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Local Pilots of HPV Vaccination in China

Local Pilots of HPV Vaccination in China

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
RegionEast
PolicyWork Program for Free Human Papilloma Virus (HPV) Vaccination for Girls of School Age in Guangdong Province (2022-2024)
PopulationGirls 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
VaxBivalent (Domestic Brand)
CostNo charge
AnnouncedNov 2021
Implemented2022-2024
LinkClick to visit
Xizang (Tibet) Autonomous Region
RegionWest
PolicyPeople’s livelihood projects (2022, 2023)
PopulationFemale students aged 13-14 years in school with local household registration and no history of HPV vaccination
VaxBivalent (Domestic Brand)
CostNo charge
AnnouncedJan 2022
Implemented2022 onwards
LinkClick to visit
Hainan Province
RegionEast
PolicyImplementation 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)
Population2022: 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
VaxBivalent (Domestic Brand)
CostNo charge
AnnouncedFeb 2022
ImplementedMar 2022 onwards
LinkClick to visit
Fujian Province
RegionEast
PolicyWork Plan of the Provincial Party Committee and Provincial Government for the People (2022, 2023)
PopulationGirls with school or household registration in the province, aged 13 to 14 ½ years old, with no history of HPV vaccination
VaxBivalent (Domestic Brand)
CostNo charge
AnnouncedFeb 2022
ImplementedMay 2022 onwards
LinkLink 1
Link 2
Chongqing Metropolitan
RegionWest
PolicyImplementation Program of HPV Vaccination for Female Students of School Age in Chongqing Municipality (Yu Wei Fa [2022] No. 48)
PopulationGirls in the second year of junior high school in the city
VaxBialent, quadrivalent
CostFlat-rate subsidy: up to $600 per person ($300 per dose for 2 doses; $200 per dose for 3 doses)
AnnouncedDec 2022
Implemented2023 onwards
LinkClick to visit
Jiangxi Province
RegionCentral
PolicyAction to Accelerate the Elimination of Cervical Cancer in Jiangxi Province and HPV Vaccination for Girls of School Age: Livelihood Practices
PopulationGirls 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.
VaxBivalent (Domestic Brand)
CostNo charge
AnnouncedFeb 2023
ImplementedAug 2023 onwards
LinkClick to visit
Jiangsu Province
RegionEast
PolicyCircular on the Provincial Government’s 55 Livelihood Matters in 13 Categories for the Year 2023
PopulationFirst-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
VaxBivalent (Domestic Brand)
CostFree of charge (pre-pilot in Wuxi, a district in Lianyungang, and two districts in Nanjing and Yangzhou, respectively)
AnnouncedMar 2023
ImplementedMar 2023 onwards
LinkClick to visit
Ordos, Inner Mongolia
RegionWest
PolicyImplementation 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
PopulationFemale students aged 13-18 years old with no history of HPV vaccination who are household members in the cityGirls from the third grade of senior high school in Jungar and Dalat Banners, Ordos City
VaxBivalentQuadrivalent, Nine-valent
CostNo charge (first in the country, piloted in Junggar Banner)No charge (Piloted in Jungar and Dalad banners)
AnnouncedDec 2020Aug 2022
ImplementedDec 2020 onwardsAug 2022 onwards
LinkClick to visit
Jinan city, Shandong Province
RegionEast
PolicyPilot work on comprehensive prevention and treatment of cervical cancer in the city and livelihood projects (2022)
PopulationGirls 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
VaxBivalent (Domestic brand)
CostNo charge
AnnouncedOct 2021
ImplementedNov2021 onwards
LinkClick to visit
Chengdu city of Sichuan Province
RegionWest
PolicyImplementation Plan for HPV Vaccination for Comprehensive Prevention and Control of Cervical Cancer in Chengdu City (2021 Edition)
PopulationGirls aged 13-14 years old in schools throughout the city
VaxBialent, Quadrivalent
CostSubsidy:600RMB/person(first in the country)
AnnouncedNov 2021
Implemented2021-2025
LinkClick to visit
Wuxi City, Jiangsu Province
RegionEast
PolicyImplementation Plan for Mass Immunization of HPV Vaccine for School-Age Girls in Wuxi City
PopulationSecond year girls (age <15) in the 6 municipalities of the city who are permanent residents.
VaxBivalent (Domestic brand)
CostNo charge (first in the province)
AnnouncedNov2021
ImplementedDec 2021-Dec 2022
LinkClick to visit
Shijiazhuang City, Hebei Province
RegionCentral
PolicyPeople’s livelihood projects (2022, 2023)
PopulationGirls aged 14 years with school or household registration in the city, with no history of HPV vaccination
VaxBivalent (Domestic brand)
CostNo charge (first in the province)
AnnouncedJanuary 2022
ImplementedFrom March 2023
LinkClick to visit
Tangshan city, Heibei Province
RegionCentral
PolicyPeople’s livelihood projects (2022, 2023)
PopulationGirls 14 years old in school in the city with no history of HPV vaccination
VaxBivalent (Domestic brand)
CostNo charge
AnnouncedJan 2022
ImplementedApril 2022 onwards
LinkClick to visit
Nanjing City, Jiangsu Province
RegionEast
PolicyImplementation Plan of the Free Vaccination Program for School-Age Girls in Nanjing, People’s Livelihood Project (2022, 2023)
PopulationFirst-year girls in the city
Vaxbivalent, quadrivalent, nine-valent (nine-valent newly included in 2023)
Cost1. No charge for domestic brand; 2. Subsidies: 492RMB/person for imported vaccine (the first in the province)
AnnouncedApril 2022
ImplementedApril 2022 onwards
LinkClick to visit
