以破解关键制约为重点 推动儿童联合疫苗研发应用
目前我国儿童免疫规划要求儿童接种的疫苗剂次数较多，和发达国家及部分发展中国家相比存在差距。推广儿童联合疫苗应用是大幅降低接种剂次数、提升儿童免疫覆盖的重要措施。
Strategic Thinking on Strengthening China’s National Immunization Program
Yanfeng Ge
Shenglan Tang
Jiahui Zhang
Shenglan Liu
Executive Summary
Implementing immunization programs is the most cost-effective way for infectious disease control. China’s national immunization program (NIP) has achieved remarkable progress over the past decades, though there is still room for optimization to achieve effective development in the future. China’s NIP has not been expanded for nearly 15 years, and several internationally recognized cost-effective vaccines, such as the HPV, PCV, Hib, and Rota Virus vaccines, are not included in the current NIP. Some high-risk population groups, such as the elderly and health workers, are not sufficiently covered by related vaccines. The financing of China’s NIP has primarily relied on government funding to pay for NIP vaccines and support its operation. The health insurance fund, which has been used in some developed countries as an important payer for vaccines, basically does not pay for vaccines in China. The current financing strategy has largely constrained the expansion of the NIP, and the high price of the non-NIP vaccines is a great barrier to increasing its coverage. In addition, there are other challenges in expanding the NIP, such as insufficient vaccine research and development capacity, production capacity, and low incentives for the vaccination services delivery. The vaccination rates for several key non-NIP vaccines have been low, and imbalanced among regions of different economic development. It has led to a high disease burden of related vaccine-preventable diseases and generated a negative impact on achieving health equity.
The past two years have observed significant improvement in China’s vaccine development, production, and vaccination service delivery capacity due to the COVID-19 pandemic. Taking this opportunity, it is highly recommended to establish a dynamic expansion strategy for China’s NIP as soon as possible and diversify the financing channels of the NIP (explore possible financing channels such as public health insurance fund, private health insurance, and out-of-pocket payment, etc.), and improve the R&D, procurement, and services delivery for key vaccines, as important efforts to optimize the implementation of the NIP and effectively increase vaccination rates.
Thanks to
This study is an output of the Innovation Lab for Vaccine and Immunization Service Delivery project supported by the Bill & Melinda Gates Foundation (INV-034554). The Bill & Melinda Gates Foundation was not involved in the design, analysis, or writing of this article. The authors are solely responsible for the content of this article and do not represent the views of the funder.
We are grateful for the support of Duke Kunshan University as the project lead, and for the technical support provided by all the partner universities, government agencies, and institutions. In addition, special thanks to the experts who provided valuable input and technical support for this brief, especially Dr. Wenzhou Yu, Director of the Center for Immunization Planning at the CDC, Dr. Heng (Anna) Du, Senior Program Officer at the Gates Foundation, Dr. Wenfeng Gong, Senior Strategy Officer, Professor Weibing Wang at the School of Public Health at Fudan University, and Ms. Duanduan Yuan, a veteran pharmaceutical and health writer and former senior pharmaceutical reporter at Southern Weekend.
Authors
Yanfeng Ge
Yanfeng Ge has been engaged in social policy research at the Development Research Center of the State Council since 1990. He is now a researcher and first-level inspector in the Social Security and Health Care Research Department, Social and Cultural Development Research Department.
Main research areas include social security, labor and employment, health care system reform, education system reform, and public sector reform. He has participated in and led many policy research works in related fields. In recent years, he has focused on medical and health policies and aging issues.
Shenglan Tang
Shenglan Tang, Mary D B T and James Semans International Professor of Medicine and Global Health at the Department of Population Health Science, Duke Medical School Professor, Duke Kunshan University.
Dr. Shenglan Tang is Professor of Medicine and Global Health at Duke Global Health Institute. He is also Associate Director of DGHI for China Initiatives, and Executive Director of Global Health Program at Duke Kunshan University in China, as well as Director of Research Hub for Asia-Pacific Observatory on Health Systems and Policies/WHO, which has research projects in Cambodia, Nepal, Vietnam and other Asian countries. In his capacity at Duke Kunshan University, he was elected as President of Chinese Consortium of Universities for Global Health (CCUGH) in November 2015. Tang has more than 30 years of experience undertaking research on health systems reform, disease control and maternal and child health in China and other countries, and has provided consultancy services on health systems strengthening to many international organizations and governments of developing countries. In 2012, Tang came to Duke from the UNICEF/UNDP/World Bank/WHO Special Program for Research and Training in Tropical Diseases (TDR), based in Geneva, where he was Unit Leader for TB/HIV and Health Systems. Before his assignment at WHO, Tang was a faculty member at Liverpool School of Tropical Medicine in UK, and School of Public Health of Fudan University (former Shanghai Medical University).
