HPV vaccination | |
| Population | Females aged 9-45 years old who are domiciled in this municipal jurisdiction | |
| Vax | Bivalent (Domestic brand) | |
| Cost | Flat-rate subsidies: 174RMB/person (first in the province) | |
| Announced | Dec2022 | |
| Implemented | Jan2023 onwards | |
| Link | Click to visit | |
| Wuqing District, Tianjing Metropolitan | ||
| Region | East | |
| Policy | Tianjin Wuqing District Healthy City Construction Promoting Healthy China Action Innovative Model Pilot Work Program” Wuqing Zheng [2023] No. 6 | |
| Population | Girls aged 9-14 with household or school registration in the district, with emphasis on promoting girls aged 13-14 (girls born between January 1, 2009 and December 31, 2010) | |
| Vax | Bivalent, quadrivalent, nine-valent | |
| Cost | 1. subsidy: 658RMB/Person; 2. Innovative model: “HPV integration clinic” at the Second People’s Hospital of the district (a medical and preventive integration clinic that integrates HPV vaccination, cervical cancer screening, diagnosis and treatment of cervical lesions, and popularization of science and technology) | |
| Announced | May 2023 | |
| Implemented | June 2023 onwards | |
| Link | Click to visit | |
| Taizhou City, Zhejiang Province | ||
| Region | East | |
| Policy | People’s livelihood projects (2023) | |
| Population | Girls with school registration in the city, newly entering the first year of junior high school from September 2022, aged 9 years old and under 15 years old at the time of the first dose of HPV vaccine, with no contraindications to vaccination and no history of HPV vaccination | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge (first in the province) | |
| Announced | Jun 2023 | |
| Implemented | Jun 2023 onwards | |
| Link | Click to visit | |
| Low health resource areas in China (other support) | ||
| Region | West | |
| Policy | The Department of Obstetrics and Gynecology of Peking Union Medical College (PUMC) Hospital led the major research project of the Central High-level Hospital Clinical Research Special Project and the demonstration project of elimination of cervical cancer in China’s low-health-resource areas (7 areas: Tongren City, Qinghai; Cooperative City, Gansu; Ordos City, Inner Mongolia; Naidong District, Shannan City, Tibet; Tori County, Xinjiang; Ganzi County, Sichuan; and Wuxiang County, Shanxi). | |
| Population | 90% of girls complete HPV vaccination by age 15 (Tongren City, Qinghai: girls aged 12-13 years) | |
| Vax | / | |
| Cost | No charge | |
| Announced | Feb 2023 | |
| Implemented | (Tongren City, Qinghai: March-June 2023) | |
| Link | Click to visit | |
| Yinchuan City, Ningxia Province (other support) | ||
| Region | West | |
| Policy | Yinchuan Women’s Federation, Yinchuan Municipal Health and Wellness Committee and Clove Garden launched “Every Woman Needs This Cancer Vaccine” Public Welfare Activity. | |
| Population | 2022: 300 girls aged 9-14 in the city; 2023: 500 girls aged 9-14 in the city | |
| Vax | Bivalent (Domestic brand) | |
| Cost | No charge (special items, flat rate) | |
| Announced | May 2022 | |
| Implemented | May 2022 onwards | |
| Link | Click to visit | |
| Zhejiang Province | ||
| Region | East | |
| Policy | Notice of the Human Resources and Social Security Department of Zhejiang Province and Other 4 Departments on Further Adjustment and Improvement of Policies Relating to Individual Accounts of Employees’ Basic Medical Insurance (Zherenshefa [2016] No. 62) | |
| Population | Women of working age enrolled in the Employee’s Health Insurance | |
| Vax | bivalent, quadrivalent, nine-valent | |
| Financing | Payment method: available for payment from the balance of the individual calendar year account of the health insurance policy | |
| Announced | June 2016 | |
| Implemented | Aug 2016 onwards | |
| Link | Link 1 Link 2 | |
| Shenzhen City, Guangdong Province | ||
| Region | East | |