Yantai City, Shandong Province
RegionEast
PolicyImplementation Plan of the Free HPV Vaccination Program for Girls of School Age in Yantai City
PopulationCitywide junior girls in school ≤14 years of age with no history of HPV vaccination
VaxBivalent (Domestic brand)
CostNo charge
AnnouncedOct 2022
ImplementedNovember 2022 onwards
LinkClick to visit
Yuxi City, Yunnan Province
RegionWest
PolicyYuxi Bivalent Human Papillomavirus (HPV2) Vaccine “Health Beneficiary Project” Three-Year Action Program (2023-2025)” Yuzhengbanfa [2022] No. 38
PopulationWith 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.
VaxBivalent (Domestic brand)
Cost1. 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)
AnnouncedNov 2022
Implemented2023-2025
LinkClick to visit
Qingdao City, Shandong Province
RegionEast
PolicyPeople’s livelihood projects (2023)
PopulationCitywide first-year girls aged ≤14 years in school with no history of HPV vaccination
VaxBivalent (Domestic brand)
CostNo charge (sector by sector)
AnnouncedJan 2023
ImplementedSep 2023 onwards
LinkClick to visit
Handan city, Hebei Province
RegionCentral
PolicyPeople’s livelihood projects (2023)
PopulationGirls 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
VaxBivalent (Domestic brand)
CostNo charge
AnnouncedFeb 2023
ImplementedMar 2023 onwards
LinkClick to visit
Songyuan city, Jiling Province (other support)
RegionEast
PolicyNotice of the subsidy given by the Preventive Health Care Station of Qian Guo Town, Qian Guo County, Songyuan on the domestic bivalent HPV vaccination
PopulationFemales aged 9-45 years old who are domiciled in this municipal jurisdiction
VaxBivalent (Domestic brand)
CostFlat-rate subsidies: 174RMB/person (first in the province)
AnnouncedDec2022
ImplementedJan2023 onwards
LinkClick to visit
Wuqing District, Tianjing Metropolitan
RegionEast
PolicyTianjin Wuqing District Healthy City Construction Promoting Healthy China Action Innovative Model Pilot Work Program” Wuqing Zheng [2023] No. 6
PopulationGirls 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)
VaxBivalent, quadrivalent, nine-valent
Cost1. 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)
AnnouncedMay 2023
ImplementedJune 2023 onwards
LinkClick to visit
Taizhou City, Zhejiang Province
RegionEast
PolicyPeople’s livelihood projects (2023)
PopulationGirls 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
VaxBivalent (Domestic brand)
CostNo charge (first in the province)
AnnouncedJun 2023
ImplementedJun 2023 onwards
LinkClick to visit
Low health resource areas in China (other support)
RegionWest
PolicyThe 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).
Population90% of girls complete HPV vaccination by age 15 (Tongren City, Qinghai: girls aged 12-13 years)
Vax/
CostNo charge
AnnouncedFeb 2023
Implemented(Tongren City, Qinghai: March-June 2023)
LinkClick to visit
Yinchuan City, Ningxia Province (other support)
RegionWest
PolicyYinchuan Women’s Federation, Yinchuan Municipal Health and Wellness Committee and Clove Garden launched “Every Woman Needs This Cancer Vaccine” Public Welfare Activity.
Population2022: 300 girls aged 9-14 in the city; 2023: 500 girls aged 9-14 in the city
VaxBivalent (Domestic brand)
CostNo charge (special items, flat rate)
AnnouncedMay 2022
ImplementedMay 2022 onwards
LinkClick to visit
Zhejiang Province
RegionEast
PolicyNotice 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)
PopulationWomen of working age enrolled in the Employee’s Health Insurance
Vaxbivalent, quadrivalent, nine-valent
FinancingPayment method: available for payment from the balance of the individual calendar year account of the health insurance policy
AnnouncedJune 2016
ImplementedAug 2016 onwards
LinkLink 1
Link 2
Shenzhen City, Guangdong Province
RegionEast
PolicyMeasures 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)
PopulationParticipants 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.
Vaxbivalent, quadrivalent
FinancingPayment method: available for payment from individual health insurance accounts
AnnouncedMar 2018
ImplementedApril 2018 onwards
LinkClick to visit
Guizhou Province
RegionWest
PolicyOpinions 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.
PopulationWomen of working age enrolled in the Employee’s Health Insurance
Vaxbivalent, quadrivalent, nine-valent
FinancingPayment method: available for payment from individual health insurance accounts
AnnouncedApril 2018
ImplementedApril 2018 onwards
LinkClick to visit
Nanjing city, Jiangsu Province
RegionEast
PolicyNotice 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)
PopulationWomen of working age enrolled in the Employee’s Health Insurance
Vaxbivalent, quadrivalent
FinancingPayment method: available for payment from individual health insurance accounts
AnnouncedMar 2021
ImplementedMar2021 onwards
LinkClick to visit
Suzhou City of Jiangsu Province
RegionEast
PolicyArticle 8 of the Rules for Implementing the Outpatient Co-payment Guarantee Mechanism of Basic Medical Insurance for Suzhou Employees (for Trial Implementation)
PopulationWomen of working age enrolled in the Employees’ Health Insurance Scheme
Vaxbivalent, quadrivalent
FinancingPayment method: available for payment from individual health insurance accounts
AnnouncedJan 2023
ImplementedJan 2023 onwards
LinkClick 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 ActionsThe 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:

