Industry Updates
01
The first vaccine product has been included in the preliminary review list of the National Healthcare Security Administration’s (NHSA) Commercial Health Insurance Innovative Drug Directory
On August 12, the NHSA announced the preliminary list of innovative drugs for commercial insurance with China’s first quadrivalent influenza virus subunit vaccine included Among the 121 drugs that passed the formal review, this was the only vaccine product, marking a breakthrough for preventive biological products being short-listed for the commercial health insurance reimbursement system.
The Commercial Health Insurance Innovative Drug Directory is designed for innovative, break-through drug products with significant clinical value, and substantial patient benefit but which cannot yet be included in the basic medical insurance directory due to not align with the “securing the essential need” principle. This initiative opens a new payment pathway for high-value innovative vaccines and is expected to provide a reference model for the future market access of other innovative vaccines.
Source: Vaccine Circle
Journal Article Recommendation
01
Economic evaluation of vaccination strategies in China: A systematic review
The article, published in Pharmacoeconomics and Policy, employed a systematic review approach to evaluate evidence from economic assessments of vaccination strategies in mainland China, aiming to inform immunization program decision-making. A comprehensive literature search was conducted across nine electronic databases in July 2023, adhering strictly to the Joanna Briggs Institute (JBI) quality appraisal criteria. A total of 133 economic studies were included, covering 20 vaccines, which encompassed both traditional immunization program vaccines (such as hepatitis B, polio, and DTP) and newer vaccines (such as HPV, influenza, and pneumococcal vaccines). The primary comparisons involved vaccination versus no vaccination and inclusion versus exclusion from the National Immunization Program (NIP).
Among the included studies, 36 high-quality studies were incorporated into a decision matrix. The findings indicated that, with the exception of HPV, studies evaluating the same vaccination strategies exhibited a high degree of consistency. Most vaccination strategies had incremental cost-effectiveness ratios (ICERs) below one times the gross domestic product (GDP) per capita or below three times the GDP per capita. Based on a descriptive comparative analysis of high-quality economic evaluations, the review recommended prioritizing the inclusion of the following vaccines in expanded immunization strategies:hepatitis A and E vaccines, domestically produced bivalent HPV vaccine (HPV-2), 13-valent pneumococcal conjugate vaccine (PCV-13), influenza vaccine, and Haemophilus influenzae type b (Hib) vaccine.
The methodological quality assessment of this systematic review highlighted that the overall quality of economic evaluation studies on immunization strategies in China depends on the availability of higher-quality primary research under local conditions, including studies on vaccine efficacy or effectiveness, epidemiology of related diseases, and disease burden. Improving scientific rigor and comparability in research can provide a more robust foundation of economic evidence to support resource optimization and decision-making for the introduction of new vaccines in China’s immunization program.
https://doi.org/10.1016/j.pharp.2025.07.001
02
From decentralization to re-centralization: lessons learned from Vietnam’s rapid reversal in the financing of the Expanded Program on Immunization
The article, published in The Lancet Regional Health – Western Pacific, examines Vietnam’s attempt to decentralize the financing and procurement responsibilities of its Expanded Program on Immunization (EPI) from the central government to provincial authorities in early 2023. This policy shift aimed to address the dual challenges of governance decentralization reforms and the reduction of international development assistance. However, within just six months of implementation, the reform triggered a systemic crisis—including widespread vaccine shortages and the steepest decline in childhood immunization coverage in two decades—prompting the central government to urgently reverse the policy. EPI financing and procurement authority was reinstated at the national level, making this rapid policy reversal a critical case study in global public health governance. This study systematically analyzes the negative impacts and root causes of Vietnam’s EPI decentralization and offers lessons for other middle-income countries.
The systemic crisis following the policy implementation manifested in several ways: (1) Supply chain challenge: Provincial governments lacked the technical capacity and financial resources to manage vaccine procurement, leading to fragmented and inefficient supply chains. Even relatively affluent cities such as Hanoi and Ho Chi Minh City reported stockouts of essential vaccines, including the pentavalent and measles vaccines, causing a severe disruption in the national immunization system. (2) Decline in coverage: Vaccine shortages directly compromised the continuity of routine childhood immunization services. National data indicated that full immunization coverage among children under one year of age plummeted to 77% in 2023—the largest sustained decline in nearly 20 years—with coverage for the third dose of the pentavalent vaccine dropping by nearly 30% compared to 2020. In some remote provinces, such as the Central Highlands, full immunization coverage fell below 60%. Decentralization of financing and procurement further exacerbated regional inequalities, placing children in fiscally weaker provinces at severe risk of losing access to basic immunization services. (3) VPDoutbreak risk: In the first half of 2024, Vietnam experienced a nationwide measles outbreak, with cases increasing 130-fold compared to the previous year. The World Health Organization (WHO) classified the situation as “very high risk,” linking the outbreak to vaccine shortages and the drastic drop in coverage.
