The World Health Organization, on its Immunization Agenda 2030, clearly outlines the strategic direction of ‘life-course approach for immunization,’ emphasizing that ‘no one is left behind.’ As the global population continues to age rapidly, the disease burden of vaccine-preventable illnesses among adults is becoming increasingly heavy. However, for most developing countries, including China, adult immunization still faces significant gaps in policy support, financing mechanisms, and service systems.
To draw on international best practices and advance the translation of evidence into policy for adult immunization in China, the Innovation Lab for Vaccine Delivery Research (VaxLab) at Duke Kunshan University hosted an online workshop titled “Pathways for Adult Immunization: Integrating Evidence, Policy, and Practice” on April 27, 2026. Leading experts from China and abroad engaged in in-depth discussions on the disease burden associated with adult immunization, policy optimization, financing models, and implementation experiences.
Adult immunization’s value long overlooked
Data shows that the global population aged 60 and older has reached 2.1 billion, and the World Health Organization predicts this figure will double by 2050. This means the potential target population for adult vaccines is expanding rapidly. As the aging population grows, vaccine-preventable diseases such as influenza, pneumococcal infection, and shingles have become major causes of hospitalization and disability among older adults, placing significant financial strain on healthcare systems.
In recent years, a number of adult vaccines have gained approval, including vaccines against respiratory syncytial virus (RSV), recombinant varicella-zoster virus, and higher valent pneumococcal conjugate vaccines. These vaccines provide effective preventive tools to meet adult immunization needs and offer opportunities to further advance the adult immunization system. However, compared to the relatively well-established childhood immunization program, the value of adult immunization has long been underestimated, and the development of adult immunization systems has lagged behind actual needs.
From both individual and population perspectives, the value of adult immunization lies not only in health promotion, disease prevention, and disease control, but also in reducing the incidence of disease and lowering healthcare costs. Even when disease cannot be completely prevented, vaccines can effectively reduce disability, severe illness, and death, and some vaccines can help mitigate the rise of antimicrobial resistance. In addition, adult immunization yields significant socioeconomic benefits, including improvements in public health, long-term care services, and family care.
Multiple gaps persist in China’s adult immunization system
Yang Weizhong, Distinguished Professor at Peking Union Medical College, shared the major challenges that China’s adult immunization currently persists. He listed several issues that required further improvement, including the institutional framework, limited financing sources, insufficient integration of preventive and clinical services, the vaccination accessibility and convenience, and persistent public vaccine hesitancy.
“How should adult vaccination services be organized? Should they be handled by hospital injection rooms, or should separate adult vaccination clinics be established? Overall, there is a lack of national guidance in this area,” said Yang Weizhong. In addition to the lack of accessibility in adult immunization services, he also emphasized challenges such as the hesitation among physicians when providing immunization-related consultations and recommendations to adult patients, the limited financing sources, and insufficient public awareness and education.
One of the obstacles to optimizing adult immunization policies lies in the inadequate monitoring of diseases and vaccination coverage. “China has established a comprehensive monitoring network for post-vaccination coverage rates and adverse reactions among children but monitoring of vaccine-preventable diseases in adults and the adults’ vaccination coverage remain severely lacking. The true burden of diseases such as shingles and pneumonia among adults is often underestimated,” said Yang Weizhong.
Australian experience on evidence-based inclusion of the shingles vaccine in the NIP
Australia’s experience with the inclusion of the shingles vaccine in its immunization program offers valuable insights for the policy development of China’s adult immunization program. Policy decisions, implementation, and the adjustments to immunization strategies in Australia are all based on comprehensive and detailed data on disease burden and vaccine safety monitoring. Professor Bette Liu, the Population Health Group Lead at the National Centre for Immunisation Research and Surveillance (NCIRS) in Australia, provided a detailed recap of the implementation of Australia’s shingles vaccine program.
In November 2016, Australia included the shingles vaccine in its National Immunization Program (NIP). Initially, the program used Zostavax®, a single-dose live attenuated vaccine, primarily targeting people aged 70 to 79. Professor Liu explained that this decision was based both on the high disease burden in this population and on evidence indicating that the vaccine remained effective for this group. In 2021 Australia’s NITAG recommended Shingrix® over Zostavax due to its higher efficacy, longer-lasting immunity, and safety profile, as well as its suitability for immunocompromised individuals. In November 2023 following cost-effectiveness assessment it replaced Zostavax® in the NIP, becoming the standard vaccine for preventing shingles. In 2024, funding support was further expanded to cover a broader range of immunocompromised individuals.