  1. China Family News. Healthy China Initiative | Healthy City Construction Promotes Healthy China Initiative Innovative Model Pilot Work Launched in Jinan, Shandong Province.
  2. “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
  3. http://wjw.nmg.gov.cn/ztlm/dqzt/jknmgxd/jknmgxd_gzdt/202212/t20221209_2185887.html
  4. http://m.people.cn/n4/2022/0129/c3770-15420539.html
  5. https://mp.weixin.qq.com/s/exgUWbzubGcBVj1iR1JrCA
  6. 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

代表性地区的基本情况、接种政策及效果、宣传推动情况

(1) 成都市

 

基本情况

成都市2022年度GDP为20817.5亿元,排名全国城市第七。成都市出台了《健康城市建设推动健康中国行动创新模式成都市宫颈癌综合防控试点工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为13-14岁在校且无HPV疫苗接种史女生。免疫程序为国产二价0-6二剂次、进口二价0-1-6三剂次、进口四价0-2-6三剂次。资助政策为国产二价疫苗(沃泽惠)免费,其它疫苗补贴600元/人,并自付20元/剂接种费。疫苗接种按照属地化管理原则,由学校所在地预防接种单位负责。截至2022年1月,目标人群首针接种率达90.04%[14]。

宣传推动

成都市开展多形式、多载体的健康教育宣传。形式包括讲座、知晓日、义诊咨询、专题课程、专题活动等,载体包括宣传册、宣传栏、展板、电视、微信、视频号、抖音平台等,覆盖相关医疗机构300余、社区300余个、和公众场所90余个。面向适龄女孩及监护人、适龄女性及全体市民开展广泛宣教,宣传材料发放至近9万名群众,讲座活动覆盖近2万名群众。宣教内容包括HPV疫苗接种、两癌防控、其它女性常见疾病防控等。

(2) 济南市

 

基本情况

济南市2022年度GDP为12027.5亿元,位列全国城市排名20。2021年,济南市出台《健康城市建设推动健康中国行动创新模式试点一济南市宫颈癌综合防治工作方案(2021—2025年)》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为≤14周岁且无HPV疫苗接种史的在校七年级女生。免疫程序为国产二价0-6二剂次。资助政策免费接种。疫苗接种按照属地化管理原则,安排分班级分时段前往学校所在地的预防接种单位进行接种。截至2022年11月,目标人群首针接种率达
94.4%[15].