As the challenges emerged, the Vietnamese government took reversal action in July 2023, reassigning key responsibilities such as vaccine procurement and budget allocation to the Ministry of Health and reintegrating EPI financing into the central government’s regular budget.
Both theoretical research and practical experience underscore that immunization programs differ fundamentally from ordinary health services, asvaccination carries strong positive externalities. For such quasi-public goods, central governments should maintain a leading role in financing, procurement, pricing, and regulation to ensure equity, accessibility, and supply stability. At the same time, capacity building for local immunization teams is essential to foster coordinated management between central and local levels, enhancing overall system resilience. This study provides critical insights for other middle-income countries: to avoid similar crises and achieve sustainable, equitable immunization, it is essential to uphold central government leadership in EPI financing and management while simultaneously strengthening local governance capacity and providing targeted support to resource-constrained regions.
https://doi.org/10.1016/j.lanwpc.2025.101648
03
Influenza Vaccination and Short-Term Risk of Stroke Among Elderly Patients With Chronic Comorbidities in a Population-Based Cohort Study
The article, published in The Journal of Clinical Hypertension, aimed to assess the impact of influenza vaccination on the one-year risk of stroke among patients aged 60 years and older with chronic obstructive pulmonary disease (COPD) and comorbid hypertension or diabetes. This retrospective population-based cohort study was conducted in four districts of Shanghai, China, between August 2017 and July 2019. Data were integrated from the chronic disease management system, immunization information system, and cerebrovascular event reporting system, including a total of 50,842 eligible patients aged 60 years or above. Individuals who received a trivalent influenza vaccine during the influenza season (August to March of the following year) were classified as the vaccination group, while stroke events were identified using ICD codes (I60–I64). Cox proportional hazards regression models were used to compare the one-year stroke risk between vaccinated and unvaccinated groups, estimating hazard ratios (HRs) and 95% confidence intervals (CIs). Sensitivity analysis was conducted using Poisson regression models, and propensity score matching was applied to control for confounding factors.
The results showed a relatively low influenza vaccination rate during the study period: 1.55% in the 2017–2018 influenza season and 1.25% in the 2018–2019 season. During both influenza seasons, vaccination was significantly associated with a reduced risk of stroke. After multivariable adjustment, the Cox regression analysis yielded an adjusted hazard ratio (aHR) of 0.27 (95% CI: 0.10–0.73) for the 2017–2018 season and 0.46 (95% CI: 0.21–1.02) for the 2018–2019 season. The Poisson regression model results (RR = 0.26, 95% CI: 0.10–0.70) were consistent with those from the Cox model. Overall, influenza vaccination was associated with a 54%–73% reduction in the one-year risk of stroke among patients with chronic conditions.
The study suggests that influenza vaccination may significantly reduce short-term stroke risk in elderly individuals with multiple chronic conditions, providing important scientific evidence to support clinical recommendations for influenza vaccination in this high-risk population.
https://doi.org/10.1111/jch.70044
04
Drivers of human papillomavirus vaccine uptake in migrant populations and interventions to improve coverage: a systematic review and meta-analysis
The article, published in The Lancet Public Health, aimed to systematically assess the current status and determinants of human papillomavirus (HPV) vaccination among migrant populations globally, as well as to summarize strategies and interventions for increasing vaccine uptake. The study sought to provide evidence supporting the WHO goal of ensuring that 90% of girls complete HPV vaccination by age 15 by 2030. A comprehensive literature search was conducted for studies published between January 1, 2006, and December 4, 2024. A total of 117 studies were included, covering 5,638,838 participants from 16 countries and one region, of whom 933,189 were migrants. The WHO behavioral and social drivers of vaccination model was applied for thematic analysis, and pooled vaccination rates were calculated using a random-effects model. Primary outcomes included HPV vaccination rates, drivers and barriers to vaccination, and proposed strategies for improving uptake.