| Policy | Measures of Shenzhen Municipality on Social Medical Insurance, Shenzhen People’s Society on the Issuance of the Catalog of Preventive Vaccination Biological Products Included in the Scope of Payment by Medical Insurance Individual Accounts (Revised in 2018) | |
| Population | Participants in the first class of the city’s basic medical insurance, the amount accumulated in the individual account exceeds 5% of the average salary of on-the-job workers in the previous year in the city, and the excess can be used to pay for the preventive vaccination expenses of the person himself/herself and his/her spouse and immediate family members who have participated in the city’s basic medical insurance. | |
| Vax | bivalent, quadrivalent | |
| Financing | Payment method: available for payment from individual health insurance accounts | |
| Announced | Mar 2018 | |
| Implemented | April 2018 onwards | |
| Link | Click to visit | |
| Guizhou Province | ||
| Region | West | |
| Policy | Opinions on Improving the Policy of Individual Accounts for Basic Medical Insurance for Urban Workers, Notice on Adjusting the Scope of Use of Individual Accounts for Medical Insurance for Employees of Institutions and Public Institutions in Construction in Guizhou Province, etc. | |
| Population | Women of working age enrolled in the Employee’s Health Insurance | |
| Vax | bivalent, quadrivalent, nine-valent | |
| Financing | Payment method: available for payment from individual health insurance accounts | |
| Announced | April 2018 | |
| Implemented | April 2018 onwards | |
| Link | Click to visit | |
| Nanjing city, Jiangsu Province | ||
| Region | East | |
| Policy | Notice on the Adjustment of the Scope of Work Related to the Use of Individual Accounts for Employee Medical Insurance (Ningxia Medical Development [2021] No. 17) | |
| Population | Women of working age enrolled in the Employee’s Health Insurance | |
| Vax | bivalent, quadrivalent | |
| Financing | Payment method: available for payment from individual health insurance accounts | |
| Announced | Mar 2021 | |
| Implemented | Mar2021 onwards | |
| Link | Click to visit | |
| Suzhou City of Jiangsu Province | ||
| Region | East | |
| Policy | Article 8 of the Rules for Implementing the Outpatient Co-payment Guarantee Mechanism of Basic Medical Insurance for Suzhou Employees (for Trial Implementation) | |
| Population | Women of working age enrolled in the Employees’ Health Insurance Scheme | |
| Vax | bivalent, quadrivalent | |
| Financing | Payment method: available for payment from individual health insurance accounts | |
| Announced | Jan 2023 | |
| Implemented | Jan 2023 onwards | |
| Link | Click to visit | |
Case studies
1) Ordos City
Background
Ordos’ GDP in 2022 was 561.3 billion CNY, ranking 45th among prefecture-level cities in China. In 2021, Ordos introduced a series of policies, including the Innovative Working Proposal to Promote Healthy Ordos Action Plan for the Healthy City Construction Initiative, to implement HPV vaccination for the target school girls.
Policy Impact
In August 2020, Ordos launched a free HPV vaccination program. Jungar Banner became the first region in China to offer free HPV vaccines. The target population is school girls aged 13-18 with no history of HPV vaccination. The immunization program used imported bivalent HPV vaccine (Cervarix) and applied a 3-dose schedule (0,1,6 month). The vaccine expense was covered by the government, and the beneficiaries only paid the vaccination service fee (20 CNY per dose) with out-of-pocket payment. Usually, the vaccination service centers contact the local school to inform the on-site vaccination arrangement, and they inform the eligible school girls to come to take the vaccine. By November 2022, nearly 70% of the target population had received the first dose of the HPV vaccine. The successful implementation of the free HPV vaccination program in Jungar Banner, Ordos, is a model for other regions.