Jiahui Zhang
Jiahui Zhang, Director of Social Security and Health Care Research Department, Social and Cultural Development Research Department, Development Research Center of the State Council.
Her main research areas are health policy and elderly service policy. In the past five years, she has participated in more than 20 international and domestic cooperative research projects and served as the main coordinator of several research projects. She has conducted in-depth and systematic research on the construction of multi-level medical security systems, improvement of graded diagnosis and treatment systems, deepening reform of drug policies, financing and salary systems of public hospitals, prevention and control strategies of major infectious diseases, scientific response to population aging, construction of elderly service systems and personnel training, and long-term care insurance. Her research and policy recommendations, such as deepening reform in the field of pharmaceuticals, conducting national negotiations on the prices of special drugs, development goals of the elderly service system, and key issues of legislation on elderly services, have been approved by leaders and have played an active role in policy adjustment in related fields.
Shenglan Liu
Shenglan Liu, Associate Researcher, Department of Social and Cultural Development Research, Development Research Center of the State Council.
She is mainly engaged in policy research related to medical and health system reform, medical security, drug policy and pharmaceutical innovation. She has completed several related topics and authored or co-authored many research reports. The topics she has participated in include "Research on some key issues of future medical and health system reform", "Research on major public policies to actively deal with population issues", "Healthy aging: a two-wheel drive between policy and industry", "Improving fertility and related policies", and "The development of a new health care system." She is also the project leader of the study on "Breaking the Barriers to Commercial Health Insurance Development and Improving Multi-level Medical Security System".
Other Papers
Implement comprehensive vaccination policies to promote uptake of the influenza vaccine in China
Annual influenza epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths worldwide. Influenza outbreaks often occur in crowded settings, such as schools, kindergartens, and nursing homes. However, vaccination remains the most cost-effective way to prevent influenza infection and its complications. Alas, the current influenza vaccination coverage in China remains disconcertingly low, ranging between a mere 2% and 4%, considerably lagging behind vaccination rates in Western countries and underscoring a palpable scope for substantial augmentation. To promote influenza vaccination, many countries have implemented effective interventions and gained experiences in policy advocacy, improving access to vaccination, incentivizing services providers, and monitoring influenza vaccination behaviors and social drivers.
We analyzed and summarized the status and challenges in using flu vaccine in China via comparing and leveraging the policy experiences from other countries. It is suggested that China should take comprehensive policy interventions on influenza vaccine health education, financing mechanisms, service system, research and development, production and supply, and monitoring and evaluation. These interventions can help increase public awareness of influenza and vaccines, improve access to immunization services, reduce the burden of costs, guarantee the manufacturers’ production and market supply, and generate high-quality research evidence, and ultimately increase influenza vaccine coverage and facilitate its introduction into China’s National Immunization Program.
Regional Pilots and Improvement Strategies of HPV-Vaccination-Friendly Policies
The age-standardized incidence and mortality rates of cervical cancer in China are rapidly growing and it increasingly affects younger individuals, underscoring the critical need for the accelerated uptake of the HPV vaccine. Since 2021, several local governments have successively introduced policies to support HPV vaccination uptake, advancing the vaccination of eligible girls/women via free or subsidized vaccination. Such pilots have increased the local HPV vaccination rate and had a positive demonstration effect. This article sorts out the main practices of the local vaccination policies, and issues and challenges encountered in vaccination strategy optimization, vaccine price negotiation, vaccine manufacturing capacity distribution, etc. It proposes to further optimize local vaccination strategies by referring to WHO recommendations to reduce the number of doses, optimize subsidy strategies to improve the efficiency of fund use, remove academic or household registration restrictions to expand the target population size, disseminate core information about vaccination to eliminate public misunderstandings, and establish sustainable financing mechanisms. It also suggests reducing vaccination costs through price negotiations and joint procurement, supporting and guiding manufacturers to expand vaccine production capacity, assessing the implementation effects of local vaccination policies, organizing experience exchanges, expanding project impact, and supporting more regions in advancing the uptake of HPV vaccine.
