Sep 20, 2022 08:03 PM

Charts of the Day: China Expands HPV Vaccine Coverage

China’s top drug regulator expanded the age range of the most popular Gardasil 9-valent human papillomavirus (HPV) vaccinations to females aged 9 to 45 years old on Aug. 30, as part of national cancer prevention efforts. Before that, the vaccine was only approved for use in women between the ages of 16 and 26.

This expansion may add more fuel to the overheated domestic HPV vaccine market, as supply has long failed to keep up with demand for HPV vaccinations in the country.

The vaccination rate for Chinese women aged 9 to 14 — a group the WHO recommends getting vaccinated — is less than 1% due to scarce supplies, high prices, patchy public awareness of HPV vaccines and other factors. Caixin estimates that extending the vaccine to women aged 9 to 45 will lead to a market shortage exceeding 1 billion doses, based on a calculation of three doses per person.

Cervical cancer, caused mainly by the HPV infection, is the fourth most common cancer among women globally. Worldwide incidences and deaths caused by this cancer have been increasing continuously since 1989, the first time when the database released global data statistics, according to the latest data from Global Cancer Observatory. In 2020 alone, more than 600,000 women were diagnosed and 341,831 women died from the disease.

In China, cervical cancer ranks as the sixth most common cancer among women in 2020, with nearly 60,000 women dying from the disease and new case numbers reaching 110,000 in 2021.


Cervical cancer can be cured if diagnosed and treated at an early stage, and vaccination against HPV is one cost-effective way to protect against the most common types of HPV.

Five HPV vaccines have been approved for use on the Chinese mainland since 2016 — two manufactured domestically and three imported jabs, which cover 2-, 4- and 9-valent HPV vaccines. Prices range from 1,800 yuan ($257) to 3,900 yuan for imported doses and under 1,000 yuan for domestic doses.

Gardasil 9, created by global pharmaceutical giant Merck, has long been short in supply since the National Medical Products Administration granted its use on the mainland. Despite its high price, the vaccine is popular because it is the only one that can shield against the nine strains of HPV, while the others only protect against two or four strains.

Although the number of doses of HPV vaccines released to market keeps growing from 2017 to 2021, the imbalance between supply and demand of this vaccine remains high. For example, even though China released over 15 million doses of the HPV vaccination in 2020, the number of women aged 9 to 14 in the country had surpassed 42 million that year.


Merck, also known as MSD, is the world’s only supplier of 4- and 9-valent HPV vaccines. In August 2020, the firm told The Paper media outlet that the supply of HPV vaccines is affected by factors such as production complexity, a four-year production cycle, strict quality control and major infrastructure investment.

“Producing an HPV vaccine that meets the quality and regulatory requirements of China requires the collaboration of MSD’s factories around the world,” the firm said.

Many community hospitals told Caixin that they have no influence over the inventory of the HPV vaccine supply since the vaccine is distributed by local disease control and prevention centers. Amid the ongoing Covid-19 outbreaks, the stockpiling of HPV vaccines has taken a bigger hit as the country’s health care resources have been focused on Covid vaccination.

“The HPV vaccines have been out of stock for a long time since the outbreak of Covid-19. Let’s not bring up the 9-valent HPV vaccines, even the 4-valent HPV vaccines are not available,” a community hospital in Wuhan, Central China’s Hubei province, told Caixin.

As of April this year, 117 countries worldwide have included HPV vaccines in their national immunization plans. However, experts interviewed by Caixin have noted that it is not yet the right time for China to include the HPV vaccine in its national immunization program, which currently includes a total of 12 vaccines including the hepatitis B vaccine.

Wang Lihong, an expert on cervical cancer prevention and control, said that such inclusion requires rigorous scientific research and many conditions need to be met, such as the vaccine’s price, production capacity and the scale of supportive public health services.

Currently, incorporating the vaccine into the national immunization plan “still has quite a distance to go,” Wang added.

Contact reporter Li Hang ( and editor Bertrand Teo (

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