宣传推动

济南市开展多形式、多载体的健康教育宣传。形式包括采访、线上线下专题活动,载体包括网络媒体、纸媒、科普展板、宣传手册、子宫颈癌与HPV疫苗知识读本、济南HPV疫苗接种手册,宣教人群广泛涵盖全体市民,宣教内容包括HPV疫苗接种、两癌防控等知识。

(3) 鄂尔多斯市

 

基本情况

鄂尔多斯市2022年度GDP为5613.44亿元,全国地级市第45位。2021年,鄂尔多斯市出台了《健康城市建设推动健康鄂尔多斯行动创新模式工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

2020年8月,鄂尔多斯市在准格尔旗率先开展HPV疫苗免费接种项目。目标人群为全市当年13-18岁在校且无HPV疫苗接种史女生。免疫程序为进口二价0-1-6三剂次,

2023年起调整为13-14岁女孩0-6二剂次。资助政策为疫苗免费,自付20元/剂接种费。组织方式为疫苗接种服务中心根据任务安排联系学校,有规划的通知适龄女孩前来完成HPV疫苗接种。截至2022年11月,目标人群首针接种率接近70%[16]。

2022年8月,启动准格尔旗和达拉特旗高三女生接种四价和九价HPV疫苗的试点工作,利用暑假时间展开接种,力争在2023年年底达成90%的接种目标[17]。自鄂尔多斯之后,由政府主导的HPV疫苗惠民行动在多地等涌现。值得注意的是,近年来多主体参与到HPV疫苗支持项目,如慈善总会、医院、妇联等为主体单位牵头组织开展了一些公益活动。

宣传推动

鄂尔多斯市开展多形式、多载体的健康教育宣传。形式包括讲座、知晓日、义诊咨询、专题课程、专题活动等,载体包括宣传册、宣传栏、展板、电视、微信、视频号、抖音平台等,宣教人群广泛涵盖在校女孩及监护人,适龄女性及全体市民。宣教内容包括HPV疫苗接种、两癌防控、其它女性常见疾病防控等。

(4) 西安市

 

基本情况

西安市2022年度GDP为11486.51亿元,排名全国第22位。2021年,西安市出台了《西安市健康城市建设推动健康中国行动创新模式试点宫颈癌综合防治工作方案》等一系列相关政策推动适龄女孩HPV疫苗接种工作。

接种政策及效果

目标人群为全市年龄满13周岁(初中)在校女生。免疫程序为国产二价0-6二剂次,进口二价0-1-6三剂次,进口四价和进口九价0-2-6三剂次。接种政策为自愿自费。各区(县)合理设立HPV疫苗专项疫苗接种门诊承担接种任务,并及时将接种信息统一录入儿童免疫规划信息平台。

宣传推动

西安市出台了《西安市宫颈癌综合防治宣传方案》(市健办发〔2022〕12号)。通过媒体宣传、社区活动、义诊等形式,宣传册、宣传栏、展板、电视、微信公众号、报纸等载体普及宫颈癌防治相关知识。

(5) 西藏自治区

 

基本情况

西藏自治区2022年度GDP为2132.64亿元,经济总量整体规模相对其他省份较小,人均GDP处于全国中等偏下水平。2022年出台《西藏自治区妇女“两癌”综合防治工作实施方案》等系列政策推动适龄女孩HPV疫苗接种。

接种政策及效果

目标人群为13-14岁在校女生。免疫程序为国产二价0-6二剂次。资助政策为免费。由学校组织,接种者在商定接种时间携带个人身份证明材料与法定监护人一同前往定点接种单位接种。

宣传推动

充分利用网络、电视、广播、报刊等媒介,以群众喜闻乐见的宣传方式,对适龄在校女生HPV疫苗接种工作的意义及内容进行广泛宣传。

近年来各地HPV疫苗惠民项目信息

“疾病负担”指标解读

疾病负担(burden of disease, BOD)是指疾病造成的失能(伤残)、生活质量下降和过早死亡对健康和社会造成的总损失,包括疾病的流行病学负担和经济负担两个方面。

 

在疾病的流行病学方面,衡量疾病负担的常用指标包括传统指标和综合指标。

 

传统指标

传统疾病负担的衡量指标包括:用于描述和反映健康状况与水平的常规指标,如死亡人数、伤残人数和患病人数等绝对数指标;以及用来比较不同特征人群疾病分布差异的指标,如发病率、伤残率、患病率、死亡率、门诊和住院率等相对数指标。

 

上述传统疾病负担的衡量指标基本上只考虑了人口的生存数量,而忽略了生存质量,不够全面;但优势在于资料相对计算方便,结果直观,可用于各种疾病的一般性描述。

 

综合指标

疾病负担不等同于死亡人数,综合指标弥补了传统指标的单一性,且可以让各种不同疾病造成的负担之间相互比较。

 

潜在寿命损失年(YPLL):通过疾病造成的寿命损失来估计疾病负担的大小。但忽略了疾病造成的失能对生存质量的影响。

 

