Purchase price of vaccines
The 2021 data showed that the market price per dose of HPV vaccine ranged from $4.5 USD to $96.32 USD, with general stability or a slight decrease observed over the past few years [1]. Data from 2020 indicates a gradual correlation between the price per dose, the procurement method, and country income levels. UNICEF/Gavi and the World Health Organization-Pan American Health Organization (WHO-PAHO) have the lowest median procurement prices at US$4.55 and US$9.58, respectively. The median price per dose was approximately $11.66 in low- and middle-income countries (LMICs), $15.73 in upper-middle-income countries, and $42.10 in high-income countries [2]. There is an overlap in the prices paid by middle-income countries/regions and some high-income countries, suggesting room for improvement in promoting a price gradient strategy for vaccine pricing.
Merck and GlaxoSmithKline have offered time-limited price commitments under specific conditions for selected countries that are no longer eligible for Gavi-related vaccine funding. However, for middle-income countries, the affordability of HPV vaccines remains a significant factor influencing their inclusion in immunization programs. Currently, vaccine prices in China exceed the median value of HPV vaccines in high- and middle-income countries. Figure 1 illustrates the comparison of vaccine price in different economic income countries and organizations with the prices of the four HPV vaccines available in China.
Figure 1. HPV Vaccine Prices in Different Countries and Procurement Methods Compared to Existing Vaccine Prices in China
Vaccine financing modalities
According to WHO and UNICEF’s monitoring data of HPV vaccination and coverage worldwide, as of November 2023, 140 (72%) of the 194 World Health Organization member countries have introduced HPV vaccines in their national immunization programs [3].
The Gavi Alliance categorizes vaccine financing sources into four types: domestic public funding (e.g., government health financing, social health insurance), domestic private funding (e.g., private health insurance, individual out-of-pocket payments), external public funding (bilateral or multilateral international aid agencies), and external private funding (international philanthropic organizations and corporations) [2]. The financing method for HPV vaccines in each country is related to its health and immunization planning financing system and whether the country has included HPV vaccines in the recommended immunization program. Currently, more than two-thirds of countries that have introduced HPV vaccines use individual out-of-pocket money to cover the HPV vaccine-related costs [2]. Meanwhile, some high-income as well as low- and middle-income countries have incorporated HPV vaccine into national immunization programs and make vaccination free for target populations through government health financing, social health insurance, or private insurance. For example, United Kingdom, Australia, Germany, Japan, and Thailand have integrated HPV vaccines into national immunization services and provide free HPV vaccination, mainly funded by domestic public funding. In the United States, HPV vaccine financing combines multiple funding sources (private health insurance, Medicaid, and Vaccine for Children) to achieve free vaccination for the target population [4]. Table 1 lists the immunization programs and financing mechanisms for HPV vaccines in selected countries and regions. In some low-income countries that have included HPV vaccines in their national immunization programs, such as Uganda, Uzbekistan, and Rwanda, financing primarily relies on external public and private funds.
At present, the HPV vaccine in China is still considered as a non-National Immunization Program (non-NIP) vaccine, the vaccination of which relied on self-payment and on a voluntary basis. By August 2023, a total of seven provincial-level regions and 27 prefectural or district/county-level regions in China had implemented government-supported HPV vaccination programs for eligible school girls. These programs offer free or fixed-subsidy HPV vaccinations targeting school-age girls. Concurrently, in the Hong Kong Special Administrative Region of China, a government-subsidized pilot HPV vaccination program commenced in 2019. This initiative provides free vaccinations specifically for girls in the fifth grade of primary school, with an allocated budget of HK$25 million for the fiscal year of 2020-2021.