Professor Liu pointed out that when formulating immunization program recommendations, multiple factors must be taken into account, including epidemiology and disease burden, differences in risk across various population groups, vaccine efficacy, and cost-effectiveness analyses. Although Australia initially lacked surveillance data on herpes zoster and postherpetic neuralgia, the NCIRS utilized the Australian Immunization Register (AIR), electronic primary care data, and antiviral prescription data as surrogate indicators to assess the impact of the disease and the effectiveness of the program’s implementation, successfully transitioning from the use of live-attenuated vaccines to the application of a new generation of recombinant protein vaccines.
Pathways for including adult vaccines in social and private health insurance
A robust vaccine financing mechanism is a critical component of a comprehensive adult immunization system.Professor Yang Weizhong pointed out that adult vaccination in China currently relies primarily on out-of-pocket payments, and vaccination rates for most adult vaccines are extremely low, with price sensitivity being one of the barriers to adult immunization. Besides the source of government revenue funding, what other potential financing mechanisms could be considered? Chen Chen, Associate Professor in the Department of Global Health at the School of Public Health, Wuhan University, delivered her presentation on “Pathways for Incorporating Adult Vaccines into Health Insurance: Evidence, Payment Models, and Policy Reflections.”
Chen Chen argues that, unlike emergency care and hospitalization, adult vaccination is not an immediate medical treatment nor an urgent necessity, but rather a planned preventive measure; therefore, an individual’s decision to get vaccinated is significantly influenced by out-of-pocket costs. Globally, the financing of adult vaccines can be broadly categorized into four types: insurance coverage (covered by public or private insurance), government funding (covered by public health programs), personal accounts (covered through health savings accounts or individual health insurance accounts), and full out-of-pocket payment.
Chen Chen focused on the first model—insurance-based coverage. She noted that the traditional logic of health insurance is predicated on post-illness reimbursement, typically covering individualized medical services, and is constrained by rules such as annual fund budgets, clinical necessity, and benefit catalogs. Adult vaccination, in contrast, exhibits different payment characteristics: it occurs prior to disease onset, reduces individual risks of infection, severe illness, and complications, and some vaccines also confer herd immunity and positive public health externalities. Furthermore, the health and economic benefits of adult vaccination may materialize over multiple years or even longer time horizons. Despite these departures from conventional health insurance payment logic, more than a dozen high-income countries—including the United States, Germany, France, Switzerland, the Czech Republic, Luxembourg, and Belgium—have incorporated adult vaccines into their social health insurance or commercial health insurance benefit packages over the past decade.
Based on country comparisons, Chen Chen summarized five key findings: First, price sensitivity is a widespread phenomenon, and removing price barriers can significantly increase vaccination rates; second, the mechanism linking official recommendations to reimbursement is a critical variable; third, public and private insurance are not mutually exclusive and can be combined—as in the French model, which achieves near-full reimbursement;Fourth, most countries do not implement universal, fully subsidized vaccination but instead set restrictions based on age, high-risk groups, or copayments to strike a balance between universal access and the sustainability of funding; Fifth, the evidence base needs to shift from a single framework to a combination of multiple frameworks to comprehensively assess the public health value of vaccines.
Building life-course immunization services through innovative moves
At this workshop, experts agreed that the development of an adult immunization system cannot simply replicate the experience of childhood immunization programs, but rather requires systematic innovation across multiple dimensions, including policy, financing, services, information, human resources, communication, and R&D. The experts called for action along the following lines: improving relevant policies and service networks; innovating diversified financing mechanisms; building a unified and efficient digital information platform; strengthening training and capacity building for healthcare personnel; conducting scientific health communication; promoting innovation in vaccine R&D and regulations; and fostering cross-sectoral governance to jointly advance the sustainable development of China’s adult immunization program.
In his concluding remarks, Yu Wenzhou, Deputy Director of the Center for Immunization Program at the Chinese Center for Disease Control and Prevention (China CDC), noted that the disease control and health departments will, in the future, further advance the implementation of the healthcare providers’ vaccine prescription, intensify research on financing for non-immunization program vaccines, and enhance the accessibility and convenience of vaccination services.
“Breakthroughs and innovations are needed in certain areas to drive the establishment of an adult immunization service system, marking a gradual shift from childhood immunization to services covering the entire population across the life cycle,” said Yu Wenzhou. This shift is not only an inevitable requirement in response to an aging population but also a key measure for implementing the World Health Organization’s “Immunization Agenda 2030” strategic goal of “leaving no one behind.”
Page Editor：Ruitong Li