In August 2022, a catch-up program was launched to vaccinate girls of the third grade in senior high schools in Jungar Banner and Dalad Banner with quadrivalent and nine-valent HPV vaccines. The program takes summer vacation to implement the vaccination, aiming to achieve a vaccination rate of 90% by the end of 2023. Following the pilot launch in Ordos, the government-led HPV vaccination programs emerge in many other cities. Multiple stakeholders, including charities, hospitals, and women’s unions, have also actively supported the HPV vaccination campaign and other related initiatives in recent years.
Advocacy
Ordos City employs a comprehensive approach to health education, utilizing various formats such as lectures, health awareness days, free clinic consultations, courses, etc. The health education content is delivered through different communication channels, including brochures, bulletin boards, posters, TV, WeChat, and TikTok. The target audiences are schoolgirls and their caregivers, women of eligible age to take the HPV vaccine, and the general public. The health education content covers information about the HPV vaccine, the prevention and control of cervical and breast cancers, and other prevalent female diseases.
(2) Chengdu City
Background
In the fiscal year 2022, Chengdu’s GDP reached 20,81.75 billion CNY, ranking 7th among all municipal cities nationwide. Chengdu has issued a series of policies to promote HPV vaccination for girls, including the Pilot Program for Comprehensive Cervical Cancer Prevention and Control in Chengdu City, an Innovative Model for Promoting Healthy City Construction and Healthy China Action.
Policy Impact
The target population is schoolgirls aged 13-14 with no history of HPV vaccination. The immunization program offers three types of HPV vaccines – domestic-manufactured bivalent HPV vaccine (0, 6 month), imported bivalent HPV vaccine (0, 1, 6 month), and imported quadrivalent HPV vaccine (0, 2, 6 month). The domestic bivalent vaccine is free, and the other vaccines receive a subsidy of 600 yuan per person, with out-of-pocket payment for the 20 CNY vaccination service fee per dose. Vaccination work is assigned to the vaccination clinics located in the same administrative areas as the target schools. By January 2022, the vaccination rate of the first dose among the target population had reached 90.04% [3].
Advocacy
A comprehensive health education campaign was conducted in Chengdu via lectures, health awareness days, free clinic consultations, courses, and activities, leveraging diverse platforms such as brochures, bulletin boards, posters, TV, WeChat, and TikTok. The campaign covered over 300 medical institutions and 300 communities and took place in around 90 public spaces.
The target audiences are school girls and their caregivers, women of the eligible age for HPV vaccination, and the general public. Nearly 90,000 individuals receive promotional materials, while lecture activities engage almost 20,000 participants. The campaign content covered information about HPV vaccination, the prevention and management of cervical and breast cancers, and the prevention of other common female diseases.
(3) Jinan City
Background
In 2022, Jinan recorded a GDP of 1,202.75 billion CNY, ranking 20th in China. In 2021, the Jinan government introduced new policies to promote HPV vaccination for school-age girls under the framework of Healthy City Construction to Promote the Pilot of Innovative Models of Healthy China Actions—The Comprehensive Program for Cervical Cancer Prevention and Control (2021-2025).
Policy Impact
The target population is seventh-grade girls ≤14 years old with no history of HPV vaccination. The immunization program is administered on a 2-dose schedule using the domestic bivalent vaccine. Vaccination is provided free of charge. The vaccination process is locally managed, with scheduled classes visiting the vaccination clinics at their school premises during allocated time slots. As of November 2022, the vaccination rate of the first dose among the target population has reached 94.4% [4].
Advocacy
Jinan conducts an integrated health education campaign, including interviews and online and offline thematic activities, using channels such as online new media, print media, posters, brochures, cervical cancer and HPV vaccine leaflets, and the Jinan HPV vaccination manual. Health education targets the general public and covers information about HPV vaccination and the prevention and control of cervical and breast cancers.
(4) Xi’an
Background
In the fiscal year 2022, Xi’an’s GDP reached 114,8.65 billion CNY, ranking 22nd in the country. In 2021, Xi’an introduced a series of policies to promote HPV vaccination for school girls under the Xi’an Healthy City Construction to Promote Healthy China Action Innovative Model – The Pilot Program of a Comprehensive Cervical Cancer Prevention and Control.
