In Depth: China’s Lagging Vaccination Program Gets a Window of Opportunity

Tang Shenglan, co-director of the Global Health Program at Duke Kunshan University (DKU), highlighted that China's national immunization program (NIP) is falling behind in incorporating new vaccines. Countries like Indonesia have recently added pneumococcal conjugate vaccine (PCV) and human papillomavirus (HPV) vaccine to their programs, both of which China has yet to consider despite WHO recommendations. [para. 1][para. 2][para. 3][para. 4]

China launched its NIP in 1978, initially covering four vaccines and expanding to 14 over three decades. However, no additional vaccines have been included in the past 17 years. Consequently, Chinese children remain susceptible to diseases preventable by available vaccines. A study led by Fang Hai revealed that pneumococcal infections resulted in around 8,000 young child deaths in 2017, a disease preventable by PCV. [para. 5][para. 6][para. 7]

The stagnation in expanding the NIP is attributed to several factors, including cost, disease prevalence, vaccine efficacy and safety, manufacturing capacity, and the social benefits of vaccines. Fiscal constraints, particularly after extensive COVID-19 control measures, have exacerbated this issue. Furthermore, unlike many low-income countries supported by international organizations or developed countries with ample resources, China doesn't benefit significantly from either category. [para. 8][para. 9][para. 10]

China's aging population might present an opportunity to expand the NIP, as fewer newborns could mean reduced costs and more funding availability for other vaccines. Experts advocate for reforms to ensure the sustainability of the NIP, including potentially using medical insurance funds for vaccinations. [para. 11][para. 12]

A 2022 DKU-led study indicated significant disparities between China’s immunization coverage and global averages for certain vaccines. For instance, PCV, HPV, and Hib vaccines have been adopted by a majority of WHO member countries, with global coverage rates in 2019 at 47.9% for PCV and 70.6% for Hib. In contrast, China’s coverage rates for these vaccines were only 7.3% and 10.5%, respectively. This gap has led to widespread preventable diseases within the country. [para. 13][para. 14][para. 15][para. 16]

Funding challenges remain acute. In 2019, China spent 173.7 billion yuan ($24 billion) treating preventable diseases, predominantly affecting children. There is a pressing need to reallocate or increase funding, with a potential one-point focus being the utilization of unspent funds from lower-than-expected newborn numbers in recent years. The central government's allocation to the NIP dropped significantly from 4.8 billion yuan in 2021 to just over 3 billion yuan in 2022, leaving uncertainty about the utilization of these funds. [para. 15][para. 16][para. 17][para. 18]

Calls to improve the NIP have gained traction in national political dialogues. China CDC officials have suggested that new vaccines might soon be incorporated into the program, supported by advancements in vaccine technology and increased domestic production capacity. [para. 19][para. 20][para. 21]

Despite the clear need and potential resources, integrating more vaccines into the NIP faces bureaucratic and regulatory challenges. For instance, current medical insurance programs, managed by the National Healthcare Security Administration, do not cover vaccination costs, although similar systems in countries like the U.S., Germany, and Japan do. This stance is upheld due to legal provisions and the necessity to prioritize treatment costs. [para. 21][para. 22][para. 23][para. 24]

Experts argue for higher-level coordination between departments to transition from a treatment-centered to a health-centered approach, emphasizing the importance of multi-channel financing to reduce the NIP's reliance on fiscal funding. This strategy could enhance the program’s sustainability and public health impact long term. [para. 25][para. 26]