In October 2025, China officially incorporated the human papillomavirus (HPV) vaccine into the National Immunization Program (NIP), marking the first expansion of the program since 2008 and a major step toward cervical cancer prevention. The policy change reflects a decade of progress in evidence generation, vaccine development, pilot implementation, public engagement, and alignment with national and global health strategies.
A viewpoint article titled “From local pilots to national policy: key issues and challenges in implementing nationwide HPV vaccination in China,” co-authored by Tang Shenglan, Zhao Fanghui, Qiao Youlin, and Du Heng, was recently published in The Lancet Regional Health – Western Pacific. The article reviews the evolution of China’s HPV vaccination policy, focuses on key challenges in nationwide implementation following the inclusion of the vaccine into the NIP, and provides corresponding policy recommendations.
Five factors enabled this transition from the free-HPV-vaccination local pilots to national policy. Extensive research established the epidemiological, clinical, and economic rationale for HPV vaccination, while domestic vaccine innovation improved supply security and affordability. Government-funded pilot programs demonstrated the feasibility of school-based vaccination and achieved substantial increases in coverage. At the same time, growing public awareness and strong policy alignment with the Healthy China 2030 agenda helped build political and social support for nationwide implementation.
Despite this achievement, four major challenges remain. First, sustainable financing is uncertain, as local governments must cover service delivery costs despite significant regional differences in fiscal capacity. Second, vaccine hesitancy and misinformation may undermine uptake, particularly among parents concerned about vaccine safety, fertility, and adolescent health. Third, public preference for higher-valent vaccines could reduce acceptance of the free domestically produced bivalent vaccine offered through the national program. Finally, reliance on school-based delivery risks excluding out-of-school adolescents, migrant populations, and girls living in remote areas, potentially creating inequities in access.
To address these challenges, the authors recommend strengthening financial coordination between central and local governments, institutionalizing collaboration between health and education sectors, improving risk communication and community engagement, evaluating alternative vaccination strategies such as single-dose schedules, and establishing robust monitoring and implementation research systems. Integrating HPV vaccination with cervical cancer screening will further enhance long-term disease prevention.
China’s experience demonstrates that successful vaccine policy expansion requires strong scientific evidence, technological innovation, policy experimentation, and sustained public engagement. While inclusion of HPV vaccination in the NIP represents a historic milestone, its ultimate impact will depend on achieving equitable, sustainable, and trusted implementation across the country.
Page Editor: Ruitong Li
Source:https://www.sciencedirect.com/science/article/pii/S2666606526000787