Policy Details
The target population is 13-year-old girls in junior high school. The immunization program is administered in a 2-dose schedule using the domestic bivalent vaccine (0,6 month), 3-dose schedule for the imported bivalent HPV vaccine (0,1,6 month), and 3-dose schedule for the quadrivalent (0,2,6 month) and nine-valent (0, 2, 6 month) imported HPV vaccines. Vaccination is voluntary and self-funded. Each district (county) sets up specialized HPV vaccine clinics to provide the vaccination service. Vaccination data is promptly recorded in the child immunization program information system.
Advocacy
Xi’an has issued the Xi’an Comprehensive Cervical Cancer Prevention and Control Advocacy Program (Municipal Health Office [2022] No. 12). Knowledge related to cervical cancer prevention and treatment is disseminated through media coverage, community activities, free clinic consultation, using brochures, bulletin boards, posters, TV, WeChat, and newspapers.
(5) Xizang (Tibet) Autonomous Region
Background
In 2022, the GDP of the Xizang Autonomous Region was 213.264 billion CNY, which was lower compared with other provinces. The per capita GDP of Xizang was at the lower middle level nationwide. In 2022, a series of policies were introduced under the Implementation Program of Comprehensive Prevention and Control of Breast and Cervical Cancers Among Women Living in the Xizang Autonomous Region, which promoted the HPV vaccination for school girls.
Policy Details
The target population group is schoolgirls aged 13-14. The immunization program is administered with a 2-dose schedule (0,6 month) using the domestic bivalent HPV vaccine. The vaccination is offered free of charge. The schools are responsible for organizing eligible girls and their caregivers to visit the vaccination clinics at the scheduled time.
Advocacy
The government initiated a health education campaign through online, broadcast, and print media, advocating the importance and health benefits of HPV vaccination among school girls.
(6) Xiamen City
Background
Xiamen’s GDP in 2022 was 780.27 billion CNY, ranking 31st among municipal cities in China. In 2020, the Xiamen Municipal Health Commission issued a Notice on the Implementation Plan for Domestic Bivalent HPV Vaccination in Xiamen to promote HPV vaccination for school-age girls.
Policy Impact
The target population is schoolgirls aged 13 to 14 with no history of HPV vaccination. The immunization program is administered by a 2-dose schedule (0, 6 month) using domestic bivalent HPV vaccine. Both the vaccines and the vaccination fee are covered by government revenue funding. The vaccination is administered in clinics in the beneficiaries’ residential areas by an appointment-based process. As of August 11, 2021, approximately 30,000 doses of domestically produced bivalent HPV vaccine have been administered free of charge to eligible girls in Xiamen.
Advocacy
The government initiated a health education campaign through online, broadcast, and print media. They also filmed a promotion video and used the government website to advocate the importance and health benefits of HPV vaccination among school girls.
Lessons Learned
The government-led, multi-sectoral coordination and social mobilization model adopted in China’s local pilot program is replicable. The model reduces vaccine costs through collective government purchasing, improving the vaccine’s accessibility and affordability. It also enhances the willingness to vaccinate, increasing the vaccination rates. The school-based approach to program implementation can efficiently identify target populations and boost students’ and their caregivers’ vaccination willingness through HPV vaccine-related health education. Vaccinations are administered by local disease prevention and control centers and public hospitals. Training to healthcare workers on precautions, potential adverse reactions, and corresponding response measures can effectively promote the safety and efficiency of the vaccination process. The following information has summarized the lessons learned based on the local pilot projects:
First, invite experts to provide guidance for the thorough program development. Before project implementation, a locally tailored project program and vaccination plan were formulated under experts’ guidance on cervical cancer prevention and control. Details included specifying the target population, vaccine types, vaccination process, payment methods, etc. To maximize the coverage of the HPV vaccine, the programs should consider the features of students from different grades. Experts’ on-site support is also valuable for the program implementation.