伤残调整寿命年(DALYs):将死亡和失能相结合,用一个指标来描述疾病的这两方面的负担。它包括因早死造成健康生命年的损失(YLL)和因伤残造成健康生命年的损失(YLD),即DALY=YLL+YLD。目前,DALY是国内外一致公认的最具代表性、运用最多的疾病负担评价指标。

 

健康期望寿命(HALE):指具有良好健康状态的生命年以及个体在比较舒适的状态下生活的平均预期时间,综合考虑生命的质量和数量两方面。

 

 

随着疾病负担研究的深入,其测量范围从流行病学负担扩大到经济负担。

 

疾病经济负担是由于发病、伤残(失能)和过早死亡给患者本人、家庭以及社会带来的经济损失,和由于预防治疗疾病所消耗的经济资源。

详细见:疾病的“经济负担”怎么计算?

 

参考资料:

陈文. 卫生经济学 [M]. 人民卫生出版社. 2017.

李茜瑶,周莹,黄辉等.疾病负担研究进展[J].中国公共卫生,2018,34(05):777-780.

什么是“年龄标化”?

在流行病学研究中,年龄是多种疾病的危险因素。以发病率为例,该指标反映了一定时期内,特定人群中癌症新发病例的情况。由于年龄是癌症发生的一个重要影响因素,年龄越大,发病率就越高。

 

如果两个国家的人群年龄结构相差很大,例如A市老年人口比例更大,B市年轻人口占比更高,直接比较两地癌症发病率的高低,我们不能确定发病率较高的市,是因为年龄构成不同还是因为其他影响因素(如饮食习惯、环境等)所导致。因此,需要用“年龄标化”的统计学方法,进一步处理数据,排除年龄影响因素的干扰,再来比较两地的发病率数据。

 

以发病率为例,即把原始数据套到一个“标准年龄结构人群里”,计算出”年龄标化发病率“,这样人群结构不同的A市和B市,就能在同一个指标尺度下进行“发病率”比较。年龄标化通常有“中标率”,即我国各地基于某一年份的中国人口年龄结构构成作为标准计算,国内不同地区的疾病数据比较采用的是“中标率”;另一种是“世标率”,即用世界标准人口构成机型标化计算,适用于国与国之间的指标比较。

 

同样地,以死亡率为例,应特别注意各之间地人口构成的差异。用标准化死亡率进行比较才能得出正确结论。如甲、乙两地在未标化前的肺癌死亡率相同,但实际上乙地人群的肺癌死亡率要明显地高于甲地,其原因在于甲地男性老年人口居多,而肺癌的死亡率又与年龄和性别有关,所以用未标化率进行比较时,就会得出甲乙两地肺癌死亡率相同的错误结论。

 

参考资料:

 

张科宏教授:年龄标化的患病率 – 丁香公开课 (dxy.cn)

科学网—癌症(粗)发病率与标化发病率的区别 – 杨雷的博文 (sciencenet.cn)

WHO年龄标化死亡率定义及计算方法

沈洪兵,齐秀英. 流行病学 [M]. 人民卫生出版社. 2015.

疾病的“经济负担”怎么计算?

疾病经济负担是由于发病、伤残(失能)和过早死亡给患者本人、家庭以及社会带来的经济损失,和由于预防治疗疾病的费用。通过计算疾病的经济负担,可以从经济层面上研究或比较不同疾病对人群健康的影响。

总疾病经济负担包括直接疾病经济负担、间接疾病经济负担和无形疾病经济负担。

直接经济负担:指直接用于预防和治疗疾病的总费用,包括直接医疗经济负担和直接非医疗经济负担两部分。直接医疗经济负担是指在医药保健部门购买卫生服务的花费,主要包括门诊费(如挂号费、检查费、处置费、诊断费、急救费等)、住院费(如手术费、治疗费等)和药费等。直接非医疗经济负担包括和疾病有关的营养费、交通费、住宿费、膳食费、陪护费和财产损失等。

间接经济负担:指由于发病、伤残(失能)和过早死亡给患者本人和社会带来的有效劳动力损失而导致的经济损失。具体包括:劳动工作时间损失、个人工作能力和效率降低造成的损失、陪护病人时损失的劳动工作时间、精神损失等。

无形经济负担:指患者及亲友因疾病在心理、精神和生活上遭受的痛苦、悲哀、不便等生活质量下降而产生的无形损失。

 

参考资料:

陈文. 卫生经济学 [M]. 人民卫生出版社. 2017.

李茜瑶,周莹,黄辉等.疾病负担研究进展[J].中国公共卫生,2018,34(05):777-780.