A recent study published in PLOS Global Public Health examined the availability and equity of four WHO-recommended non-National Immunization Program (non-NIP) vaccines in China: Haemophilus influenzae type b (Hib), pneumococcal conjugate vaccine (PCV13), rotavirus vaccine, and human papillomavirus (HPV) vaccine. Although these vaccines are recommended for routine immunization by the World Health Organization, they were not included in China’s National Immunization Program in 2022 and, therefore required voluntary out-of-pocket payment, resulting in lower uptake and uneven access.
Using procurement and utilization data from 355 county-level CDCs and 2,609 vaccination clinics across 27 provinces, the study evaluated vaccine availability from a supply-side perspective. Overall, county-level availability exceeded 85% for all four vaccine categories, with HPV vaccines showing the highest availability (96.9%) and PCV13 the lowest (86.5%). However, pronounced regional and urban–rural disparities were identified. Eastern and urban areas consistently demonstrated greater vaccine availability, while western and rural regions had substantially lower access. At the clinic level, inequalities were even more evident: more than 70% of urban clinics provided all four vaccine categories, compared with only around 20% of clinics in western China. Over 30% of Western clinics and more than 20% of rural clinics did not provide any of the four WHO-recommended vaccines.
The study also found a clear “pro-rich” distribution pattern, with vaccine availability concentrated in economically developed provinces. Higher-priced vaccines, including DTaP-IPV-Hib combination vaccines and PCV13, exhibited the greatest inequity, suggesting that vaccine cost is a major driver of unequal access. Additional contributing factors included fragmented provincial procurement systems, limited healthcare infrastructure in underserved areas, high distribution costs in remote regions, insufficient provider incentives, and disparities in household purchasing power and vaccine awareness.
The authors conclude that improving vaccine equity in China will require expanding public financing and incorporating more WHO-recommended vaccines into the National Immunization Program. They also recommend standardizing procurement mechanisms across provinces and strengthening immunization service capacity in less-developed regions through investments in workforce, infrastructure, and delivery systems. Overall, the study highlights the critical role of institutional and financial support in reducing disparities in access to life-saving vaccines.
Reference:
Guo, L., Guo, F., Jiang, W., Zhang, X., Dong, D., Chen, S., Wan, Q., & Tang, S. (2026). Availability of Hib, Pneumococcal, Rotavirus, and HPV vaccines in China: Implication for equity in access to immunization services. PLOS Global Public Health, 6(4), e0006151. https://doi.org/10.1371/journal.pgph.0006151
Compiled and written by: Xinyue Zhou (CHN), Tianyi Deng (ENG)
Reviewed and edited by: Zhangyang Pan, Lei Guo
Page editing by: Ruitong Li