Secondly, use digital tools to collect information on the public’s vaccination willingness to provide evidence for the program development, including the vaccination strategies, advocacy campaign, and the distribution of vaccines. For example, Jinan City has developed the “Healthy Jinan” WeChat Mini Program for HPV vaccination registration. Parents fill out the registration, which school teachers then review and confirm. The practice provides timely and accurate information to facilitate the program implementation. Similarly, Gaoping City in Jincheng has developed a mobile APP, enabling citizens to make online appointments for vaccination.
Third, clarify each government department and stakeholder’s responsibilities. The Prefectural or Municipal Health Commission teams lead the multi-sectoral collaboration involving local disease prevention and control units, hospitals, and education departments. The work includes program promotion, vaccine procurement and distribution, workforce training, setting up a post-vaccination monitoring system, developing an emergency response plan for vaccine safety incidents, monitoring and investigating AED cases, and evaluating vaccine effectiveness.
Fourth, enhance vaccine advocacy to break down information barriers and combat misinformation. By utilizing online and offline channels to disseminate HPV vaccine-related information and knowledge, advocators can raise the public’s awareness about vaccination. The advocacy campaign can also leverage the influence of leading media and use a school-based approach to combat misinformation by addressing the FAQ about the HPV vaccine, which reduces vaccine hesitancy and facilitates the target population to complete the vaccination as early as possible.
Fifth, explore and adopt innovative service models. For example, Chengdu has established weekend and holiday vaccination centers to provide convenience for student vaccination. In some regions, disseminating vaccination knowledge among people of all ages has applied a “small hands pulling big hands” strategy, meaning children receiving health education at school can share the knowledge with their parents. Wuxi Maternal and Child Health Hospital launched an HPV vaccination consultation clinic, where healthcare professionals offer vaccination and cervical cancer prevention guidance. In the Yinzhou District of Ningbo, HPV vaccination strategies target the eligible population in pairs – mothers and daughters and female students and teachers. Mothers are eligible for priority appointments on the same day when their daughters receive HPV vaccination. Female teachers can enjoy priority vaccination without an appointment during Teachers’ Day.
Sixth, enhance the vaccine price negotiation and collective procurement mechanisms and innovate vaccine financing policies. Price is an important barrier to increasing vaccination rates, with remote regions being particularly sensitive to vaccine prices. Adopting a centralized vaccination strategy for the target population and implementing a competitive procurement mechanism can bring out the synergy between competitive procurement and accurate demand and funding allocation. Recently, Guangdong, Jiangsu, Fujian, and Hainan have successively negotiated with vaccine manufacturers in government procurement for livelihood projects, gaining lower purchasing prices for HPV vaccines through a sizeable market, which promotes the efficient use of government revenue and boosts vaccine coverage [6].
Seventh, leverage the influence of local government, academia, and media to enhance the program’s impact. Continuing to identify issues and optimize the program implementation will offer best practices and lessons learned for other cities and regions to introduce HPV vaccination into their local immunization programs.
Content Reviewer: Kelly Hunter, Tianyi Deng, Zhangyang Pan
Page Editor: Jiaqi Zu
References:
- China Family News. Healthy China Initiative | Healthy City Construction Promotes Healthy China Initiative Innovative Model Pilot Work Launched in Jinan, Shandong Province.
- “Rose Action” contributes to adolescent girls’ health education. https://www.cwdf.org.cn/index.php?m=content&c=index&a=show&catid=26&id=4913
- http://wjw.nmg.gov.cn/ztlm/dqzt/jknmgxd/jknmgxd_gzdt/202212/t20221209_2185887.html
- http://m.people.cn/n4/2022/0129/c3770-15420539.html
- https://mp.weixin.qq.com/s/exgUWbzubGcBVj1iR1JrCA
- The national immunization program still needs to be further expanded, how to crack the “bid but not procure” for non-NIP vaccines at the provincial level? https://www.21jingji.com/article/20240430/herald/cadc8f6defbe16e11298794e7387d2a3.html