The findings indicated that HPV vaccination coverage among migrants is generally low, with substantial gender differences. The pooled vaccination rate among female migrants was 23.0% (95% CI: 10.0–44.0; I² = 99.3%; n = 7,614), compared to 21.0% (95% CI: 5.0–58.0; I² = 99.3%; n = 2,764) in males, and 17.0% (95% CI: 8.0–33.0; I² = 98.0%; n = 3,583) in the overall population. Key barriers included concerns about vaccine safety, cultural and religious beliefs, limited knowledge about HPV and the vaccine, exposure to negative information, and lack of healthcare provider recommendations. Practical barriers encompassed poor access to information, language difficulties, limited availability of vaccination services, and high vaccine costs. Facilitators included trust in vaccines and healthcare providers, parental attitudes toward adolescent sexual behavior, social network support, and clear, credible medical advice.
Evidence-based strategies recommended by the review included developing culturally adapted, segmented health education materials; leveraging trusted intermediaries such as religious leaders for outreach; implementing innovative service models like multi-vaccine delivery and mobile vaccination clinics; and strengthening system-level support, including robust electronic health records and vaccination tracking systems. These multidimensional interventions could substantially improve HPV vaccination coverage among migrant populations.
The study highlights that migrants face complex, multi-level barriers to HPV vaccination, spanning individual knowledge, family and socio-cultural norms, healthcare delivery, and systemic factors, resulting in persistently low coverage and missed opportunities for immunization. In low- and middle-income countries, challenges are further compounded by severe vaccine shortages and out-of-pocket payment requirements. To fulfill the global commitment to equitable immunization across the life course and accelerate cervical cancer elimination, comprehensive and coordinated strategies are urgently needed. In particular, collaborative approaches with migrant communities to co-design culturally appropriate vaccination models represent a critical pathway to improving vaccine uptake.
https://doi.org/10.1016/S2468-2667(25)00148-3
05
Feature representation in analysing childhood vaccination defaulter risk predictors: A scoping review of studies in low-resource settings
The article, published in PLOS Digital Health, employed a systematic literature review to explore feature representation approaches in risk prediction models for childhood immunization default in low-resource settings, with a particular focus on African countries. The study examined three default scenarios: failure to complete scheduled vaccinations on time, failure to follow the national immunization schedule, and zero-dose status (children who have never received any vaccine). It included quantitative studies from low- and middle-income countries published between 2018 and January 2025.
After rigorous screening, 18 studies were selected from an initial pool of 4,174 articles. All included studies utilized quantitative methods to evaluate determinants of childhood immunization default. Most relied on secondary survey data, and outcome variables were commonly binary, indicating whether a child completed timely vaccination, achieved full immunization, or was classified as zero-dose. Frequently used predictors at the individual level included maternal education, number of antenatal visits, place of delivery, type of residence, household socioeconomic status (measured through a wealth index), and maternal demographic characteristics such as age and employment status. At the community level, predictors often comprised contextual indicators such as poverty rates, maternal literacy rates, and unemployment rates.
In terms of feature engineering, binary encoding was the predominant representation method for categorical variables. For instance, delivery location was often coded as “institutional delivery” versus “home delivery.” Continuous variables, such as household wealth index, were commonly reduced to a single component through principal component analysis (PCA) for modeling purposes. While these approaches facilitate model construction and training due to their simplicity and adaptability, they may lead to the loss of gradient information embedded in original variables (e.g., differences in years of education or wealth strata), potentially limiting the precision of risk factor effect estimation.
The analysis revealed that logistic regression remains the dominant modeling approach. However, with the increasing availability of large-scale data, ensemble learning techniques such as random forests and gradient boosting machines, as well as multilayer perceptrons, have demonstrated superior predictive performance, particularly in handling nationally representative survey data. These advanced methods often achieved higher recall and area under the receiver operating characteristic curve (AUC-ROC) compared to traditional algorithms like support vector machines. Nevertheless, some studies reported inconsistencies between performance metrics (e.g., high recall but low AUC), highlighting the need to address overfitting and sample imbalance, which may undermine model generalizability.
In summary, risk prediction for childhood immunization defaults in low-resource settings has largely centered on maternal education and healthcare accessibility as core features. However, feature representation methods remain limited, with binary encoding dominating current practice. Future work should explore more nuanced approaches, such as frequency encoding to preserve ordinal relationships, and integrate real-time immunization data to enhance dynamic risk prediction. Such improvements could increase the timeliness and practical utility of prediction models for guiding targeted interventions.
https://doi.org/10.1371/journal.pdig.0000965
Content Editors: Tianyi Deng
Page Editor: Rurong Li