Table 1: Target populations and financing mechanisms in selected countries/regions which have introduced HPV vaccines into the national immunization programs
| Country or area | Recommended HPV Vaccine Types | Target Population | Year of inclusion in the national immunization Program | Financing mechanisms |
| United Kingdom | Quadrivalent | Mainly for children aged 12-13 (including boys), with catch-up vaccination available for those under 25, and for some men under 45 | 2008 (Since 2019, boys include) | Carried out through the National Health Service Vaccine Program, paid by the National Health Service (NHS) Trust and free of charge to individuals |
| German | Bivalent | Females aged 12-17 | 2007 | The full cost of the vaccination is covered by the public health insurance, and is also available to women between the ages of 18 and 26, subject to reimbursement through the health insurance. |
| Japan | Bivalent, quadrivalent | Females aged 13-16 (included in routine immunization Category A, but recommendation suspended due to prior adverse events) | 2013 | Subsidized by national and local taxes, paid by the National Health Insurance, and free of charge to the population. |
| Republic of Korea | Bivalent, quadrivalent | 12-year-old girls | 2016 | Covered by the National Immunization Program and free for individuals |
| Thailand | Bivalent, quadrivalent | 5th grade girls, recommended for females 9-26 and males 13-21 | 2017 | Paid by the National Immunization Project, financially subsidized by the Office of the National Health Security, free of charge for individuals |
| Hong Kong, China | Nine-valent | 5th grade girls | 2019 | Government-subsidized pilot project on Free Cervical Cancer Vaccination, free of charge for individuals |
| United States of America | Nine-valent | Young people aged 9-26 years (mainly for children aged 11-12), both male and female, and some adults under 45 | 2006 (recommended nine-valent since 2014) | Multiple funding mechanisms: People with private health insurance: covered by private health insurance, with or without individual co-payments is determined by the terms of insurance. People without health insurance: paid by Medicaid, Vaccines for Children (VFC), Immunization Assistance Program (IAP), or Children’s Health Insurance Program (CHIP). |
| Australia | Bivalent, nine-valent | Mainly for children aged 12-13 years (including boys), some immunocompromised people aged 9 years and above can also be vaccinated. | 2007 (Since 2013, men include) | Covered by the National Immunization Program (NIP) and the public health insurance (Medicare); the first 2 doses are free of charge for the individual, while those who need the third dose have to pay by out-of-pocket money. |
Willingness to pay for HPV vaccine in our population
Before the introduction of the HPV vaccine in China, a cross-sectional study was conducted across 21 urban and rural areas. The study found that 68% of the surveyed women were willing to spend approximately 500 CNY on the HPV vaccine. Additionally, 6% of women were willing to spend over 2000 CNY on imported vaccines, and 44% of the surveyed government officials believed that the cost of the HPV vaccine should be shared between the government and individuals [5]. A study using a discrete choice experiment approach revealed that parents would be willing to spend about 2326.32 RMB for HPV vaccination if the vaccine’s efficacy could be increased from 50% to 90% [6]. With increased media coverage and public awareness of the vaccine’s effectiveness, a 2019 cross-sectional survey found that among those willing to be vaccinated, about 63% women and 54% men were willing to pay 1000 RMB or more for the 3-dose-schedule HPV vaccination. The amount they were willing to pay was related to their willingness to get vaccinated. The median willingness to pay was 900 RMB for women with a more neutral attitude towards vaccination, 1500 RMB for those with a higher willingness, and 2000 RMB for those with an extreme willingness. The willingness to pay was relatively lower among men at all levels of vaccination willingness: 800, 1000, and 1100 RMB for those who were neutral, highly willing, and extremely willing, respectively [7].
Content Reviewer: Kelly Hunter, Menglu Jiang
Page Editor: Jiaqi Zu
References:
- WHO HPV vaccine Global Market Study, April 2022. (n.d.). https://www.who.int/publications/m/item/who-hpv-vaccine-global-market-study-april-2022
- UNICEF: Human Papillomavirus Vaccine: Supply and Demand Update. Accessed 26th March 2020, 2020.
- World Health Organization. (2023, November 17). Global partners cheer progress towards eliminating cervical cancer and underline challenges. Www.who.int. https://www.who.int/news/item/17-11-2023-global-partners-cheer-progress-towards-eliminating-cervical-cancer-and-underline-challenges
- Lai X, Fang H: An Overview of Immunization Programs and Vaccine Financing in the United States, United Kingdom, Germany, and Japan. Chinese Medical Journal, 2020, 100(2): 85-89.
- Zhao F-H, Tiggelaar SM, Hu S-Y, Zhao N, Hong Y, Niyazi M, Gao X-H, Ju L-R, Zhang L-Q, Feng X-X: A multi-center survey of HPV knowledge and attitudes toward HPV vaccination among women, government officials, and medical personnel in China. Asian Pacific journal of cancer prevention: APJCP 2012, 13(5):2369.
- Zhu S, Chang J, Hayat K, Li P, Ji W, Fang Y: Parental preferences for HPV vaccination in junior middle school girls in China: A discrete choice experiment. Vaccine 2020, 38(52):8310-8317.
- Hu S, Xu X, Zhang Y, Liu Y, Yang C, Wang Y, Wang Y, Yu Y, Hong Y, Zhang X: A nationwide post-marketing survey of knowledge, attitude and practice toward human papillomavirus vaccine in general population: implications for vaccine roll-out in mainland China. Vaccine 2021, 39(1):35-44.
